Combined panel of serum human tissue kallikreins and CA-125 for the detection of epithelial ovarian cancer.

PubMed

Koh, Stephen Chee Liang; Huak, Chan Yiong; Lutan, Delfi; Marpuang, Johny; Ketut, Suwiyoga; Budiana, Nyoma Gede; Saleh, Agustria Zainu; Aziz, Mohamad Farid; Winarto, Hariyono; Pradjatmo, Heru; Hoan, Nguyen Khac Han; Thanh, Pham Viet; Choolani, Mahesh

2012-07-01

To determine the predictive accuracy of the combined panels of serum human tissue kallikreins (hKs) and CA-125 for the detection of epithelial ovarian cancer. Serum specimens collected from 5 Indonesian centers and 1 Vietnamese center were analyzed for CA-125, hK6, and hK10 levels. A total of 375 specimens from patients presenting with ovarian tumors, which include 156 benign cysts, 172 epithelial ovarian cancers (stage I/II, n=72; stage III/IV, n=100), 36 germ cell tumors and 11 borderline tumors, were included in the study analysis. Receiver operating characteristic analysis were performed to determine the cutoffs for age, CA-125, hK6, and hK10. Sensitivity, specificity, negative, and positive predictive values were determined for various combinations of the biomarkers. The levels of hK6 and hK10 were significantly elevated in ovarian cancer cases compared to benign cysts. Combination of 3 markers, age/CA-125/hk6 or CA-125/hk6/hk10, showed improved specificity (100%) and positive predictive value (100%) for prediction of ovarian cancer, when compared to the performance of single markers having 80-92% specificity and 74-87% positive predictive value. Four-marker combination, age/CA-125/hK6/hK10 also showed 100% specificity and 100% positive predictive value, although it demonstrated low sensitivity (11.9%) and negative predictive value (52.8%). The combination of human tissue kallikreins and CA-125 showed potential for improving prediction of epithelial ovarian cancer in patients presenting with ovarian tumors.

A comparative study of the typhidot (Dot-EIA) and Widal tests in blood culture positive cases of typhoid fever.

PubMed

Khoharo, Haji Khan

2011-07-01

Seventy-six blood culture positive typhoid cases and forty-eight controls were studied. The typhidot test was positive in 74 (97.36%) cases, with a sensitivity, specificity and positive predictive value of 96%, 89.5%, and 95%, respectively, compared to the Widal test which was positive in 56 (73.68%) cases with a sensitivity, specificity, and positive predictive value of 72%, 87%, and 87%, respectively (P = 0.001). In the control group, seven (14.5%) cases tested positive for the Widal test and two (4.16%) for the typhidot (P = 0.001), yielding the sensitivity and specificity for the Widal test and the typhidot test of 63% and 83%, and 85% and 97%, respectively. We conclude that the Dot-EIA (enzyme immunoassay; typhidot) is a more sensitive and specific test which is easy to perform and more reliable compared to the Widal test and that it is useful in early therapy.

Optical coherence tomography in the diagnosis of dysplasia and adenocarcinoma in Barret's esophagus

NASA Astrophysics Data System (ADS)

Gladkova, N. D.; Zagaynova, E. V.; Zuccaro, G.; Kareta, M. V.; Feldchtein, F. I.; Balalaeva, I. V.; Balandina, E. B.

2007-02-01

Statistical analysis of endoscopic optical coherence tomography (EOCT) surveillance of 78 patients with Barrett's esophagus (BE) is presented in this study. The sensitivity of OCT device in retrospective open detection of early malignancy (including high grade dysplasia and intramucosal adenocarcinoma (IMAC)) was 75%, specificity 82%, diagnostic accuracy - 80%, positive predictive value- 60%, negative predictive value- 87%. In the open recognition of IMAC sensitivity was 81% and specificity were 85% each. Results of a blind recognition with the same material were similar: sensitivity - 77%, specificity 85%, diagnostic accuracy - 82%, positive predictive value- 70%, negative predictive value- 87%. As the endoscopic detection of early malignancy is problematic, OCT holds great promise in enhancing the diagnostic capability of clinical GI endoscopy.

A 3-Year Study of Predictive Factors for Positive and Negative Appendicectomies.

PubMed

Chang, Dwayne T S; Maluda, Melissa; Lee, Lisa; Premaratne, Chandrasiri; Khamhing, Srisongham

2018-03-06

Early and accurate identification or exclusion of acute appendicitis is the key to avoid the morbidity of delayed treatment for true appendicitis or unnecessary appendicectomy, respectively. We aim (i) to identify potential predictive factors for positive and negative appendicectomies; and (ii) to analyse the use of ultrasound scans (US) and computed tomography (CT) scans for acute appendicitis. All appendicectomies that took place at our hospital from the 1st of January 2013 to the 31st of December 2015 were retrospectively recorded. Test results of potential predictive factors of acute appendicitis were recorded. Statistical analysis was performed using Fisher exact test, logistic regression analysis, sensitivity, specificity, and positive and negative predictive values calculation. 208 patients were included in this study. 184 patients had histologically proven acute appendicitis. The other 24 patients had either nonappendicitis pathology or normal appendix. Logistic regression analysis showed statistically significant associations between appendicitis and white cell count, neutrophil count, C-reactive protein, and bilirubin. Neutrophil count was the test with the highest sensitivity and negative predictive values, whereas bilirubin was the test with the highest specificity and positive predictive values (PPV). US and CT scans had high sensitivity and PPV for diagnosing appendicitis. No single test was sufficient to diagnose or exclude acute appendicitis by itself. Combining tests with high sensitivity (abnormal neutrophil count, and US and CT scans) and high specificity (raised bilirubin) may predict acute appendicitis more accurately.

Performance of the dipstick screening test as a predictor of negative urine culture.

PubMed

Marques, Alexandre Gimenes; Doi, André Mario; Pasternak, Jacyr; Damascena, Márcio Dos Santos; França, Carolina Nunes; Martino, Marinês Dalla Valle

2017-01-01

To investigate whether the urine dipstick screening test can be used to predict urine culture results. A retrospective study conducted between January and December 2014 based on data from 8,587 patients with a medical order for urine dipstick test, urine sediment analysis and urine culture. Sensitivity, specificity, positive and negative predictive values were determined and ROC curve analysis was performed. The percentage of positive cultures was 17.5%. Nitrite had 28% sensitivity and 99% specificity, with positive and negative predictive values of 89% and 87%, respectively. Leukocyte esterase had 79% sensitivity and 84% specificity, with positive and negative predictive values of 51% and 95%, respectively. The combination of positive nitrite or positive leukocyte esterase tests had 85% sensitivity and 84% specificity, with positive and negative predictive values of 53% and 96%, respectively. Positive urinary sediment (more than ten leukocytes per microliter) had 92% sensitivity and 71% specificity, with positive and negative predictive values of 40% and 98%, respectively. The combination of nitrite positive test and positive urinary sediment had 82% sensitivity and 99% specificity, with positive and negative predictive values of 91% and 98%, respectively. The combination of nitrite or leukocyte esterase positive tests and positive urinary sediment had the highest sensitivity (94%) and specificity (84%), with positive and negative predictive values of 58% and 99%, respectively. Based on ROC curve analysis, the best indicator of positive urine culture was the combination of positives leukocyte esterase or nitrite tests and positive urinary sediment, followed by positives leukocyte and nitrite tests, positive urinary sediment alone, positive leukocyte esterase test alone, positive nitrite test alone and finally association of positives nitrite and urinary sediment (AUC: 0.845, 0.844, 0.817, 0.814, 0.635 and 0.626, respectively). A negative urine culture can be predicted by negative dipstick test results. Therefore, this test may be a reliable predictor of negative urine culture. Verificar se a triagem de urina por fitas reativas é capaz de predizer a cultura de urina. Métodos Estudo retrospectivo realizado entre janeiro e dezembro de 2014 com 8.587 pacientes, com solicitação médica de triagem de urina (fita), sedimento urinário e cultura de urina. sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e curva ROC. Foram positivas 17,5% das culturas. O nitrito apresentou sensibilidade de 28% e especificidade de 99%. O valor preditivo positivo foi de 89% e o valor preditivo negativo de 87%. Esterase apresentou sensibilidade de 79% e especificidade de 84%. Valor preditivo positivo e valor preditivo negativo foram de 51% e 95%, respectivamente. A combinação de nitrito ou esterase positivos apresentou sensibilidade de 85% e especificidade de 84%. Valor preditivo positivo e valor preditivo negativo foram, respectivamente, 53% e 96%. O sedimento positivo (mais de dez leucócitos por microlitro) apresentou sensibilidade de 92% e especificidade de 71%. O valor preditivo positivo foi 40% e o negativo, 98%. A combinação de nitrito e sedimento urinário positivos apresentou sensibilidade de 82% e especificidade de 99%. Os valores preditivos positivo e negativo foram 91% e 98%, respectivamente. Para o nitrito ou esterase positivos mais os leucócitos positivos, a sensibilidade foi de 94% e a especificidade de 84%. O valor preditivo positivo foi de 58% e o negativo foi de 99%. Com base na curva ROC, o melhor indicador de urocultura positiva foi a associação entre a esterase ou nitrito positivos na fita mais os leucócitos positivos no sedimento, seguido por nitrito e esterase positivos, sedimento urinário positivo isolado, esterase positiva isolada, nitrito positivo isolado e, finalmente, pela associação entre nitrito e sedimento urinário positivos (AUC: 0,845, 0,844, 0,817, 0,814, 0,635 e 0,626, respectivamente). Uma urocultura negativa pode ser prevista com resultados negativos na fita. Portanto, este teste pode ser um preditor confiável de urocultura negativa.

Sensitivity, Specificity, and Predictive Values of Pediatric Metabolic Syndrome Components in Relation to Adult Metabolic Syndrome: The Princeton LRC Follow-up Study

PubMed Central

Huang, Terry T-K; Nansel, Tonja R.; Belsheim, Allen R.; Morrison, John A.

2008-01-01

Objective To estimate the sensitivity, specificity, and predictive values of pediatric metabolic syndrome (MetS) components (obesity, fasting glucose, triglycerides, high-density lipoprotein, and blood pressure) at various cutoffs in relation to adult MetS. Study design Data from the NHLBI Lipid Research Clinics (LRC) Princeton Prevalence Study (1973–76) and the Princeton Follow-up Study (PFS, 2000-4) were used to calculate sensitivity, specificity, and positive and negative predictive values for each component at a given cutoff, as well as for aggregates of components. Results Individual pediatric components alone showed low to moderate sensitivity, high specificity, and moderate predictive values in relation to adult MetS. When all five pediatric MetS components were considered, the presence of at least one abnormality had higher sensitivity for adult MetS than individual components alone. When multiple abnormalities were mandatory for MetS, positive predictive value was high and sensitivity was low. Childhood body mass alone showed neither high sensitivity nor high positive predictive value for adult MetS. Conclusions Considering multiple metabolic variables in childhood can improve the predictive utility for adult MetS, compared to each component or body mass alone. MetS variables may be useful for identifying some at risk children for prevention interventions. PMID:18206687

Use of the Abbott Architect HIV antigen/antibody assay in a low incidence population.

PubMed

Dubravac, Terry; Gahan, Thomas F; Pentella, Michael A

2013-12-01

With the availability of 4th generation HIV diagnostic tests which are capable of detecting acute infection, Iowa evaluated the 3rd and 4th generation HIV test and compared the performance of these products in a low incidence population. This study was conducted to evaluate the performance of an HIV antigen/antibody combination (4th generation) assay compared to an EIA 3rd generation assay. Over a 4 month period, 2037 specimens submitted for HIV screening were tested by Bio-Rad GS HIV-1/HIV-2 Plus O EIA and the Abbott Architect i1000SR HIV Ag/Ab Combo. The performance characteristics of sensitivity, specificity, positive predictive value and negative predictive value were determined. Of the 2037 specimens tested, there were 13 (0.64%) true positives detected. None of the positive specimens were from patients in the acute phase of infection. The Abbott antigen/antibody combo assay had a sensitivity, specificity, positive-predictive value and negative predictive value of 100%, 99.85%, 81.25%, and 100% respectively. The Bio-Rad EIA assay had a sensitivity, specificity, positive-predictive value and negative predictive value of 100%, 99.80%, 76.47% and 100%, respectively. The EIA had four false positive results which tested negative by the antigen/antibody assay and western blot. In a low-incidence state where early infections are less commonly encountered, the EIA assay and the antigen/antibody assay performed with near equivalency. The antigen/antibody assay had one less false positive result. While no patients were detected in the acute stage of infection, the use of the antigen/antibody assay presents the opportunity to detect an infected patient sooner and prevent transmission to others. Copyright © 2013 Elsevier B.V. All rights reserved.

[Serum PTH levels as a predictive factor of hypocalcaemia after total thyroidectomy].

PubMed

Díez Alonso, Manuel; Sánchez López, José Daniel; Sánchez-Seco Peña, María Isabel; Ratia Jiménez, Tomás; Arribas Gómez, Ignacio; Rodríguez Pascual, Angel; Martín-Duce, Antonio; Guadalix Hidalgo, Gregorio; Hernández Domínguez, Sara; Granell Vicent, Javier

2009-02-01

Postoperative parathyroid hormone (PTH) levels as a predictor of hypocalcaemia in patients subjected to total thyroidectomy is analyzed. Prospective study involving 67 patients who underwent total thyroidectomy due to a benign disease. Serum PTH and ionised calcium were measured 20 h after surgery. Sensitivity, specificity and predictive values of PTH and ionised calcium levels were calculated to predict clinical and analytical hypocalcaemia. A total of 42 (62.7%) patients developed hypocalcaemia (ionised calcium<0.95 mmol/l), but only 20 (29.9%) presented with symptoms. PTH concentration the day after surgery was significantly lower in the group that developed symptomatic hypocalcaemia (5.57+/-6.4 pg/ml) than in the asymptomatic (21.5+/-15.3 pg/ml) or normocalcaemic (26.8+/-24.9 pg/ml) groups (p=0.001). Taking the value of 13 pg/ml as a cut-off point of PTH levels, sensitivity, specificity, positive predictive value and negative predictive value were 54%, 72%, 76% and 48%, respectively. On the other hand, sensitivity for predicting symptomatic hypocalcaemia was 95% and specificity was 76%. The test showed a high incidence of false positives (11/30, 36%). Negative predictive value was 97% and positive predictive value was 65%. In multivariate analysis, PTH and ionised calcium were the only perioperative factors that showed an independent predictive value as risk indicators of symptomatic hypocalcaemia. Normal PTH levels 20 h after surgery practically rule out the subsequent appearance of hypocalcaemia symptoms. On the other hand, low PTH levels are not necessarily associated to symptomatic hypocalcaemia due to the high number of false positives.

Severe community-acquired pneumonia. Assessment of severity criteria.

PubMed

Ewig, S; Ruiz, M; Mensa, J; Marcos, M A; Martinez, J A; Arancibia, F; Niederman, M S; Torres, A

1998-10-01

The purpose of the study was to validate the criteria used in the guidelines of the American Thoracic Society (ATS) for severe community-acquired pneumonia (CAP). Severe pneumonia was defined as admission to the intensive care unit (ICU). Overall 331 nonsevere (84%) and 64 severe cases (16%) of CAP were prospectively studied. Mortality was 19 of 395 (5%) and 19 of 64 (30%), respectively. Single severity criteria as well as the ATS definition of severe pneumonia were assessed calculating the operative indices. A modified prediction rule including minor (baseline) and major (baseline or evolutionary) criteria was derived. Single minor criteria at admission had a low sensitivity and positive predictive value. Defining severe pneumonia according to the ATS guidelines had a high sensitivity (98%). However, specificity and positive predictive value were low (32% and 24%, respectively). A modified prediction rule (presence of two or three minor criteria [systolic blood pressure < 90 mm Hg, multilobar involvement, PaO2/FIO2 < 250] or one of two major criteria [requirement of mechanical ventilation, presence of septic shock]) had a sensitivity of 78%, a specificity of 94%, a positive predictive value of 75%, and a negative predictive value of 95%. The ATS definition of severe pneumonia was highly sensitive but insufficiently specific and had a low positive predictive value. Our suggested modified rule had a more balanced performance and, if validated in an independent population, may represent a more accurate definition of severe CAP.

Impact of obesity on the predictive accuracy of prostate-specific antigen density and prostate-specific antigen in native Korean men undergoing prostate biopsy.

PubMed

Kim, Jae Heon; Doo, Seung Whan; Yang, Won Jae; Lee, Kwang Woo; Lee, Chang Ho; Song, Yun Seob; Jeon, Yoon Su; Kim, Min Eui; Kwon, Soon-Sun

2014-10-01

To evaluate the impact of obesity on the biopsy detection of prostate cancer. We retrospectively reviewed data of 1182 consecutive Korean patients (≥50 years) with serum prostate-specific antigen levels of 3-10 ng/mL who underwent initial extended 12-cores biopsy from September 2009 to March 2013. Patients who took medications that were likely to influence the prostate-specific antigen level were excluded. Receiver operating characteristic curves were plotted for prostate-specific antigen and prostate-specific antigen density predicting cancer status among non-obese and obese men. A total of 1062 patients (mean age 67.1 years) were enrolled in the analysis. A total of 230 men (21.7%) had a positive biopsy. In the overall study sample, the area under the receiver operator characteristic curve of serum prostate-specific antigen for predicting prostate cancer on biopsy were 0.584 and 0.633 for non-obese and obese men, respectively (P = 0.234). However, the area under the curve for prostate-specific antigen density in predicting cancer status showed a significant difference (non-obese 0.696, obese 0.784; P = 0.017). There seems to be a significant difference in the ability of prostate-specific antigen density to predict biopsy results between non-obese and obese men. Obesity positively influenced the overall ability of prostate-specific antigen density to predict prostate cancer. © 2014 The Japanese Urological Association.

Comparison of bronchoalveolar lavage cytology and transbronchial biopsy in the diagnosis of carcinoma of lung.

PubMed

Ahmed, Ayesha; Ahmed, Sajjad

2004-01-01

The objectives of this study were to compare bronchoalveolar lavage (BAL) cytology and transbronchial biopsy in the diagnosis of carcinoma lung and to determine accuracy of BAL cytology using histopathlologic examination of transbronchial biopsy as gold standard at our center. This study was carried out at Department of Histopathology, Ayub Medical College, Abbottabad, from 1.09.2000 to 28.02.2003. BAL fluid and bronchial biopsy were received and processed simultaneously. Four cytology and a set of histopathology slides were prepared. These were screened and diagnosis recorded. Sensitivity, Specificity, False Positive, False Negative, Positive predictive value and Negative predictive value of BAL cytology were determined using histopathology of transbronchial biopsy as gold standard. We found the sensitivity of BAL cytology to be 93.44% as compared with transbronchial biopsy. The specificity was 100%. There was no false positive while false negative results were 6.55 %. The positive predictive value was 100 %, while the negative predictive value was 75 %. The overall diagnostic efficacy of BAL cytology was 94.52 %. BAL cytology is a highly sensitive and specific test for diagnosis of carcinoma lung. It can be used as a quick and reliable diagnostic method for diagnosis of lung malignancy.

Diagnostic value and cost utility analysis for urine Gram stain and urine microscopic examination as screening tests for urinary tract infection.

PubMed

Wiwanitkit, Viroj; Udomsantisuk, Nibhond; Boonchalermvichian, Chaiyaporn

2005-06-01

The aim of this study was to evaluate the diagnostic properties of urine Gram stain and urine microscopic examination for screening for urinary tract infection (UTI), and to perform an additional cost utility analysis. This descriptive study was performed on 95 urine samples sent for urine culture to the Department of Microbiology, Faculty of Medicine, Chulalongkorn University. The first part of the study was to determine the diagnostic properties of two screening tests (urine Gram stain and urine microscopic examination). Urine culture was set as the gold standard and the results from both methods were compared to this. The second part of this study was to perform a cost utility analysis. The sensitivity of urine Gram stain was 96.2%, the specificity 93.0%, the positive predictive value 94.3% and the negative predictive value 95.2%. False positives occurred with a frequency of 7.0% and false negatives 3.8%. For the microscopic examination, the sensitivity was 65.4%, specificity 74.4%, positive predictive value 75.6% and negative predictive value 64.0%. False positives occurred with a frequency of 25.6% and false negatives 34.6%. Combining urine Gram stain and urine microscopic examination, the sensitivity was 98.1%, specificity 74.4%, positive predictive value 82.3% and negative predictive value 97.0%. False positives occurred with a frequency of 25.6% and false negatives 1.9%. However, the cost per utility of the combined method was higher than either urine microscopic examination or urine Gram stain alone. Urine Gram stain provided the lowest cost per utility. Economically, urine Gram stain is the proper screening tool for presumptive diagnosis of UTI.

Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology.

PubMed

LaPrade, Robert F; Ho, Charles P; James, Evan; Crespo, Bernardo; LaPrade, Christopher M; Matheny, Lauren M

2015-01-01

The purpose of this study was to determine the diagnostic accuracy of 3 T MRI, including sensitivity, specificity, negative and positive predictive values, for detection of posterior medial and lateral meniscus root tears and avulsions. All patients who had a 3 T MRI of the knee, followed by arthroscopic surgery, were included in this study. Arthroscopy was considered the gold standard. Meniscus root tears diagnosed at arthroscopy and on MRI were defined as a complete meniscus root detachment within 9 mm of the root. All surgical data were collected prospectively and stored in a data registry. MRI exams were reported prospectively by a musculoskeletal radiologist and reviewed retrospectively. There were 287 consecutive patients (156 males, 131 females; mean age 41.7 years) in this study. Prevalence of meniscus posterior root tears identified at arthroscopy was 9.1, 5.9% for medial and 3.5% for lateral root tears (one patient had both). Sensitivity was 0.770 (95% CI 0.570, 0.901), specificity was 0.729 (95% CI 0.708, 0.741), positive predictive value was 0.220 (95% CI 0.163, 0.257) and negative predictive value was 0.970 (95% CI 0.943, 0.987). For medial root tears, sensitivity was 0.824 (95% CI 0.569, 0.953), specificity was 0.800 (95% CI 0.784, 0.808), positive predictive value was 0.206 (95% CI 0.142, 0.238) and negative predictive value was 0.986 (95% CI 0.967, 0.996). For lateral meniscus posterior root tears, sensitivity was 0.600 (95% CI 0.281, 0.860), specificity was 0.903 (95% CI 0.891, 0.912), positive predictive value was 0.181 (95% CI 0.085, 0.261) and negative predictive value was 0.984 (95% CI 0.972, 0.994). This study demonstrated moderate sensitivity and specificity of 3 T MRI to detect posterior meniscus root tears. The negative predictive value of 3 T MRI to detect posterior meniscus root tears was high; however, the positive predictive value was low. Sensitivity was higher for medial root tears, indicating a higher risk of missing lateral root tears on MRI. Imaging has an important role in identifying meniscus posterior horn root tears; however, some root tears may not be identified until arthroscopy. Prognostic study (diagnostic), Level II.

[Evaluation of performance of five bioinformatics software for the prediction of missense mutations].

PubMed

Chen, Qianting; Dai, Congling; Zhang, Qianjun; Du, Juan; Li, Wen

2016-10-01

To study the prediction performance evaluation with five kinds of bioinformatics software (SIFT, PolyPhen2, MutationTaster, Provean, MutationAssessor). From own database for genetic mutations collected over the past five years, Chinese literature database, Human Gene Mutation Database, and dbSNP, 121 missense mutations confirmed by functional studies, and 121 missense mutations suspected to be pathogenic by pedigree analysis were used as positive gold standard, while 242 missense mutations with minor allele frequency (MAF)>5% in dominant hereditary diseases were used as negative gold standard. The selected mutations were predicted with the five software. Based on the results, the performance of the five software was evaluated for their sensitivity, specificity, positive predict value, false positive rate, negative predict value, false negative rate, false discovery rate, accuracy, and receiver operating characteristic curve (ROC). In terms of sensitivity, negative predictive value and false negative rate, the rank was MutationTaster, PolyPhen2, Provean, SIFT, and MutationAssessor. For specificity and false positive rate, the rank was MutationTaster, Provean, MutationAssessor, SIFT, and PolyPhen2. For positive predict value and false discovery rate, the rank was MutationTaster, Provean, MutationAssessor, PolyPhen2, and SIFT. For area under the ROC curve (AUC) and accuracy, the rank was MutationTaster, Provean, PolyPhen2, MutationAssessor, and SIFT. The prediction performance of software may be different when using different parameters. Among the five software, MutationTaster has the best prediction performance.

Evaluation of two real time PCR assays for the detection of bacterial DNA in amniotic fluid.

PubMed

Girón de Velasco-Sada, Patricia; Falces-Romero, Iker; Quiles-Melero, Inmaculada; García-Perea, Adela; Mingorance, Jesús

2018-01-01

The aim of this study was to evaluate two non-commercial Real-Time PCR assays for the detection of microorganisms in amniotic fluid followed by identification by pyrosequencing. We collected 126 amniotic fluids from 2010 to 2015 for the evaluation of two Real-Time PCR assays for detection of bacterial DNA in amniotic fluid (16S Universal PCR and Ureaplasma spp. specific PCR). The method was developed in the Department of Microbiology of the University Hospital La Paz. Thirty-seven samples (29.3%) were positive by PCR/pyrosequencing and/or culture, 4 of them were mixed cultures with Ureaplasma urealyticum. The Universal 16S Real-Time PCR was compared with the standard culture (81.8% sensitivity, 97.4% specificity, 75% positive predictive value, 98% negative predictive value). The Ureaplasma spp. specific Real-Time PCR was compared with the Ureaplasma/Mycoplasma specific culture (92.3% sensitivity, 89.4% specificity, 50% positive predictive value, 99% negative predictive value) with statistically significant difference (p=0.005). Ureaplasma spp. PCR shows a rapid response time (5h from DNA extraction until pyrosequencing) when comparing with culture (48h). So, the response time of bacteriological diagnosis in suspected chorioamnionitis is reduced. Copyright © 2017 Elsevier B.V. All rights reserved.

Analysis of the Sensitivity and Specificity of Noninvasive Imaging Tests for the Diagnosis of Renal Artery Stenosis

PubMed Central

Borelli, Flavio Antonio de Oliveira; Pinto, Ibraim M. F.; Amodeo, Celso; Smanio, Paola E. P.; Kambara, Antonio M.; Petisco, Ana Claudia G.; Moreira, Samuel M.; Paiva, Ricardo Calil; Lopes, Hugo Belotti; Sousa, Amanda G. M. R.

2013-01-01

Background Aging and atherosclerosis are related to renovascular hypertension in elderly individuals. Regardless of comorbidities, renal artery stenosis is itself an important cause of cardiovascular morbidity and mortality. Objective To define the sensitivity, specificity, positive predictive value, and negative predictive value of noninvasive imaging tests used in the diagnosis of renal artery stenosis. Methods In a group of 61 patients recruited, 122 arteries were analized, thus permitting the definition of sensitivity, specificity, and the relative contribution of each imaging study performed (Doppler, scintigraphy and computed tomographic angiography in comparison to renal arteriography). Results The mean age was 65.43 years (standard deviation: 8.7). Of the variables related to the study population that were compared to arteriography, two correlated with renal artery stenosis, renal dysfunction and triglycerides. The median glomerular filtration rate was 52.8 mL/min/m2. Doppler showed sensitivity of 82.90%, specificity of 70%, a positive predictive value of 85% and negative predictive value of 66.70%. For tomography, sensitivity was 66.70%, specificity 80%, positive predictive value 87.50% and negative predictive value 55.20%. With these findings, we could identify the imaging tests that best detected stenosis. Conclusion Tomography and Doppler showed good quality and efficacy in the diagnosis of renal artery stenosis, with Doppler having the advantage of not requiring the use of contrast medium for the assessment of a disease that is common in diabetics and is associated with renal dysfunction and severe left ventricular dysfunction. PMID:24061685

Artificial neural networks: Predicting head CT findings in elderly patients presenting with minor head injury after a fall.

PubMed

Dusenberry, Michael W; Brown, Charles K; Brewer, Kori L

2017-02-01

To construct an artificial neural network (ANN) model that can predict the presence of acute CT findings with both high sensitivity and high specificity when applied to the population of patients≥age 65years who have incurred minor head injury after a fall. An ANN was created in the Python programming language using a population of 514 patients ≥ age 65 years presenting to the ED with minor head injury after a fall. The patient dataset was divided into three parts: 60% for "training", 20% for "cross validation", and 20% for "testing". Sensitivity, specificity, positive and negative predictive values, and accuracy were determined by comparing the model's predictions to the actual correct answers for each patient. On the "cross validation" data, the model attained a sensitivity ("recall") of 100.00%, specificity of 78.95%, PPV ("precision") of 78.95%, NPV of 100.00%, and accuracy of 88.24% in detecting the presence of positive head CTs. On the "test" data, the model attained a sensitivity of 97.78%, specificity of 89.47%, PPV of 88.00%, NPV of 98.08%, and accuracy of 93.14% in detecting the presence of positive head CTs. ANNs show great potential for predicting CT findings in the population of patients ≥ 65 years of age presenting with minor head injury after a fall. As a good first step, the ANN showed comparable sensitivity, predictive values, and accuracy, with a much higher specificity than the existing decision rules in clinical usage for predicting head CTs with acute intracranial findings. Copyright © 2016 Elsevier Inc. All rights reserved.

Checking the predictive accuracy of basic symptoms against ultra high-risk criteria and testing of a multivariable prediction model: Evidence from a prospective three-year observational study of persons at clinical high-risk for psychosis.

PubMed

Hengartner, M P; Heekeren, K; Dvorsky, D; Walitza, S; Rössler, W; Theodoridou, A

2017-09-01

The aim of this study was to critically examine the prognostic validity of various clinical high-risk (CHR) criteria alone and in combination with additional clinical characteristics. A total of 188 CHR positive persons from the region of Zurich, Switzerland (mean age 20.5 years; 60.2% male), meeting ultra high-risk (UHR) and/or basic symptoms (BS) criteria, were followed over three years. The test battery included the Structured Interview for Prodromal Syndromes (SIPS), verbal IQ and many other screening tools. Conversion to psychosis was defined according to ICD-10 criteria for schizophrenia (F20) or brief psychotic disorder (F23). Altogether n=24 persons developed manifest psychosis within three years and according to Kaplan-Meier survival analysis, the projected conversion rate was 17.5%. The predictive accuracy of UHR was statistically significant but poor (area under the curve [AUC]=0.65, P<.05), whereas BS did not predict psychosis beyond mere chance (AUC=0.52, P=.730). Sensitivity and specificity were 0.83 and 0.47 for UHR, and 0.96 and 0.09 for BS. UHR plus BS achieved an AUC=0.66, with sensitivity and specificity of 0.75 and 0.56. In comparison, baseline antipsychotic medication yielded a predictive accuracy of AUC=0.62 (sensitivity=0.42; specificity=0.82). A multivariable prediction model comprising continuous measures of positive symptoms and verbal IQ achieved a substantially improved prognostic accuracy (AUC=0.85; sensitivity=0.86; specificity=0.85; positive predictive value=0.54; negative predictive value=0.97). We showed that BS have no predictive accuracy beyond chance, while UHR criteria poorly predict conversion to psychosis. Combining BS with UHR criteria did not improve the predictive accuracy of UHR alone. In contrast, dimensional measures of both positive symptoms and verbal IQ showed excellent prognostic validity. A critical re-thinking of binary at-risk criteria is necessary in order to improve the prognosis of psychotic disorders. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Arterial spin labeling-based Z-maps have high specificity and positive predictive value for neurodegenerative dementia compared to FDG-PET.

PubMed

Fällmar, David; Haller, Sven; Lilja, Johan; Danfors, Torsten; Kilander, Lena; Tolboom, Nelleke; Egger, Karl; Kellner, Elias; Croon, Philip M; Verfaillie, Sander C J; van Berckel, Bart N M; Ossenkoppele, Rik; Barkhof, Frederik; Larsson, Elna-Marie

2017-10-01

Cerebral perfusion analysis based on arterial spin labeling (ASL) MRI has been proposed as an alternative to FDG-PET in patients with neurodegenerative disease. Z-maps show normal distribution values relating an image to a database of controls. They are routinely used for FDG-PET to demonstrate disease-specific patterns of hypometabolism at the individual level. This study aimed to compare the performance of Z-maps based on ASL to FDG-PET. Data were combined from two separate sites, each cohort consisting of patients with Alzheimer's disease (n = 18 + 7), frontotemporal dementia (n = 12 + 8) and controls (n = 9 + 29). Subjects underwent pseudocontinuous ASL and FDG-PET. Z-maps were created for each subject and modality. Four experienced physicians visually assessed the 166 Z-maps in random order, blinded to modality and diagnosis. Discrimination of patients versus controls using ASL-based Z-maps yielded high specificity (84%) and positive predictive value (80%), but significantly lower sensitivity compared to FDG-PET-based Z-maps (53% vs. 96%, p < 0.001). Among true-positive cases, correct diagnoses were made in 76% (ASL) and 84% (FDG-PET) (p = 0.168). ASL-based Z-maps can be used for visual assessment of neurodegenerative dementia with high specificity and positive predictive value, but with inferior sensitivity compared to FDG-PET. • ASL-based Z-maps yielded high specificity and positive predictive value in neurodegenerative dementia. • ASL-based Z-maps had significantly lower sensitivity compared to FDG-PET-based Z-maps. • FDG-PET might be reserved for ASL-negative cases where clinical suspicion persists. • Findings were similar at two study sites.

(Bad) Feelings about Meeting Them? Episodic and Chronic Intergroup Emotions Associated with Positive and Negative Intergroup Contact As Predictors of Intergroup Behavior

PubMed Central

Kauff, Mathias; Asbrock, Frank; Wagner, Ulrich; Pettigrew, Thomas F.; Hewstone, Miles; Schäfer, Sarina J.; Christ, Oliver

2017-01-01

Based on two cross-sectional probability samples (Study 1: N = 1,382, Study 2: N = 1,587), we studied the interplay between positive and negative intergroup contact, different types of intergroup emotions (i.e., episodic intergroup emotions encountered during contact and more general chronic intergroup emotions), and outgroup behavior in the context of intergroup relations between non-immigrant Germans and foreigners living in Germany. In Study 1, we showed that positive and negative contact are related to specific episodic intergroup emotions (i.e., anger, fear and happiness). Results of Study 2 indicate an indirect effect of episodic intergroup emotions encountered during contact experiences on specific behavioral tendencies directed at outgroup members via more chronic situation-independent intergroup emotions. As expected, anger predicted approaching (discriminatory) behavioral tendencies (i.e., aggression) while fear predicted avoidance. The results extend the existing literature on intergroup contact and emotions by addressing positive and negative contact simultaneously and differentiating between situation-specific episodic and chronic intergroup emotions in predicting discriminatory behavioral tendencies. PMID:28900403

Psychophysiological prediction of choice: relevance to insight and drug addiction

PubMed Central

Moeller, Scott J.; Hajcak, Greg; Parvaz, Muhammad A.; Dunning, Jonathan P.; Volkow, Nora D.

2012-01-01

An important goal of addiction research and treatment is to predict behavioural responses to drug-related stimuli. This goal is especially important for patients with impaired insight, which can interfere with therapeutic interventions and potentially invalidate self-report questionnaires. This research tested (i) whether event-related potentials, specifically the late positive potential, predict choice to view cocaine images in cocaine addiction; and (ii) whether such behaviour prediction differs by insight (operationalized in this study as self-awareness of image choice). Fifty-nine cocaine abusers and 32 healthy controls provided data for the following laboratory components that were completed in a fixed-sequence (to establish prediction): (i) event-related potential recordings while passively viewing pleasant, unpleasant, neutral and cocaine images, during which early (400–1000 ms) and late (1000–2000 ms) window late positive potentials were collected; (ii) self-reported arousal ratings for each picture; and (iii) two previously validated tasks: one to assess choice for viewing these same images, and the other to group cocaine abusers by insight. Results showed that pleasant-related late positive potentials and arousal ratings predicted pleasant choice (the choice to view pleasant pictures) in all subjects, validating the method. In the cocaine abusers, the predictive ability of the late positive potentials and arousal ratings depended on insight. Cocaine-related late positive potentials better predicted cocaine image choice in cocaine abusers with impaired insight. Another emotion-relevant event-related potential component (the early posterior negativity) did not show these results, indicating specificity of the late positive potential. In contrast, arousal ratings better predicted respective cocaine image choice (and actual cocaine use severity) in cocaine abusers with intact insight. Taken together, the late positive potential could serve as a biomarker to help predict drug-related choice—and possibly associated behaviours (e.g. drug seeking in natural settings, relapse after treatment)—when insight (and self-report) is compromised. PMID:23148349

Exfoliative cytology: a helpful tool for the diagnosis of paracoccidioidomycosis.

PubMed

Cardoso, S V; Moreti, M M; Costa, I M; Loyola, A M

2001-07-01

To describe the main cytological findings associated with smears collected from oral lesions of paracoccidioidomycosis and to appraise the use of cytology as a diagnostic tool for the disease. Cytological smears and biopsies were collected from 40 lesions with a clinical suspicion of paracoccidioidomycosis. Evaluation of the sensitivity, specificity, positive and negative predictive values, accuracy and the positive likeness ratio of the oral smear when compared with the histological diagnosis, was performed. The latter is considered the 'gold standard' for comparison. The main morphological findings were the rounded-shaped, birefringent and multiple-budded fungi, Langhans' giant cells and epithelioid cells. The following associative measures were found: sensitivity, 67.9%; specificity, 91.7%; positive predictive value, 95.0%; negative predictive value, 55.0%; accuracy, 75.0%; and positive likeness ratio, 8.14. The cytological findings of paracoccidioidomycosis are characteristic and cytology is accurate in the diagnosis of the disease. Positive patients should be treated. Negative patients should be submitted to biopsy to confirm or to dismiss the diagnosis of this mycosis.

Unscrambling Egg Allergy: The Diagnostic Value of Specific IgE Concentrations and Skin Prick Tests for Ovomucoid and Egg White in the Management of Children with Hen's Egg Allergy.

PubMed

Marriage, D E; Erlewyn-Lajeunesse, M; Unsworth, D J; Henderson, A J

2012-01-01

Resolution of egg allergy occurs in the majority of egg allergic children. Positive specific IgE antibodies to ovomucoid (OVM) have been suggested to be of greater predictive value for persistent egg allergy than specific IgE to egg white. The performance of OVM-specific IgE antibody levels in a cohort of children referred for a routine egg challenge was compared with egg white specific IgE levels in predicting a positive egg challenge. 24/47 subjects had persistent egg allergy. Receiver operating characteristic analysis showed that OVM-specific IgE testing was the most useful test for the diagnosis of persistent egg allergy. The optimal decision points for the prediction of persistent egg allergy were >0.35 kUA/L for specific IgE levels to both EW and OVM, and ≥3 mm for SPT. Children with specific IgE levels suggestive of persistent egg allergy need not be subject to an egg provocation challenge, reducing both costs and risks to the child.

Mortality risk prediction in burn injury: Comparison of logistic regression with machine learning approaches.

PubMed

Stylianou, Neophytos; Akbarov, Artur; Kontopantelis, Evangelos; Buchan, Iain; Dunn, Ken W

2015-08-01

Predicting mortality from burn injury has traditionally employed logistic regression models. Alternative machine learning methods have been introduced in some areas of clinical prediction as the necessary software and computational facilities have become accessible. Here we compare logistic regression and machine learning predictions of mortality from burn. An established logistic mortality model was compared to machine learning methods (artificial neural network, support vector machine, random forests and naïve Bayes) using a population-based (England & Wales) case-cohort registry. Predictive evaluation used: area under the receiver operating characteristic curve; sensitivity; specificity; positive predictive value and Youden's index. All methods had comparable discriminatory abilities, similar sensitivities, specificities and positive predictive values. Although some machine learning methods performed marginally better than logistic regression the differences were seldom statistically significant and clinically insubstantial. Random forests were marginally better for high positive predictive value and reasonable sensitivity. Neural networks yielded slightly better prediction overall. Logistic regression gives an optimal mix of performance and interpretability. The established logistic regression model of burn mortality performs well against more complex alternatives. Clinical prediction with a small set of strong, stable, independent predictors is unlikely to gain much from machine learning outside specialist research contexts. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Sensitivity, Specificity, PPV, and NPV for Predictive Biomarkers

PubMed Central

2015-01-01

Molecularly targeted cancer drugs are often developed with companion diagnostics that attempt to identify which patients will have better outcome on the new drug than the control regimen. Such predictive biomarkers are playing an increasingly important role in precision oncology. For diagnostic tests, sensitivity, specificity, positive predictive value, and negative predictive are usually used as performance measures. This paper discusses these indices for predictive biomarkers, provides methods for their calculation with survival or response endpoints, and describes assumptions involved in their use. PMID:26109105

Prostate Specific Membrane Antigen Positron Emission Tomography May Improve the Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging in Localized Prostate Cancer.

PubMed

Rhee, H; Thomas, P; Shepherd, B; Gustafson, S; Vela, I; Russell, P J; Nelson, C; Chung, E; Wood, G; Malone, G; Wood, S; Heathcote, P

2016-10-01

Positron emission tomography using ligands targeting prostate specific membrane antigen has recently been introduced. Positron emission tomography imaging with (68)Ga-PSMA-HBED-CC has been shown to detect metastatic prostate cancer lesions at a high rate. In this study we compare multiparametric magnetic resonance imaging and prostate specific membrane antigen positron emission tomography of the prostate with whole mount ex vivo prostate histopathology to determine the true sensitivity and specificity of these imaging modalities for detecting and locating tumor foci within the prostate. In a prospective clinical trial setting 20 patients with localized prostate cancer and a planned radical prostatectomy were recruited. All patients underwent multiparametric magnetic resonance imaging and positron emission tomography before surgery, and whole mount histopathology slides were directly compared to the images. European Society of Urogenital Radiology guidelines for reporting magnetic resonance imaging were used as a template for regional units of analysis. The uropathologist and radiologists were blinded to individual components of the study, and the final correlation was performed by visual and deformable registration analysis. A total of 50 clinically significant lesions were identified from the whole mount histopathological analysis. Based on regional analysis the sensitivity, specificity, positive predictive value and negative predictive value for multiparametric magnetic resonance imaging were 44%, 94%, 81% and 76%, respectively. With prostate specific membrane antigen positron emission tomography the sensitivity, specificity, positive predictive value and negative predictive value were 49%, 95%, 85% and 88%, respectively. Prostate specific membrane antigen positron emission tomography yielded a higher specificity and positive predictive value. A significant proportion of cancers are potentially missed and underestimated by both imaging modalities. Prostate specific membrane antigen positron emission tomography may be used in addition to multiparametric magnetic resonance imaging to help improve local staging in those patients undergoing retropubic radical prostatectomy. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Ultrasonographic fetal head position to predict mode of delivery: a systematic review and bivariate meta-analysis.

PubMed

Verhoeven, C J M; Rückert, M E P F; Opmeer, B C; Pajkrt, E; Mol, B W J

2012-07-01

We performed a systematic review to determine whether sonographic assessment of occipital position of the fetal head can contribute to the prediction of the mode of delivery. We performed a systematic literature search of electronic databases from inception to May 2011. Two reviewers independently extracted data from the included studies. We used a bivariate model to estimate point estimates for sensitivity and specificity curves for the outcome Cesarean delivery. Eligible studies were cohort studies or cross-sectional studies that reported on both the position of the fetal head, as assessed by ultrasound, before or at the beginning of active labor as well as the outcome of labor in women at term. We included 11 primary articles reporting on 5053 women, of whom 898 had a Cesarean section. All studies indicated disappointing values for sensitivity and specificity in the prediction of Cesarean section. Summary point estimates of sensitivity and specificity were 0.39 (95% CI, 0.32-0.48) and 0.71 (95% CI, 0.67-0.74), respectively. Sonographic assessment of occipital position of the fetal head before delivery should not be used in the prediction of mode of delivery. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

The predictive value of single-photon emission computed tomography/computed tomography for sentinel lymph node localization in head and neck cutaneous malignancy.

PubMed

Remenschneider, Aaron K; Dilger, Amanda E; Wang, Yingbing; Palmer, Edwin L; Scott, James A; Emerick, Kevin S

2015-04-01

Preoperative localization of sentinel lymph nodes in head and neck cutaneous malignancies can be aided by single-photon emission computed tomography/computed tomography (SPECT/CT); however, its true predictive value for identifying lymph nodes intraoperatively remains unquantified. This study aims to understand the sensitivity, specificity, and positive and negative predictive values of SPECT/CT in sentinel lymph node biopsy for cutaneous malignancies of the head and neck. Blinded retrospective imaging review with comparison to intraoperative gamma probe confirmed sentinel lymph nodes. A consecutive series of patients with a head and neck cutaneous malignancy underwent preoperative SPECT/CT followed by sentinel lymph node biopsy with a gamma probe. Two nuclear medicine physicians, blinded to clinical data, independently reviewed each SPECT/CT. Activity within radiographically defined nodal basins was recorded and compared to intraoperative gamma probe findings. Sensitivity, specificity, and negative and positive predictive values were calculated with subgroup stratification by primary tumor site. Ninety-two imaging reads were performed on 47 patients with cutaneous malignancy who underwent SPECT/CT followed by sentinel lymph node biopsy. Overall sensitivity was 73%, specificity 92%, positive predictive value 54%, and negative predictive value 96%. The predictive ability of SPECT/CT to identify the basin or an adjacent basin containing the single hottest node was 92%. SPECT/CT overestimated uptake by an average of one nodal basin. In the head and neck, SPECT/CT has higher reliability for primary lesions of the eyelid, scalp, and cheek. SPECT/CT has high sensitivity, specificity, and negative predictive value, but may overestimate relevant nodal basins in sentinel lymph node biopsy. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Ottawa Ankle Rules and Subjective Surgeon Perception to Evaluate Radiograph Necessity Following Foot and Ankle Sprain

PubMed Central

Pires, RES; Pereira, AA; Abreu-e-Silva, GM; Labronici, PJ; Figueiredo, LB; Godoy-Santos, AL; Kfuri, M

2014-01-01

Background: Foot and ankle injuries are frequent in emergency departments. Although only a few patients with foot and ankle sprain present fractures and the fracture patterns are almost always simple, lack of fracture diagnosis can lead to poor functional outcomes. Aim: The present study aims to evaluate the reliability of the Ottawa ankle rules and the orthopedic surgeon subjective perception to assess foot and ankle fractures after sprains. Subjects and Methods: A cross-sectional study was conducted from July 2012 to December 2012. Ethical approval was granted. Two hundred seventy-four adult patients admitted to the emergency department with foot and/or ankle sprain were evaluated by an orthopedic surgeon who completed a questionnaire prior to radiographic assessment. The Ottawa ankle rules and subjective perception of foot and/or ankle fractures were evaluated on the questionnaire. Results: Thirteen percent (36/274) patients presented fracture. Orthopedic surgeon subjective analysis showed 55.6% sensitivity, 90.1% specificity, 46.5% positive predictive value and 92.9% negative predictive value. The general orthopedic surgeon opinion accuracy was 85.4%. The Ottawa ankle rules presented 97.2% sensitivity, 7.8% specificity, 13.9% positive predictive value, 95% negative predictive value and 19.9% accuracy respectively. Weight-bearing inability was the Ottawa ankle rule item that presented the highest reliability, 69.4% sensitivity, 61.6% specificity, 63.1% accuracy, 21.9% positive predictive value and 93% negative predictive value respectively. Conclusion: The Ottawa ankle rules showed high reliability for deciding when to take radiographs in foot and/or ankle sprains. Weight-bearing inability was the most important isolated item to predict fracture presence. Orthopedic surgeon subjective analysis to predict fracture possibility showed a high specificity rate, representing a confident method to exclude unnecessary radiographic exams. PMID:24971221

Patch testing and allergen-specific serum IgE and IgG antibodies in the diagnosis of canine adverse food reactions.

PubMed

Bethlehem, Simone; Bexley, Jennifer; Mueller, Ralf S

2012-02-15

Adverse food reaction (AFR) is a common differential diagnosis for pruritic dogs. The only way to diagnose AFR is an elimination diet of 6-8 weeks with a protein and a carbohydrate source not previously fed. In humans, patch testing has been shown to be a useful tool to diagnose food allergies. In veterinary medicine, serum food allergen-specific antibody testing is widely offered to identify suitable ingredients for such diets. The aim of this study was to determine sensitivity, specificity, negative and positive predictability of patch testing with and serum antibody testing for a variety of common food stuffs. Twenty-five allergic dogs underwent an elimination diet and individual rechallenge with selected food stuffs, food patch testing and serum testing for food-antigen specific IgE and IgG. Eleven clinically normal control dogs only were subjected to patch and serum testing. The sensitivity and specificity of the patch test were 96.7 and 89.0% respectively, negative and positive predictability were 99.3 and 63.0%. For IgE and IgG the sensitivity was 6.7 and 26.7%, specificity were 91.4 and 88.3%, the negative predictive values 80.7 and 83.7% and the positive predictive values were 15.4 and 34.8%. Based on these results, a positive reaction of a dog on these tests is not very helpful, but a negative result indicates that this antigen is tolerated well. We conclude that patch testing (and to a lesser degree serum testing) can be helpful in choosing ingredients for an elimination diet in a dog with suspected AFR. Copyright © 2012. Published by Elsevier B.V.

Children's acquisition of nouns and verbs in Italian: contrasting the roles of frequency and positional salience in maternal language.

PubMed

Longobardi, Emiddia; Rossi-Arnaud, Clelia; Spataro, Pietro; Putnick, Diane L; Bornstein, Marc H

2015-01-01

Because of its structural characteristics, specifically the prevalence of verb types in infant-directed speech and frequent pronoun-dropping, the Italian language offers an attractive opportunity to investigate the predictive effects of input frequency and positional salience on children's acquisition of nouns and verbs. We examined this issue in a sample of twenty-six mother-child dyads whose spontaneous conversations were recorded, transcribed, and coded at 1;4 and 1;8. The percentages of nouns occurring in the final position of maternal utterances at 1;4 predicted children's production of noun types at 1;8. For verbs, children's growth rates were positively predicted by the percentages of input verbs occurring in utterance-initial position, but negatively predicted by the percentages of verbs located in the final position of maternal utterances at 1;4. These findings clearly illustrate that the effects of positional salience vary across lexical categories.

Interleukin (IL)-1A and IL-6: Applications to the predictive diagnostic testing of radiation pneumonitis

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

Chen Yuhchyau; Hyrien, Ollivier; Williams, Jacqueline

2005-05-01

Purpose: To explore the application of interleukin (IL)-1{alpha} and IL-6 measurements in the predictive diagnostic testing for symptomatic radiation pneumonitis (RP). Methods and materials: In a prospective protocol investigating RP and cytokines, IL-1{alpha} and IL-6 values were analyzed by enzyme-linked immunosorbent assay from serial weekly blood samples of patients receiving chest radiation. We analyzed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) over selected threshold values for both cytokines in the application to diagnostic testing. Results: The average coefficient of variation was 51% of the weekly mean IL-1{alpha} level and 39% of the weekly mean IL-6 value.more » Interleukin 1{alpha} and IL-6 became positively correlated with time. Specificity for both cytokines was better than sensitivity. IL-6 globally outperformed IL-1{alpha} in predicting RP, with higher PPV and NPV. Conclusions: Our data demonstrate the feasibility of applying IL-1{alpha} and IL-6 measurements of blood specimens to predict RP. Interleukin-6 measurements offer stronger positive predictive value than IL-1{alpha}. This application might be further explored in a larger sample of patients.« less

Should bedside sonography be used first to diagnose pneumothorax secondary to blunt trauma?

PubMed

Donmez, Halil; Tokmak, Turgut Tursem; Yildirim, Afra; Buyukoglan, Hakan; Ozturk, Mehmet; Yaşar Ayaz, Umit; Mavili, Ertugrul

2012-01-01

BACKGROUND.: Our purpose was to evaluate the effectiveness of bedside sonography (US) in the detection of pneumothorax secondary to blunt thoracic trauma. METHODS.: In this prospective study, 240 hemithoraces of 120 consecutive patients with multiple trauma were evaluated with chest radiographs (CXR) and bedside thoracic US for the diagnosis of pneumothorax. CT examinations were performed in 68 patients. Fifty-two patients who did not undergo CT examinations were excluded from the study. US examinations were performed independently at bedside by two radiologists who were not informed about CXR and CT findings. CXRs were interpreted by two radiologists who were unaware of the US and CT results. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CXR and US were calculated. RESULTS.: One hundred thirty-six hemithoraces were assessed in 68 patients. A total of 35 pneumothoraces were detected in 33 patients. On US, the diagnosis of pneumothorax was correct in 32 hemithoraces. In 98 hemithoraces without pneumothorax, US was normal. With US examination, there were three false-positive and three false-negative results. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of US were 91.4%, 97%, 91.4%, 97%, and 97%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CXR were 82.7%, 89.7%, 68.5%, 95%, and 89.5%, respectively. CONCLUSIONS.: Bedside thoracic US is an accurate method that can be used in trauma patients instead of CXR for the detection of pneumothorax. Copyright © 2012 Wiley Periodicals, Inc.

Periprosthetic infection: where do we stand with regard to Gram stain?

PubMed

Ghanem, Elie; Ketonis, Constantinos; Restrepo, Camilo; Joshi, Ashish; Barrack, Robert; Parvizi, Javad

2009-02-01

One of the routinely used intraoperative tests for diagnosis of periprosthetic infection (PPI) is the Gram stain. It is not known if the result of this test can vary according to the type of joint affected or the number of specimen samples collected. We examined the role of this diagnostic test in a large cohort of patients from a single institution. A positive gram stain was defined as the visualization of bacterial cells or "many neutrophils" (> 5 per high-power field) in the smear. The sensitivity, specificity, and predictive values of each individual diagnostic arm of Gram stain were determined. Combinations were performed in series, which required both tests to be positive to confirm infection, and also in parallel, which necessitated both tests to be negative to rule out infection. The presence of organisms and "many" neutrophils on a Gram smear had high specificity (98-100%) and positive predictive value (89-100%) in both THA and TKA. The sensitivities (30-50%) and negative predictive values (70-79%) of the 2 tests were low for both joint types. When the 2 tests were combined in series, the specificity and positive predictive value were absolute (100%). The sensitivity and the negative predictive value improved for both THA and TKA (43-64% and 82%, respectively). Although the 2 diagnostic arms of Gram staining can be combined to achieve improved negative predictive value (82%), Gram stain continues to have little value in ruling out PPI. With the advances in the field of molecular biology, novel diagnostic modalities need to be designed that can replace these traditional and poor tests.

Use of the International Classification of Diseases, 9th revision, coding in identifying chronic hepatitis B virus infection in health system data: implications for national surveillance.

PubMed

Mahajan, Reena; Moorman, Anne C; Liu, Stephen J; Rupp, Loralee; Klevens, R Monina

2013-05-01

With increasing use electronic health records (EHR) in the USA, we looked at the predictive values of the International Classification of Diseases, 9th revision (ICD-9) coding system for surveillance of chronic hepatitis B virus (HBV) infection. The chronic HBV cohort from the Chronic Hepatitis Cohort Study was created based on electronic health records (EHR) of adult patients who accessed services from 2006 to 2008 from four healthcare systems in the USA. Using the gold standard of abstractor review to confirm HBV cases, we calculated the sensitivity, specificity, positive and negative predictive values using one qualifying ICD-9 code versus using two qualifying ICD-9 codes separated by 6 months or greater. Of 1 652 055 adult patients, 2202 (0.1%) were confirmed as having chronic HBV. Use of one ICD-9 code had a sensitivity of 83.9%, positive predictive value of 61.0%, and specificity and negative predictive values greater than 99%. Use of two hepatitis B-specific ICD-9 codes resulted in a sensitivity of 58.4% and a positive predictive value of 89.9%. Use of one or two hepatitis B ICD-9 codes can identify cases with chronic HBV infection with varying sensitivity and positive predictive values. As the USA increases the use of EHR, surveillance using ICD-9 codes may be reliable to determine the burden of chronic HBV infection and would be useful to improve reporting by state and local health departments.

Intra-Operative Frozen Sections for Ovarian Tumors – A Tertiary Center Experience

PubMed Central

Arshad, Nur Zaiti Md; Ng, Beng Kwang; Paiman, Noor Asmaliza Md; Mahdy, Zaleha Abdullah; Noor, Rushdan Mohd

2018-01-01

Background: Accuracy of diagnosis with intra-operative frozen sections is extremely important in the evaluation of ovarian tumors so that appropriate surgical procedures can be selected. Study design: All patients who with intra-operative frozen sections for ovarian masses in a tertiary center over nine years from June 2008 until April 2017 were reviewed. Frozen section diagnosis and final histopathological reports were compared. Main outcome measures: Sensitivity, specificity, positive and negative predictive values of intra-operative frozen section as compared to final histopathological results for ovarian tumors. Results: A total of 92 cases were recruited for final evaluation. The frozen section diagnoses were comparable with the final histopathological reports in 83.7% of cases. The sensitivity, specificity, positive predictive value and negative predictive value for benign and malignant ovarian tumors were 95.6%, 85.1%, 86.0% and 95.2% and 69.2%, 100%, 100% and 89.2% respectively. For borderline ovarian tumors, the sensitivity and specificity were 76.2% and 88.7%, respectively; the positive predictive value was 66.7% and the negative predictive value was 92.7%. Conclusion: The accuracy of intra-operative frozen section diagnoses for ovarian tumors is high and this approach remains a reliable option in assessing ovarian masses intra-operatively. PMID:29373916

A positive Babinski reflex predicts delayed neuropsychiatric sequelae in Chinese patients with carbon monoxide poisoning.

PubMed

Zou, Jian-Fang; Guo, Qiming; Shao, Hua; Li, Bin; Du, Yuxiu; Liu, Maofeng; Liu, Fengling; Dai, Lixin; Chung, Min-Hsien; Lin, Hung-Jung; Guo, How-Ran; Yang, Tzu-Meng; Huang, Chien-Cheng; Hsu, Chien-Chin

2014-01-01

As the human population increased in China, the carbon monoxide is a serious environmental toxin in public health. However, predicting the delayed neuropsychiatric sequelae (DNS) of carbon monoxide poisoning (COP) has not been well studied. We investigated the independent predictors of DNS in patients with COP. This study was conducted at four hospitals in China. Data were retrospectively collected from 258 patients with COP between November 1990 and October 2011. DNS was the primary endpoint. A positive Babinski reflex was the independent predictor for DNS: sensitivity = 53.8% (95% confidence interval [CI]: 26.1-79.6), specificity = 88.6% (95% CI: 83.7-92.1), positive predictive value (PPV) = 20.0% (95% CI: 9.1-37.5), and negative predictive value (NPV) = 97.3% (95% CI: 94.0-98.9). The area under the receiver operating characteristic curve = 0.712 (95% CI: 0.544-0.880). A positive Babinski reflex was very memorable, immediately available, and applicable in clinical practice. Even when the sensitivity and PPV of a positive Babinski reflex were unsatisfactory, it had a good specificity and NPV for excluding the risk of DNS. In patients without a positive Babinski reflex, the risk for DNS was only 2.7%. This finding may help physicians make decisions about dispositions for patients with COP.

Sensitivity, specificity, positive and negative predictive values: diagnosing purple mange.

PubMed

Collier, Jill; Huebscher, Roxana

2010-04-01

To shed light on several epidemiological terms for better understanding of diagnostic testing measures by using a mythical condition, "purple mange." Scientific literature related to epidemiology and statistical tests. Nurse practitioners (NPs) use the concepts of sensitivity (SEN), specificity (SPEC), positive predictive value (PPV), and negative predictive value (NPV) daily in primary care and specialty areas. In addition, PPV and NPV vary with the prevalence of a condition. At times, NPs misunderstand the meaning of these terms. In order to develop appropriate treatment plans, an understanding of the concepts of SEN, SPEC, PPV, and NPV is important for interpreting test results. The authors have used this mythical condition purple mange as a teaching tool for NP students.

Validation of the 4P's Plus screen for substance use in pregnancy validation of the 4P's Plus.

PubMed

Chasnoff, I J; Wells, A M; McGourty, R F; Bailey, L K

2007-12-01

The purpose of this study is to validate the 4P's Plus screen for substance use in pregnancy. A total of 228 pregnant women enrolled in prenatal care underwent screening with the 4P's Plus and received a follow-up clinical assessment for substance use. Statistical analyses regarding reliability, sensitivity, specificity, and positive and negative predictive validity of the 4Ps Plus were conducted. The overall reliability for the five-item measure was 0.62. Seventy-four (32.5%) of the women had a positive screen. Sensitivity and specificity were very good, at 87 and 76%, respectively. Positive predictive validity was low (36%), but negative predictive validity was quite high (97%). Of the 31 women who had a positive clinical assessment, 45% were using less than 1 day per week. The 4P's Plus reliably and effectively screens pregnant women for risk of substance use, including those women typically missed by other perinatal screening methodologies.

Young adults' internet addiction: Prediction by the interaction of parental marital conflict and respiratory sinus arrhythmia.

PubMed

Zhang, Hui; Spinrad, Tracy L; Eisenberg, Nancy; Luo, Yun; Wang, Zhenhong

2017-10-01

The aim of the current study was to address the potential moderating roles of respiratory sinus arrhythmia (RSA; baseline and suppression) and participant sex in the relation between parents' marital conflict and young adults' internet addiction. Participants included 105 (65 men) Chinese young adults who reported on their internet addiction and their parents' marital conflict. Marital conflict interacted with RSA suppression to predict internet addiction. Specifically, high RSA suppression was associated with low internet addiction, regardless of parental marital conflict; however, for participants with low RSA suppression, a positive relation between marital conflict and internet addiction was found. Internet addiction also was predicted by a significant three-way interaction among baseline RSA, marital conflict, and participant sex. Specifically, for men, marital conflict positively predicted internet addiction under conditions of low (but not high) baseline RSA. For women, marital conflict positively predicted internet addiction under conditions of high (but not low) baseline RSA. Findings highlight the importance of simultaneous consideration of physiological factors, in conjunction with family factors, in the prediction of young adults' internet addiction. Copyright © 2017 Elsevier B.V. All rights reserved.

Correcting the anion gap for hypoalbuminaemia does not improve detection of hyperlactataemia

PubMed Central

Dinh, C H; Ng, R; Grandinetti, A; Joffe, A; Chow, D C

2006-01-01

Background An elevated lactate level reflects impaired tissue oxygenation and is a predictor of mortality. Studies have shown that the anion gap is inadequate as a screen for hyperlactataemia, particularly in critically ill and trauma patients. A proposed explanation for the anion gap's poor sensitivity and specificity in detecting hyperlactataemia is that the serum albumin is frequently low. This study therefore, sought to compare the predictive values of the anion gap and the anion gap corrected for albumin (cAG) as an indicator of hyperlactataemia as defined by a lactate ⩾2.5 mmol/l. Methods A retrospective review of 639 sets of laboratory values from a tertiary care hospital. Patients' laboratory results were included in the study if serum chemistries and lactate were drawn consecutively. The sensitivity, specificity, and predictive values were obtained. A receiver operator characteristics curve (ROC) was drawn and the area under the curve (AUC) was calculated. Results An anion gap ⩾12 provided a sensitivity, specificity, positive predictive value, and negative predictive value of 39%, 89%, 79%, and 58%, respectively, and a cAG ⩾12 provided a sensitivity, specificity, positive predictive value, and negative predictive value of 75%, 59%, 66%, and 69%, respectively. The ROC curves between anion gap and cAG as a predictor of hyperlactataemia were almost identical. The AUC was 0.757 and 0.750, respectively. Conclusions The sensitivities, specificities, and predictive values of the anion gap and cAG were inadequate in predicting the presence of hyperlactataemia. The cAG provides no additional advantage over the anion gap in the detection of hyperlactataemia. PMID:16858097

Prediction of early and late preeclampsia by flow-mediated dilation of the brachial artery*

PubMed Central

Brandão, Augusto Henriques Fulgêncio; Evangelista, Aline Aarão; Martins, Raphaela Menin Franco; Leite, Henrique Vítor; Cabral, Antônio Carlos Vieira

2014-01-01

Objective To assess the accuracy in the prediction of both early and late preeclampsia by flow-mediated dilation of the brachial artery (FMD), a biophysical marker for endothelial dysfunction. Materials and Methods A total of 91 patients, considered at high risk for development of preeclampsia were submitted to brachial artery FMD between 24 and 28 weeks of gestation. Results Nineteen out of the selected patients developed preeclampsia, 8 in its early form and 11 in the late form. With a cut-off value of 6.5%, the FMD sensitivity for early preeclampsia prediction was 75.0%, with specificity of 73.3%, positive predictive value (PPV) of 32.4% and negative predictive value (NPV) of 91.9%. For the prediction of late preeclampsia, sensitivity = 83.3%, specificity = 73.2%, PPV = 34.4% and NPV = 96.2% were observed. And for the prediction of all associated forms of preeclampsia, sensitivity = 84.2%, specificity = 73.6%, PPV = 45.7% and NPV = 94.6% were observed. Conclusion FMD of the brachial artery is a test with good accuracy in the prediction of both early and late preeclampsia, which may represent a positive impact on the follow-up of pregnant women at high risk for developing this syndrome. PMID:25741086

The role of nerve monitoring to predict postoperative recurrent laryngeal nerve function in thyroid and parathyroid surgery.

PubMed

Eid, Issam; Miller, Frank R; Rowan, Stephanie; Otto, Randal A

2013-10-01

To determine the role and efficacy of intraoperative recurrent laryngeal nerve (RLN) stimulation in the prediction of early and permanent postoperative nerve function in thyroid and parathyroid surgery. A retrospective review of thyroid and parathyroid surgeries was performed with calculation of sensitivity and specificity of the response of intraoperative stimulation for different pathological groups. Normal electromyography (EMG) response with 0.5 mAmp stimulation was considered a positive stimulation response with postoperative function determined by laryngoscopy. No EMG response at >1-2 mAmps was considered a negative response. The rates of early and permanent paralysis, as well as sensitivity, specificity, and positive and negative predictive values for postoperative nerve function were calculated for separate pathological groups. The number of nerves at risk analyzed was 909. The overall early and permanent paralysis rates were 3.1% and 1.2%, respectively, with the highest rate being for Grave's disease cases. The overall sensitivity was 98.4%. The specificity was lower at 62.5% but acceptable in thyroid carcinoma and Grave's disease patients. The majority of nerves with a positive stimulation result and postoperative paralysis on laryngoscopy recovered function in 3 to 12 weeks, showing positive stimulation to be a good predictor of eventual recovery. Stimulation of the RLN during thyroid and parathyroid surgery is a useful tool in predicting postoperative RLN function. The sensitivity of stimulation is high, showing positive stimulation to be an excellent predictor of normal nerve function. Negative stimulation is more predictive of paralysis in cases of thyroid carcinoma and Grave's disease. 2b. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Diagnostic accuracy of uriSed automated urine microscopic sediment analyzer and dipstick parameters in predicting urine culture test results.

PubMed

Huysal, Kağan; Budak, Yasemin U; Karaca, Ayse Ulusoy; Aydos, Murat; Kahvecioğlu, Serdar; Bulut, Mehtap; Polat, Murat

2013-01-01

Urinary tract infection (UTI) is one of the most common types of infection. Currently, diagnosis is primarily based on microbiologic culture, which is time- and labor-consuming. The aim of this study was to assess the diagnostic accuracy of urinalysis results from UriSed (77 Electronica, Budapest, Hungary), an automated microscopic image-based sediment analyzer, in predicting positive urine cultures. We examined a total of 384 urine specimens from hospitalized patients and outpatients attending our hospital on the same day for urinalysis, dipstick tests and semi-quantitative urine culture. The urinalysis results were compared with those of conventional semiquantitative urine culture. Of 384 urinary specimens, 68 were positive for bacteriuria by culture, and were thus considered true positives. Comparison of these results with those obtained from the UriSed analyzer indicated that the analyzer had a specificity of 91.1%, a sensitivity of 47.0%, a positive predictive value (PPV) of 53.3% (95% confidence interval (CI) = 40.8-65.3), and a negative predictive value (NPV) of 88.8% (95% CI = 85.0-91.8%). The accuracy was 83.3% when the urine leukocyte parameter was used, 76.8% when bacteriuria analysis of urinary sediment was used, and 85.1% when the bacteriuria and leukocyturia parameters were combined. The presence of nitrite was the best indicator of culture positivity (99.3% specificity) but had a negative likelihood ratio of 0.7, indicating that it was not a reliable clinical test. Although the specificity of the UriSed analyzer was within acceptable limits, the sensitivity value was low. Thus, UriSed urinalysis resuIts do not accurately predict the outcome of culture.

FUN-LDA: A Latent Dirichlet Allocation Model for Predicting Tissue-Specific Functional Effects of Noncoding Variation: Methods and Applications.

PubMed

Backenroth, Daniel; He, Zihuai; Kiryluk, Krzysztof; Boeva, Valentina; Pethukova, Lynn; Khurana, Ekta; Christiano, Angela; Buxbaum, Joseph D; Ionita-Laza, Iuliana

2018-05-03

We describe a method based on a latent Dirichlet allocation model for predicting functional effects of noncoding genetic variants in a cell-type- and/or tissue-specific way (FUN-LDA). Using this unsupervised approach, we predict tissue-specific functional effects for every position in the human genome in 127 different tissues and cell types. We demonstrate the usefulness of our predictions by using several validation experiments. Using eQTL data from several sources, including the GTEx project, Geuvadis project, and TwinsUK cohort, we show that eQTLs in specific tissues tend to be most enriched among the predicted functional variants in relevant tissues in Roadmap. We further show how these integrated functional scores can be used for (1) deriving the most likely cell or tissue type causally implicated for a complex trait by using summary statistics from genome-wide association studies and (2) estimating a tissue-based correlation matrix of various complex traits. We found large enrichment of heritability in functional components of relevant tissues for various complex traits, and FUN-LDA yielded higher enrichment estimates than existing methods. Finally, using experimentally validated functional variants from the literature and variants possibly implicated in disease by previous studies, we rigorously compare FUN-LDA with state-of-the-art functional annotation methods and show that FUN-LDA has better prediction accuracy and higher resolution than these methods. In particular, our results suggest that tissue- and cell-type-specific functional prediction methods tend to have substantially better prediction accuracy than organism-level prediction methods. Scores for each position in the human genome and for each ENCODE and Roadmap tissue are available online (see Web Resources). Copyright © 2018 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

Literature-based condition-specific miRNA-mRNA target prediction.

PubMed

Oh, Minsik; Rhee, Sungmin; Moon, Ji Hwan; Chae, Heejoon; Lee, Sunwon; Kang, Jaewoo; Kim, Sun

2017-01-01

miRNAs are small non-coding RNAs that regulate gene expression by binding to the 3'-UTR of genes. Many recent studies have reported that miRNAs play important biological roles by regulating specific mRNAs or genes. Many sequence-based target prediction algorithms have been developed to predict miRNA targets. However, these methods are not designed for condition-specific target predictions and produce many false positives; thus, expression-based target prediction algorithms have been developed for condition-specific target predictions. A typical strategy to utilize expression data is to leverage the negative control roles of miRNAs on genes. To control false positives, a stringent cutoff value is typically set, but in this case, these methods tend to reject many true target relationships, i.e., false negatives. To overcome these limitations, additional information should be utilized. The literature is probably the best resource that we can utilize. Recent literature mining systems compile millions of articles with experiments designed for specific biological questions, and the systems provide a function to search for specific information. To utilize the literature information, we used a literature mining system, BEST, that automatically extracts information from the literature in PubMed and that allows the user to perform searches of the literature with any English words. By integrating omics data analysis methods and BEST, we developed Context-MMIA, a miRNA-mRNA target prediction method that combines expression data analysis results and the literature information extracted based on the user-specified context. In the pathway enrichment analysis using genes included in the top 200 miRNA-targets, Context-MMIA outperformed the four existing target prediction methods that we tested. In another test on whether prediction methods can re-produce experimentally validated target relationships, Context-MMIA outperformed the four existing target prediction methods. In summary, Context-MMIA allows the user to specify a context of the experimental data to predict miRNA targets, and we believe that Context-MMIA is very useful for predicting condition-specific miRNA targets.

The value of negative Chlamydia trachomatis antibody in prediction of normal tubes in infertile women.

PubMed

Raoofi, Z; Barchinegad, M; Haghighi, L

2013-01-01

To evaluate the value of Chlamydia trachomatis antibody testing in prediction of at least one normal tube in infertile women. Eighty infertile women without any history of abdominal or pelvic surgery, pelvic inflammatory disease, and endometriosis were recruited in this cross-sectional study from 2009 to 2010. The patients underwent hysterosalpingography, laparoscopy, and anti Chlamydia trachomatis IgG antibody (CAT) testing. We compared laparoscopy findings and CAT regarding sensitivity, specificity, accuracy, and predicting value of tubal conditions. The CAT was positive in 50 patients (62.5%) and laparoscopy was positive in 32 patients (40%). The CAT was significantly higher in women with tubal disease (1.88 +/- 0.34) versus in women with normal tubes (1.21 +/- 0.28) (p = 0.003). Five out of 30 sero-negative women had unilateral tubal abnormality and none of them had bilateral tubal obstruction or severe pelvic adhesion. The sensitivity, specificity, positive and negative predictive value, and accuracy of the CAT in prediction of one normal tube were 100%, 42.25%, 18%, 100%, and 48.75%, respectively. The negative predictive value of CAT to predict at least one normal tube in infertile women without history of abdominal or pelvic surgery, pelvic inflammatory disease, and endometriosis was 100%.

Development and Validation of an Algorithm to Identify Planned Readmissions From Claims Data.

PubMed

Horwitz, Leora I; Grady, Jacqueline N; Cohen, Dorothy B; Lin, Zhenqiu; Volpe, Mark; Ngo, Chi K; Masica, Andrew L; Long, Theodore; Wang, Jessica; Keenan, Megan; Montague, Julia; Suter, Lisa G; Ross, Joseph S; Drye, Elizabeth E; Krumholz, Harlan M; Bernheim, Susannah M

2015-10-01

It is desirable not to include planned readmissions in readmission measures because they represent deliberate, scheduled care. To develop an algorithm to identify planned readmissions, describe its performance characteristics, and identify improvements. Consensus-driven algorithm development and chart review validation study at 7 acute-care hospitals in 2 health systems. For development, all discharges qualifying for the publicly reported hospital-wide readmission measure. For validation, all qualifying same-hospital readmissions that were characterized by the algorithm as planned, and a random sampling of same-hospital readmissions that were characterized as unplanned. We calculated weighted sensitivity and specificity, and positive and negative predictive values of the algorithm (version 2.1), compared to gold standard chart review. In consultation with 27 experts, we developed an algorithm that characterizes 7.8% of readmissions as planned. For validation we reviewed 634 readmissions. The weighted sensitivity of the algorithm was 45.1% overall, 50.9% in large teaching centers and 40.2% in smaller community hospitals. The weighted specificity was 95.9%, positive predictive value was 51.6%, and negative predictive value was 94.7%. We identified 4 minor changes to improve algorithm performance. The revised algorithm had a weighted sensitivity 49.8% (57.1% at large hospitals), weighted specificity 96.5%, positive predictive value 58.7%, and negative predictive value 94.5%. Positive predictive value was poor for the 2 most common potentially planned procedures: diagnostic cardiac catheterization (25%) and procedures involving cardiac devices (33%). An administrative claims-based algorithm to identify planned readmissions is feasible and can facilitate public reporting of primarily unplanned readmissions. © 2015 Society of Hospital Medicine.

Periprosthetic infection: where do we stand with regard to Gram stain?

PubMed Central

Ghanem, Elie; Ketonis, Constantinos; Restrepo, Camilo; Joshi, Ashish; Barrack, Robert

2009-01-01

Background and purpose One of the routinely used intraoperative tests for diagnosis of periprosthetic infection (PPI) is the Gram stain. It is not known if the result of this test can vary according to the type of joint affected or the number of specimen samples collected. We examined the role of this diagnostic test in a large cohort of patients from a single institution. Materials and methods A positive gram stain was defined as the visualization of bacterial cells or “many neutrophils” (> 5 per high-power field) in the smear. The sensitivity, specificity, and predictive values of each individual diagnostic arm of Gram stain were determined. Combinations were performed in series, which required both tests to be positive to confirm infection, and also in parallel, which necessitated both tests to be negative to rule out infection. Results The presence of organisms and “many” neutrophils on a Gram smear had high specificity (98–100%) and positive predictive value (89–100%) in both THA and TKA. The sensitivities (30–50%) and negative predictive values (70–79%) of the 2 tests were low for both joint types. When the 2 tests were combined in series, the specificity and positive predictive value were absolute (100%). The sensitivity and the negative predictive value improved for both THA and TKA (43–64% and 82%, respectively). Interpretation Although the 2 diagnostic arms of Gram staining can be combined to achieve improved negative predictive value (82%), Gram stain continues to have little value in ruling out PPI. With the advances in the field of molecular biology, novel diagnostic modalities need to be designed that can replace these traditional and poor tests. PMID:19297787

The Diagnostic Performance of Multiparametric Magnetic Resonance Imaging to Detect Significant Prostate Cancer.

PubMed

Thompson, J E; van Leeuwen, P J; Moses, D; Shnier, R; Brenner, P; Delprado, W; Pulbrook, M; Böhm, M; Haynes, A M; Hayen, A; Stricker, P D

2016-05-01

We assess the accuracy of multiparametric magnetic resonance imaging for significant prostate cancer detection before diagnostic biopsy in men with an abnormal prostate specific antigen/digital rectal examination. A total of 388 men underwent multiparametric magnetic resonance imaging, including T2-weighted, diffusion weighted and dynamic contrast enhanced imaging before biopsy. Two radiologists used PI-RADS to allocate a score of 1 to 5 for suspicion of significant prostate cancer (Gleason 7 with more than 5% grade 4). PI-RADS 3 to 5 was considered positive. Transperineal template guided mapping biopsy of 18 regions (median 30 cores) was performed with additional manually directed cores from magnetic resonance imaging positive regions. The anatomical location, size and grade of individual cancer areas in the biopsy regions (18) as the primary outcome and in prostatectomy specimens (117) as the secondary outcome were correlated to the magnetic resonance imaging positive regions. Of the 388 men who were enrolled in the study 344 were analyzed. Multiparametric magnetic resonance imaging was positive in 77.0% of patients, 62.5% had prostate cancer and 41.6% had significant prostate cancer. The detection of significant prostate cancer by multiparametric magnetic resonance imaging had a sensitivity of 96%, specificity of 36%, negative predictive value of 92% and positive predictive value of 52%. Adding PI-RADS to the multivariate model, including prostate specific antigen, digital rectal examination, prostate volume and age, improved the AUC from 0.776 to 0.879 (p <0.001). Anatomical concordance analysis showed a low mismatch between the magnetic resonance imaging positive regions and biopsy positive regions (4 [2.9%]), and the significant prostate cancer area in the radical prostatectomy specimen (3 [3.3%]). In men with an abnormal prostate specific antigen/digital rectal examination, multiparametric magnetic resonance imaging detected significant prostate cancer with an excellent negative predictive value and moderate positive predictive value. The use of multiparametric magnetic resonance imaging to diagnose significant prostate cancer may result in a substantial number of unnecessary biopsies while missing a minimum of significant prostate cancers. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Prediction of challenge test results by flour-specific IgE and skin prick test in symptomatic bakers.

PubMed

van Kampen, V; Rabstein, S; Sander, I; Merget, R; Brüning, T; Broding, H C; Keller, C; Müsken, H; Overlack, A; Schultze-Werninghaus, G; Walusiak, J; Raulf-Heimsoth, M

2008-07-01

Wheat and rye flours are among the most important allergens causing occupational asthma. Usually, the diagnosis of baker's asthma is based on inhalation challenge tests with flours. To evaluate the relevance of flour-specific serum immunoglobulin E (IgE) and skin prick test (SPT) in the diagnosis of baker's asthma and to define flour-specific IgE concentrations and wheal sizes that allow a prediction of the outcome of challenge testing. Bronchial and nasal challenge tests with wheat (rye) flour were performed in 71 (95) symptomatic bakers. Determinations of flour-specific IgE as well as SPTs were performed in all subjects. Analyses included the calculation of sensitivity, specificity, positive (PPV) and negative predictive values (NPV) at different IgE concentrations and different wheal sizes, and receiver-operating characteristics (ROC) plots with the challenge result as gold standard. Thirty-seven bakers were positive in the challenge with wheat flour, while 63 were positive with rye flour. Depending on the flour-specific IgE concentrations (wheal size), PPV was 74-100% (74-100%) for wheat and 82-100% (91-100%) for rye flour, respectively. The minimal cut-off values with a PPV of 100% were 2.32 kU/l (5.0 mm) for wheat flour and 9.64 kU/l (4.5 mm) for rye flour. The shapes of the ROC plots were similar for wheat and rye flour. High concentrations of flour-specific IgE and clear SPT results in symptomatic bakers are good predictors for a positive challenge test. Challenge tests with flours may be avoided in strongly sensitized bakers.

Enriching peptide libraries for binding affinity and specificity through computationally directed library design

PubMed Central

Foight, Glenna Wink; Chen, T. Scott; Richman, Daniel; Keating, Amy E.

2017-01-01

Peptide reagents with high affinity or specificity for their target protein interaction partner are of utility for many important applications. Optimization of peptide binding by screening large libraries is a proven and powerful approach. Libraries designed to be enriched in peptide sequences that are predicted to have desired affinity or specificity characteristics are more likely to yield success than random mutagenesis. We present a library optimization method in which the choice of amino acids to encode at each peptide position can be guided by available experimental data or structure-based predictions. We discuss how to use analysis of predicted library performance to inform rounds of library design. Finally, we include protocols for more complex library design procedures that consider the chemical diversity of the amino acids at each peptide position and optimize a library score based on a user-specified input model. PMID:28236241

Enriching Peptide Libraries for Binding Affinity and Specificity Through Computationally Directed Library Design.

PubMed

Foight, Glenna Wink; Chen, T Scott; Richman, Daniel; Keating, Amy E

2017-01-01

Peptide reagents with high affinity or specificity for their target protein interaction partner are of utility for many important applications. Optimization of peptide binding by screening large libraries is a proven and powerful approach. Libraries designed to be enriched in peptide sequences that are predicted to have desired affinity or specificity characteristics are more likely to yield success than random mutagenesis. We present a library optimization method in which the choice of amino acids to encode at each peptide position can be guided by available experimental data or structure-based predictions. We discuss how to use analysis of predicted library performance to inform rounds of library design. Finally, we include protocols for more complex library design procedures that consider the chemical diversity of the amino acids at each peptide position and optimize a library score based on a user-specified input model.

Life history theory predicts fish assemblage response to hydrologic regimes.

PubMed

Mims, Meryl C; Olden, Julian D

2012-01-01

The hydrologic regime is regarded as the primary driver of freshwater ecosystems, structuring the physical habitat template, providing connectivity, framing biotic interactions, and ultimately selecting for specific life histories of aquatic organisms. In the present study, we tested ecological theory predicting directional relationships between major dimensions of the flow regime and life history composition of fish assemblages in perennial free-flowing rivers throughout the continental United States. Using long-term discharge records and fish trait and survey data for 109 stream locations, we found that 11 out of 18 relationships (61%) tested between the three life history strategies (opportunistic, periodic, and equilibrium) and six hydrologic metrics (two each describing flow variability, predictability, and seasonality) were statistically significant (P < or = 0.05) according to quantile regression. Our results largely support a priori hypotheses of relationships between specific flow indices and relative prevalence of fish life history strategies, with 82% of all significant relationships observed supporting predictions from life history theory. Specifically, we found that (1) opportunistic strategists were positively related to measures of flow variability and negatively related to predictability and seasonality, (2) periodic strategists were positively related to high flow seasonality and negatively related to variability, and (3) the equilibrium strategists were negatively related to flow variability and positively related to predictability. Our study provides important empirical evidence illustrating the value of using life history theory to understand both the patterns and processes by which fish assemblage structure is shaped by adaptation to natural regimes of variability, predictability, and seasonality of critical flow events over broad biogeographic scales.

[Development and validation of an algorithm to identify cancer recurrences from hospital data bases].

PubMed

Manzanares-Laya, S; Burón, A; Murta-Nascimento, C; Servitja, S; Castells, X; Macià, F

2014-01-01

Hospital cancer registries and hospital databases are valuable and efficient sources of information for research into cancer recurrences. The aim of this study was to develop and validate algorithms for the detection of breast cancer recurrence. A retrospective observational study was conducted on breast cancer cases from the cancer registry of a third level university hospital diagnosed between 2003 and 2009. Different probable cancer recurrence algorithms were obtained by linking the hospital databases and the construction of several operational definitions, with their corresponding sensitivity, specificity, positive predictive value and negative predictive value. A total of 1,523 patients were diagnosed of breast cancer between 2003 and 2009. A request for bone gammagraphy after 6 months from the first oncological treatment showed the highest sensitivity (53.8%) and negative predictive value (93.8%), and a pathology test after 6 months after the diagnosis showed the highest specificity (93.8%) and negative predictive value (92.6%). The combination of different definitions increased the specificity and the positive predictive value, but decreased the sensitivity. Several diagnostic algorithms were obtained, and the different definitions could be useful depending on the interest and resources of the researcher. A higher positive predictive value could be interesting for a quick estimation of the number of cases, and a higher negative predictive value for a more exact estimation if more resources are available. It is a versatile and adaptable tool for other types of tumors, as well as for the needs of the researcher. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Norcocaine in human hair as a biomarker of heavy cocaine use in a high risk population.

PubMed

Poon, S; Gareri, J; Walasek, P; Koren, G

2014-08-01

In hair analysis, cocaine (COC) and its metabolites have been studied relatively extensively with a consistent focus of distinguishing active drug use and excluding external contamination. Although quantitative cut-offs using major metabolite, benzolecgonine (BE), in hair have been proposed to distinguish likely active use from passive exposure, exogenously formed BE may result in false positive tests. Hence, the presence of less commonly detected COC metabolite, norcocaine (NCOC), may be useful in increasing certainty of illicit COC use and evaluating likelihood of environmental contamination. The objective of the present study was to observe the pattern of NCOC detection in a clinical population of suspected users and evaluate the possible role of NCOC in distinguishing systemic exposure from external contamination to COC and assessing intensity of cocaine use. Hair samples collected between January 2011 and May 2013 from the Motherisk Laboratory were analyzed by GC-MS for the presence of COC, BE, and NCOC. NCOC positivity rates (%) for various COC concentration ranges as well as sensitivity, specificity, positive predictive value, and negative predictive values of NCOC as a biomarker of different COC use profiles was calculated. The rate of NCOC positivity (%) within COC concentration ranges (ng/mg) 0.13-0.4 (above LOD, below LOQ), 0.4-3, 3-6, 6-10, 10-14, >14 were 0.26, 4.15, 29.63, 55.85, 80.37, and 94.02, respectively; p<0.0001 for all positivity comparisons between ranges. These results were used to determine a COC cut-off concentration for differing levels of COC use. The presence of NCOC above the LOD of 0.13 ng/mg predicted COC concentrations exceeding 14.00 ng/mg, with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 94.0%, 87.9%, 41.5%, and 99.4%, respectively. The presence NCOC above the LOD of 0.13 ng/mg predicted COC concentrations exceeding the 75th percentile, with sensitivity, specificity, PPV, and NPV of 76.6%, 94.7%, 74.7%, and 95.2%, respectively. Despite an inability to definitively rule out external contamination, the presence of NCOC in hair is strongly associated with elevated COC levels and performs as a highly specific surrogate marker for frequent/intensive cocaine use and highly sensitive marker for intensive/daily use of cocaine. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The Accuracy of the Spot Sign and the Blend Sign for Predicting Hematoma Expansion in Patients with Spontaneous Intracerebral Hemorrhage.

PubMed

Zheng, Jun; Yu, Zhiyuan; Xu, Zhao; Li, Mou; Wang, Xiaoze; Lin, Sen; Li, Hao; You, Chao

2017-05-12

BACKGROUND Hematoma expansion is associated with poor outcome in intracerebral hemorrhage (ICH) patients. The spot sign and the blend sign are reliable tools for predicting hematoma expansion in ICH patients. The aim of this study was to compare the accuracy of the two signs in the prediction of hematoma expansion. MATERIAL AND METHODS Patients with spontaneous ICH were screened for the presence of the computed tomography angiography (CTA) spot sign and the non-contrast CT (NCCT) blend sign within 6 hours after onset of symptoms. The sensitivity, specificity, and positive and negative predictive values of the spot sign and the blend sign in predicting hematoma expansion were calculated. The accuracy of the spot sign and the blend sign in predicting hematoma expansion was analyzed by receiver-operator analysis. RESULTS A total of 115 patients were enrolled in this study. The spot sign was observed in 25 (21.74%) patients, whereas the blend sign was observed in 22 (19.13%) patients. Of the 28 patients with hematoma expansion, the CTA spot sign was found on admission CT scans in 16 (57.14%) and the NCCT blend sign in 12 (42.86%), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of the spot sign for predicting hematoma expansion were 57.14%, 89.66%, 64.00%, and 86.67%, respectively. In contrast, the sensitivity, specificity, positive predictive value, and negative predictive value of the blend sign were 42.86%, 88.51%, 54.55%, and 82.80%, respectively. The area under the curve (AUC) of the spot sign was 0.734, which was higher than that of the blend sign (0.657). CONCLUSIONS Both the spot sign and the blend sign seemed to be good predictors for hematoma expansion, and the spot sign appeared to have better predictive accuracy.

The Accuracy of the Spot Sign and the Blend Sign for Predicting Hematoma Expansion in Patients with Spontaneous Intracerebral Hemorrhage

PubMed Central

Zheng, Jun; Yu, Zhiyuan; Xu, Zhao; Li, Mou; Wang, Xiaoze; Lin, Sen; Li, Hao; You, Chao

2017-01-01

Background Hematoma expansion is associated with poor outcome in intracerebral hemorrhage (ICH) patients. The spot sign and the blend sign are reliable tools for predicting hematoma expansion in ICH patients. The aim of this study was to compare the accuracy of the two signs in the prediction of hematoma expansion. Material/Methods Patients with spontaneous ICH were screened for the presence of the computed tomography angiography (CTA) spot sign and the non-contrast CT (NCCT) blend sign within 6 hours after onset of symptoms. The sensitivity, specificity, and positive and negative predictive values of the spot sign and the blend sign in predicting hematoma expansion were calculated. The accuracy of the spot sign and the blend sign in predicting hematoma expansion was analyzed by receiver-operator analysis. Results A total of 115 patients were enrolled in this study. The spot sign was observed in 25 (21.74%) patients, whereas the blend sign was observed in 22 (19.13%) patients. Of the 28 patients with hematoma expansion, the CTA spot sign was found on admission CT scans in 16 (57.14%) and the NCCT blend sign in 12 (42.86%), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of the spot sign for predicting hematoma expansion were 57.14%, 89.66%, 64.00%, and 86.67%, respectively. In contrast, the sensitivity, specificity, positive predictive value, and negative predictive value of the blend sign were 42.86%, 88.51%, 54.55%, and 82.80%, respectively. The area under the curve (AUC) of the spot sign was 0.734, which was higher than that of the blend sign (0.657). Conclusions Both the spot sign and the blend sign seemed to be good predictors for hematoma expansion, and the spot sign appeared to have better predictive accuracy. PMID:28498827

Utility of urine lipoarabinomannan (LAM) in diagnosing tuberculosis and predicting mortality with and without HIV: prospective TB cohort from the Thailand Big City TB Research Network.

PubMed

Suwanpimolkul, Gompol; Kawkitinarong, Kamon; Manosuthi, Weerawat; Sophonphan, Jiratchaya; Gatechompol, Sivaporn; Ohata, Pirapon June; Ubolyam, Sasiwimol; Iampornsin, Thatri; Katerattanakul, Pairaj; Avihingsanon, Anchalee; Ruxrungtham, Kiat

2017-06-01

To evaluate the applicability and accuracy of the urine lipoarabinomannan (LAM) test in tuberculosis (TB)/HIV co-infected patients and HIV-negative patients with disseminated TB. Frozen urine samples obtained at baseline from patients in the TB research cohort with proven culture-positive TB were selected for blinded urine LAM testing. One hundred and nine patients were categorized into four groups: (1) HIV-positive patients with TB; (2) HIV-negative patients with disseminated TB; (3) HIV-negative immunocompromised patients with TB; and (4) patients with diseases other than TB. The sensitivity of urine LAM testing for culture-positive TB, specificity of urine LAM testing for patients without TB, positive predictive value (PPV), and negative predictive value (NPV) were assessed. The sensitivity of the urine LAM test in group 1 patients with a CD4 T-cell count of >100, ≤100, and ≤50 cells/mm 3 was 38.5%, 40.6%, and 45%, respectively. The specificity and PPV of the urine LAM test were >80%. The sensitivity of the test was 20% in group 2 and 12.5% in group 3, and the specificity and PPV were 100% for both groups. A positive urine LAM test result was significantly associated with death. This promising diagnostic tool could increase the yield of TB diagnosis and may predict the mortality rate of TB infection, particularly in TB/HIV co-infected patients. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Immunohistochemical expression of p16 in lipoblastomas.

PubMed

Cappellesso, Rocco; d'Amore, Emanuele S G; Dall'Igna, Patrizia; Guzzardo, Vincenza; Vassarotto, Elisa; Rugge, Massimo; Alaggio, Rita

2016-01-01

Lipoblastoma (LB) is a rare benign adipocytic tumor of childhood occasionally showing histological similarities to myxoid liposarcoma (ML) or well-differentiated liposarcoma (WDL). p16 immunohistochemistry has proved to be useful in distinguishing various types of liposarcomas, in particular WDL from lipoma, with higher sensitivity and specificity than MDM2 and CDK4 immunohistochemistry. In this study, we reported the histologic features of a series of 30 LB with emphasis on the potential diagnostic pitfalls and investigated the immunohistochemical expression of p16. Moreover, p16 immunostaining was performed in 16 liposarcomas (11 WDL and 5 ML), 16 lipomas, and 16 cases of liponecrosis in order to evaluate its usefulness in the differential diagnosis of challenging lesions occurring in older children. Overall, p16 immunostaining was positive in 3 LBs and in 12 out of 16 liposarcomas (10 WDL and 2 ML), with a sensitivity of 75%, a specificity of 90%, a positive predictive value of 80%, and a negative predictive value of 87%. All lipomas were p16 negative, whereas 5 liponecroses were positive. Accounting altogether the benign lesions versus liposarcomas, p16 showed a sensitivity of 75%, a specificity of 87%, a positive predictive value of 60%, and a negative predictive value of 93%. Our data suggest that a negative p16 immunostaining may be helpful in excluding a liposarcoma when occurring in unusual clinical contexts, such as in adolescence or late recurrence. However, such finding should be interpreted with caution since also some liposarcomas lack p16 and occasional LBs are positive. Copyright © 2015 Elsevier Inc. All rights reserved.

Behavioral observations of positive and negative valence systems in early childhood predict physiological measures of emotional processing three years later.

PubMed

Kessel, Ellen M; Kujawa, Autumn; Goldstein, Brandon; Hajcak, Greg; Bufferd, Sara J; Dyson, Margaret; Klein, Daniel N

2017-07-01

The Research Domain Criteria (RDoC) constructs of Positive Valence Systems (PVS) and Negative Valence Systems (NVS) are presumed to manifest behaviorally through early-emerging temperamental negative affectivity (NA) and positive affectivity (PA). The late positive potential (LPP) is a physiological measure of attention towards both negative and positive emotional stimuli; however, its associations with behavioral aspects of PVS and NVS have yet to be examined. In a community sample of children (N = 340), we examined longitudinal relationships between observational measures of temperamental PA and NA assessed at age 6, and the LPP to both pleasant and unpleasant images assessed at age 9. Lower PA at age 6 predicted reduced LPP amplitudes to pleasant, but not unpleasant, images. NA as a composite measure was not related to the LPP, but specific associations were observed with facets of NA: greater fear predicted an enhanced LPP to unpleasant images, whereas greater sadness predicted a reduced LPP to unpleasant images. We were unable to evaluate concurrent associations between behavioral observations of temperament and the LPP, and effect sizes were modest. Results support correspondence between behavioral and physiological measures of emotional processing across development, and provide evidence of discriminant validity in that PA was specifically related to the LPP to pleasant images, while facets of NA were specifically linked to the LPP to unpleasant images. Distinct associations of temperamental sadness and fear with the LPP highlight the importance of further evaluating subconstructs of NVS. Copyright © 2016 Elsevier B.V. All rights reserved.

An investigation of new toxicity test method performance in validation studies: 1. Toxicity test methods that have predictive capacity no greater than chance.

PubMed

Bruner, L H; Carr, G J; Harbell, J W; Curren, R D

2002-06-01

An approach commonly used to measure new toxicity test method (NTM) performance in validation studies is to divide toxicity results into positive and negative classifications, and the identify true positive (TP), true negative (TN), false positive (FP) and false negative (FN) results. After this step is completed, the contingent probability statistics (CPS), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) are calculated. Although these statistics are widely used and often the only statistics used to assess the performance of toxicity test methods, there is little specific guidance in the validation literature on what values for these statistics indicate adequate performance. The purpose of this study was to begin developing data-based answers to this question by characterizing the CPS obtained from an NTM whose data have a completely random association with a reference test method (RTM). Determining the CPS of this worst-case scenario is useful because it provides a lower baseline from which the performance of an NTM can be judged in future validation studies. It also provides an indication of relationships in the CPS that help identify random or near-random relationships in the data. The results from this study of randomly associated tests show that the values obtained for the statistics vary significantly depending on the cut-offs chosen, that high values can be obtained for individual statistics, and that the different measures cannot be considered independently when evaluating the performance of an NTM. When the association between results of an NTM and RTM is random the sum of the complementary pairs of statistics (sensitivity + specificity, NPV + PPV) is approximately 1, and the prevalence (i.e., the proportion of toxic chemicals in the population of chemicals) and PPV are equal. Given that combinations of high sensitivity-low specificity or low specificity-high sensitivity (i.e., the sum of the sensitivity and specificity equal to approximately 1) indicate lack of predictive capacity, an NTM having these performance characteristics should be considered no better for predicting toxicity than by chance alone.

Testing predictive models of positive and negative affect with psychosocial, acculturation, and coping variables in a multiethnic undergraduate sample.

PubMed

Kuo, Ben Ch; Kwantes, Catherine T

2014-01-01

Despite the prevalence and popularity of research on positive and negative affect within the field of psychology, there is currently little research on affect involving the examination of cultural variables and with participants of diverse cultural and ethnic backgrounds. To the authors' knowledge, currently no empirical studies have comprehensively examined predictive models of positive and negative affect based specifically on multiple psychosocial, acculturation, and coping variables as predictors with any sample populations. Therefore, the purpose of the present study was to test the predictive power of perceived stress, social support, bidirectional acculturation (i.e., Canadian acculturation and heritage acculturation), religious coping and cultural coping (i.e., collective, avoidance, and engagement coping) in explaining positive and negative affect in a multiethnic sample of 301 undergraduate students in Canada. Two hierarchal multiple regressions were conducted, one for each affect as the dependent variable, with the above described predictors. The results supported the hypotheses and showed the two overall models to be significant in predicting affect of both kinds. Specifically, a higher level of positive affect was predicted by a lower level of perceived stress, less use of religious coping, and more use of engagement coping in dealing with stress by the participants. Higher level of negative affect, however, was predicted by a higher level of perceived stress and more use of avoidance coping in responding to stress. The current findings highlight the value and relevance of empirically examining the stress-coping-adaptation experiences of diverse populations from an affective conceptual framework, particularly with the inclusion of positive affect. Implications and recommendations for advancing future research and theoretical works in this area are considered and presented.

Development of an enzyme-linked immunosorbent assay for serodiagnosis of ringworm infection in cattle.

PubMed

Bagut, Elena Tatiana; Cambier, Ludivine; Heinen, Marie-Pierre; Cozma, Vasile; Monod, Michel; Mignon, Bernard

2013-08-01

The aim of this study was to develop an in-house enzyme-linked immunosorbent assay (ELISA) for the serological diagnosis of ringworm infection in cattle. We used available recombinant forms of Trichophyton rubrum dipeptidyl peptidase V (TruDppV) and T. rubrum leucin aminopeptidase 2 (TruLap2), which are 98% identical to Trichophyton verrucosum orthologues. Field serum samples from 135 cattle with ringworm infection, as confirmed by direct microscopy, fluorescence microscopy, and PCR, and from 55 cattle without any apparent skin lesions or history of ringworm infection that served as negative controls were used. Sensitivities, specificities, and positive and negative predictive values were determined to evaluate the diagnostic value of our ELISA. Overall, the ELISAs based on recombinant TruDppV and TruLap2 discriminated well between infected animals and healthy controls. Highly significant differences (P < 0.0001, Mann-Whitney U test) were noted between optical density values obtained when sera from infected versus control cattle were tested. The ELISA developed for the detection of specific antibodies against DppV gave 89.6% sensitivity, 92.7% specificity, a 96.8% positive predictive value, and a 78.4% negative predictive value. The recombinant TruLap2-based ELISA displayed 88.1% sensitivity, 90.9% specificity, a 95.9% positive predictive value, and a 75.7% negative predictive value. To the best of our knowledge, this is the first ELISA based on recombinant antigens for assessing immune responses to ringworm infection in cattle; it is particularly suitable for epidemiological studies and also for the evaluation of vaccines and/or vaccination procedures.

Sensitivity and Specificity of Procalcitonin in Predicting Bacterial Infections in Patients With Renal Impairment

PubMed Central

El-sayed, Dena; Grotts, Jonathan; Golgert, William A.; Sugar, Alan M.

2014-01-01

Background  It is unclear whether procalcitonin is an accurate predictor of bacterial infections in patients with renal impairment, although it is used as a biomarker for early diagnosis of sepsis. We determined the sensitivity, specificity, positive and negative predictive values, accuracy and best predictive value of procalcitonin for predicting bacterial infection in adult patients with severe renal impairment. Methods  Retrospective study at a single-center community teaching hospital involving 473 patients, ages 18–65, with Modification of Diet in Renal Disease eGFR ≤30 ml/min per 1.73 m2, admitted between January 2009 and June 2012, with 660 independent hospital visits. A positive or negative culture (blood or identifiable focus of infection) was paired to the highest procalcitonin result performed 48 hours before or after collecting the culture. Results  The sensitivity and specificity to predict bacterial infection, using a procalcitonin level threshold of 0.5 ng/mL, was 0.80 and 0.35 respectively. When isolating for presence of bacteremia, the sensitivity and specificity were 0.89 and 0.35 respectively. An equation adjusting for optimum thresholds of procalcitonin levels for predicting bacterial infection at different levels of eGFR had a sensitivity and specificity of 0.55 and 0.80 respectively. Conclusions  Procalcitonin is not a reliably sensitive or specific predictor of bacterial infection in patients with renal impairment when using a single threshold. Perhaps two thresholds should be employed, where below the lower threshold (i.e. 0.5 ng/mL) bacterial infection is unlikely with a sensitivity of 0.80, and above the higher threshold (i.e. 3.2 ng/mL) bacterial infection is very likely with a specificity of 0.75. PMID:25734138

Sensitivity and specificity of procalcitonin in predicting bacterial infections in patients with renal impairment.

PubMed

El-Sayed, Dena; Grotts, Jonathan; Golgert, William A; Sugar, Alan M

2014-09-01

It is unclear whether procalcitonin is an accurate predictor of bacterial infections in patients with renal impairment, although it is used as a biomarker for early diagnosis of sepsis. We determined the sensitivity, specificity, positive and negative predictive values, accuracy and best predictive value of procalcitonin for predicting bacterial infection in adult patients with severe renal impairment. Retrospective study at a single-center community teaching hospital involving 473 patients, ages 18-65, with Modification of Diet in Renal Disease eGFR ≤30 ml/min per 1.73 m(2), admitted between January 2009 and June 2012, with 660 independent hospital visits. A positive or negative culture (blood or identifiable focus of infection) was paired to the highest procalcitonin result performed 48 hours before or after collecting the culture. The sensitivity and specificity to predict bacterial infection, using a procalcitonin level threshold of 0.5 ng/mL, was 0.80 and 0.35 respectively. When isolating for presence of bacteremia, the sensitivity and specificity were 0.89 and 0.35 respectively. An equation adjusting for optimum thresholds of procalcitonin levels for predicting bacterial infection at different levels of eGFR had a sensitivity and specificity of 0.55 and 0.80 respectively. Procalcitonin is not a reliably sensitive or specific predictor of bacterial infection in patients with renal impairment when using a single threshold. Perhaps two thresholds should be employed, where below the lower threshold (i.e. 0.5 ng/mL) bacterial infection is unlikely with a sensitivity of 0.80, and above the higher threshold (i.e. 3.2 ng/mL) bacterial infection is very likely with a specificity of 0.75.

Utility of a routine urinalysis in children who require clean intermittent catheterization.

PubMed

Forster, C S; Haslam, D B; Jackson, E; Goldstein, S L

2017-10-01

Children who require clean intermittent catheterization (CIC) frequently have positive urine cultures. However, diagnosing a urinary tract infection (UTI) can be difficult, as there are no standardized criteria. Routine urinalysis (UA) has good predictive accuracy for UTI in the general pediatric population, but data are limited on the utility of routine UA in the population of children who require CIC. To determine the utility of UA parameters (e.g. leukocyte esterase, nitrites, and pyuria) to predict UTI in children who require CIC, and identify a composite UA that has maximal predictive accuracy for UTI. A cross-sectional study of 133 children who required CIC, and had a UA and urine culture sent as part of standard of care. Patients in the no-UTI group all had UA and urine cultures sent as part of routine urodynamics, and were asymptomatic. Patients included in the UTI group had growth of ≥50,000 colony-forming units/ml of a known uropathogen on urine culture, in addition to two or more of the following symptoms: fever, abdominal pain, back pain, foul-smelling urine, new or worse incontinence, and pain with catheterization. Categorical data were compared using Chi-squared test, and continuous data were compared with Student's t-test. Sensitivity, specificity, and positive and negative predictive values were calculated for individual UA parameters, as well as the composite UA. Logistic regression was performed on potential composite UA models to identify the model that best fit the data. There was a higher proportion of patients in the no-UTI group with negative leukocyte esterase compared with the UTI group. There was a higher proportion of patients with UTI who had large leukocyte esterase and positive nitrites compared with the no-UTI group (Summary Figure). There was no between-group difference in urinary white blood cells. Positive nitrites were the most specific (84.4%) for UTI. None of the parameters had a high positive predictive value, while all had high negative predictive values. The composite model with the best Akaike information criterion was >10 urinary white blood cells and either moderate or large leukocyte esterase, which had a positive predictive value of 33.3 and a negative predictive value of 90.4. Routine UA had limited sensitivity, but moderate specificity, in predicting UTI in children who required CIC. The composite UA and moderate or large leukocyte esterase both had good negative predictive values for the outcome of UTI. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Accuracy of ultrasound for the prediction of placenta accreta.

PubMed

Bowman, Zachary S; Eller, Alexandra G; Kennedy, Anne M; Richards, Douglas S; Winter, Thomas C; Woodward, Paula J; Silver, Robert M

2014-08-01

Ultrasound has been reported to be greater than 90% sensitive for the diagnosis of accreta. Prior studies may be subject to bias because of single expert observers, suspicion for accreta, and knowledge of risk factors. We aimed to assess the accuracy of ultrasound for the prediction of accreta. Patients with accreta at a single academic center were matched to patients with placenta previa, but no accreta, by year of delivery. Ultrasound studies with views of the placenta were collected, deidentified, blinded to clinical history, and placed in random sequence. Six investigators prospectively interpreted each study for the presence of accreta and findings reported to be associated with its diagnosis. Sensitivity, specificity, positive predictive, negative predictive value, and accuracy were calculated. Characteristics of accurate findings were compared using univariate and multivariate analyses. Six investigators examined 229 ultrasound studies from 55 patients with accreta and 56 controls for 1374 independent observations. 1205/1374 (87.7% overall, 90% controls, 84.9% cases) studies were given a diagnosis. There were 371 (27.0%) true positives; 81 (5.9%) false positives; 533 (38.8%) true negatives, 220 (16.0%) false negatives, and 169 (12.3%) with uncertain diagnosis. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 53.5%, 88.0%, 82.1%, 64.8%, and 64.8%, respectively. In multivariate analysis, true positives were more likely to have placental lacunae (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.4-1.6), loss of retroplacental clear space (OR, 2.4; 95% CI, 1.1-4.9), or abnormalities on color Doppler (OR, 2.1; 95% CI, 1.8-2.4). Ultrasound for the prediction of placenta accreta may not be as sensitive as previously described. Copyright © 2014 Mosby, Inc. All rights reserved.

Relationship between positive mental health and appreciation in Korean individuals.

PubMed

Lim, Young-Jin

2017-06-01

Appreciation is a key component of subjective well-being and may contribute to positive mental health. Few studies have examined relationships between specific aspects of appreciation and the 3 dimensions of positive mental health, and thus, the aim of this study was to identify associations between aspects of appreciation and positive mental health. Appreciation and positive mental health were measured in 266 Korean university students (50% females) using the Appreciation Inventory and the Mental Health Continuum-Short Form. The results obtained showed that Have Focus significantly predicted Emotional Well-being; Have Focus and Loss/Adversity significantly predicted Social Well-being and Have Focus, Expression and Nature/Daily Life significantly predicted Psychological Well-being. The implications of results that might enable positive mental health to be enhanced are discussed. © 2015 International Union of Psychological Science.

Urinary tract infections in pregnancy: evaluation of diagnostic framework.

PubMed

Jido, Tukur Ado

2014-01-01

This study was performed with the objective to examine the diagnostic framework for urinary tract infection (UTI) in pregnancy and physician response to the clinical diagnosis and to correlate responses to the results of urine culture and sensitivity. Over a 6-month period, 81 consecutive patients attending the labor ward admission of a district general hospital with the diagnosis of UTI during pregnancy were analyzed. Relevant information on symptom complex, result of dipstick urinalysis and culture and sensitivity were recorded. Data were analyzed using descriptive statistics. Of the 78 patients analyzed, 79% had increased urinary frequency, 73.1% had suprapubic pains and 53.1% had dysuria. All the patients had urinalysis with dipsticks, 41 (52.6%) were positive for nitrites and 64 (82.1%) were positive for leukocyte esterase. All 78 patients had urine culture and sensitivity, 21 (26.8%) of who were positive, and coliforms were the most commonly isolated pathogens. The sensitivity for nitrite was 80.9%, specificity 57.9% and positive predictive value 41.4%. The corresponding figures for leukocyte esterase were sensitivity 100%, specificity 24.6% and positive predictive value 32.8%. Sixty-six (84.6%) patients had treatment started on the basis of the clinical diagnosis, mostly with co-amoxyclavullinic acid or amoxicillin alone. A high resistance rate to these empirically chosen antibiotics was seen in the sensitivity pattern of isolated pathogens. Current clinical diagnostic algorithms for the diagnosis of UTI when applied in the context of pregnancy have low specificity and positive predictive values; yet, empirical antibiotics are frequently employed on this basis. These are often not in keeping with the sensitivity pattern of isolated organisms. There is need for a continuing research for more specific bedside tests.

The precision-recall plot is more informative than the ROC plot when evaluating binary classifiers on imbalanced datasets.

PubMed

Saito, Takaya; Rehmsmeier, Marc

2015-01-01

Binary classifiers are routinely evaluated with performance measures such as sensitivity and specificity, and performance is frequently illustrated with Receiver Operating Characteristics (ROC) plots. Alternative measures such as positive predictive value (PPV) and the associated Precision/Recall (PRC) plots are used less frequently. Many bioinformatics studies develop and evaluate classifiers that are to be applied to strongly imbalanced datasets in which the number of negatives outweighs the number of positives significantly. While ROC plots are visually appealing and provide an overview of a classifier's performance across a wide range of specificities, one can ask whether ROC plots could be misleading when applied in imbalanced classification scenarios. We show here that the visual interpretability of ROC plots in the context of imbalanced datasets can be deceptive with respect to conclusions about the reliability of classification performance, owing to an intuitive but wrong interpretation of specificity. PRC plots, on the other hand, can provide the viewer with an accurate prediction of future classification performance due to the fact that they evaluate the fraction of true positives among positive predictions. Our findings have potential implications for the interpretation of a large number of studies that use ROC plots on imbalanced datasets.

Unexpected but Incidental Positive Outcomes Predict Real-World Gambling.

PubMed

Otto, A Ross; Fleming, Stephen M; Glimcher, Paul W

2016-03-01

Positive mood can affect a person's tendency to gamble, possibly because positive mood fosters unrealistic optimism. At the same time, unexpected positive outcomes, often called prediction errors, influence mood. However, a linkage between positive prediction errors-the difference between expected and obtained outcomes-and consequent risk taking has yet to be demonstrated. Using a large data set of New York City lottery gambling and a model inspired by computational accounts of reward learning, we found that people gamble more when incidental outcomes in the environment (e.g., local sporting events and sunshine) are better than expected. When local sports teams performed better than expected, or a sunny day followed a streak of cloudy days, residents gambled more. The observed relationship between prediction errors and gambling was ubiquitous across the city's socioeconomically diverse neighborhoods and was specific to sports and weather events occurring locally in New York City. Our results suggest that unexpected but incidental positive outcomes influence risk taking. © The Author(s) 2016.

Usefulness of Two Aspergillus PCR Assays and Aspergillus Galactomannan and β-d-Glucan Testing of Bronchoalveolar Lavage Fluid for Diagnosis of Chronic Pulmonary Aspergillosis

PubMed Central

Urabe, Naohisa; Sano, Go; Suzuki, Junko; Hebisawa, Akira; Nakamura, Yasuhiko; Koyama, Kazuya; Ishii, Yoshikazu; Tateda, Kazuhiro; Homma, Sakae

2017-01-01

ABSTRACT We evaluated the usefulness of an Aspergillus galactomannan (GM) test, a β-d-glucan (βDG) test, and two different Aspergillus PCR assays of bronchoalveolar lavage fluid (BALF) samples for the diagnosis of chronic pulmonary aspergillosis (CPA). BALF samples from 30 patients with and 120 patients without CPA were collected. We calculated the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for each test individually and in combination with other tests. The optical density index values, as determined by receiver operating characteristic analysis, for the diagnosis of CPA were 0.5 and 100 for GM and βDG testing of BALF, respectively. The sensitivity and specificity of the GM test, βDG test, and PCR assays 1 and 2 were 77.8% and 90.0%, 77.8% and 72.5%, 86.7% and 84.2%, and 66.7% and 94.2%, respectively. A comparison of the PCR assays showed that PCR assay 1 had a better sensitivity, a better negative predictive value, and a better negative likelihood ratio and PCR assay 2 had a better specificity, a better positive predictive value, and a better positive likelihood ratio. The combination of the GM and βDG tests had the highest diagnostic odds ratio. The combination of the GM and βDG tests on BALF was more useful than any single test for diagnosing CPA. PMID:28330887

Assessing Breast Cancer Risk with an Artificial Neural Network

PubMed

Sepandi, Mojtaba; Taghdir, Maryam; Rezaianzadeh, Abbas; Rahimikazerooni, Salar

2018-04-25

Objectives: Radiologists face uncertainty in making decisions based on their judgment of breast cancer risk. Artificial intelligence and machine learning techniques have been widely applied in detection/recognition of cancer. This study aimed to establish a model to aid radiologists in breast cancer risk estimation. This incorporated imaging methods and fine needle aspiration biopsy (FNAB) for cyto-pathological diagnosis. Methods: An artificial neural network (ANN) technique was used on a retrospectively collected dataset including mammographic results, risk factors, and clinical findings to accurately predict the probability of breast cancer in individual patients. Area under the receiver-operating characteristic curve (AUC), accuracy, sensitivity, specificity, and positive and negative predictive values were used to evaluate discriminative performance. Result: The network incorporating the selected features performed best (AUC = 0.955). Sensitivity and specificity of the ANN were respectively calculated as 0.82 and 0.90. In addition, negative and positive predictive values were respectively computed as 0.90 and 0.80. Conclusion: ANN has potential applications as a decision-support tool to help underperforming practitioners to improve the positive predictive value of biopsy recommendations. Creative Commons Attribution License

Charting the Eccles' Expectancy-Value Model from Mothers' Beliefs in Childhood to Youths' Activities in Adolescence

ERIC Educational Resources Information Center

Simpkins, Sandra D.; Fredricks, Jennifer A.; Eccles, Jacquelynne S.

2012-01-01

The Eccles' expectancy-value model posits that a cascade of mechanisms explain associations between parents' beliefs and youths' achievement-related behaviors. Specifically, parents' beliefs predict parents' behaviors; in turn, parents' behaviors predict youths' motivational beliefs, and youths' motivational beliefs predict their behaviors. This…

Type specificity of complement-fixing antibody against herpes simplex virus type 2 AG-4 early antigen in patients with asymptomatic infection.

PubMed Central

Sherlock, C H; Ashley, R L; Shurtleff, M L; Mack, K D; Corey, L

1986-01-01

We evaluated the type specificity of complement-fixing (CF) antibody against the AG-4 early antigen of herpes simplex virus (HSV) type 2 (HSV-2) by comparing a commercial AG-4 CF kit (Simplex-2; Gene Link Australia, Inc., Princeton, N.J.) with quantal microneutralization (MN) and absorption-Western blotting in testing sera from patients with and without a history of genital herpes. Sera characterized as HSV type 1 (HSV-1) or HSV-2 positive or negative by MN were selected and tested by CF, and those with discordant results were further analyzed for specific antibodies by absorption with HSV-1 or HSV-2 antigen and Western blotting with heterologous HSV proteins. A total of 34 of 42 (81%) sera HSV-2 positive by MN, 19 of 43 (44%) sera HSV-1 positive by MN, and 0 of 19 sera negative by MN were positive by CF. Absorption-Western blotting showed that 12 of 18 (67%) sera HSV-1 positive by MN but positive by CF had no HSV-2-specific antibody and that all 7 sera HSV-2 positive by MN but negative by CF had HSV-2-specific antibody. When MN and absorption-Western blotting data were combined to analyze patients with no history of genital herpes, 7 of 19 (37%) with no HSV-2-specific antibody were positive by CF, and 7 of 27 (26%) with HSV-2-specific antibody were negative by CF. The positive and negative predictive values for the CF test were 78 and 75%, respectively, in this group. The presence of antibody to the HSV AG-4 antigen does not discriminate sufficiently between HSV-1- and HSV-2-infected patients to be of value in predicting HSV-2 infection in the absence of symptomatic disease. Images PMID:3023439

Validation of Medicaid claims-based diagnosis of myocardial infarction using an HIV clinical cohort

PubMed Central

Brouwer, Emily S.; Napravnik, Sonia; Eron, Joseph J; Simpson, Ross J; Brookhart, M. Alan; Stalzer, Brant; Vinikoor, Michael; Floris-Moore, Michelle; Stürmer, Til

2014-01-01

Background In non-experimental comparative effectiveness research using healthcare databases, outcome measurements must be validated to evaluate and potentially adjust for misclassification bias. We aimed to validate claims-based myocardial infarction algorithms in a Medicaid population using an HIV clinical cohort as the gold standard. Methods Medicaid administrative data were obtained for the years 2002–2008 and linked to the UNC CFAR HIV Clinical Cohort based on social security number, first name and last name and myocardial infarction were adjudicated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results There were 1,063 individuals included. Over a median observed time of 2.5 years, 17 had a myocardial infarction. Specificity ranged from 0.979–0.993 with the highest specificity obtained using criteria with the ICD-9 code in the primary and secondary position and a length of stay ≥ 3 days. Sensitivity of myocardial infarction ascertainment varied from 0.588–0.824 depending on algorithm. Conclusion: Specificities of varying claims-based myocardial infarction ascertainment criteria are high but small changes impact positive predictive value in a cohort with low incidence. Sensitivities vary based on ascertainment criteria. Type of algorithm used should be prioritized based on study question and maximization of specific validation parameters that will minimize bias while also considering precision. PMID:23604043

LCR testing for gonorrhoea and chlamydia in population surveys and other screenings of low prevalence populations: coping with decreased positive predictive value.

PubMed

Zenilman, J M; Miller, W C; Gaydos, C; Rogers, S M; Turner, C F

2003-04-01

Nucleic acid amplification tests have facilitated field based STD studies and increased screening activities. However, even with highly specific tests, the positive predictive value (PPV) of such tests may be lower than desirable in low prevalence populations. We estimated PPVs for a single LCR test in a population survey in which positive specimens were retested. The Baltimore STD and Behavior Survey (BSBS) was a population based behavioural survey of adults which included collecting urine specimens to assess the prevalence of gonorrhoea and chlamydial infection. Gonorrhoea and chlamydial infection were diagnosed by ligase chain reaction (LCR). Nearly all positive results were retested by LCR. Because of cost considerations, negative results were not confirmed. Predicted curves for the PPV were calculated for a single testing assuming an LCR test sensitivity of 95%, and test specificities in the range 95.0%-99.9%, for disease prevalences between 1% and 10%. Positive specimens were retested to derive empirical estimates of the PPV of a positive result on a single LCR test. 579 participants age 18-35 provided urine specimens. 20 (3.5%) subjects initially tested positive for chlamydial infection, and 39 (6.7%) tested positive for gonococcal infection. If positive results on the repeat LCR are taken as confirmation of a "true" infection, the observed PPV for the first LCR testing was 89.5% for chlamydial infection and 83.3% for gonorrhoea. This is within the range of theoretical PPVs calculated from the assumed sensitivities and specificities of the LCR assays. Empirical performance of a single LCR testing approximated the theoretically predicted PPV in this field study. This result demonstrates the need to take account of the lower PPVs obtained when such tests are used in field studies or clinical screening of low prevalence populations. Repeat testing of specimens, preferably with a different assay (for example, polymerase chain reaction), and disclosure of the non-trivial potential for false positive test results would seem appropriate in all such studies.

Accuracy statistics in predicting Independent Activities of Daily Living (IADL) capacity with comprehensive and brief neuropsychological test batteries.

PubMed

Karzmark, Peter; Deutsch, Gayle K

2018-01-01

This investigation was designed to determine the predictive accuracy of a comprehensive neuropsychological and brief neuropsychological test battery with regard to the capacity to perform instrumental activities of daily living (IADLs). Accuracy statistics that included measures of sensitivity, specificity, positive and negative predicted power and positive likelihood ratio were calculated for both types of batteries. The sample was drawn from a general neurological group of adults (n = 117) that included a number of older participants (age >55; n = 38). Standardized neuropsychological assessments were administered to all participants and were comprised of the Halstead Reitan Battery and portions of the Wechsler Adult Intelligence Scale-III. A comprehensive test battery yielded a moderate increase over base-rate in predictive accuracy that generalized to older individuals. There was only limited support for using a brief battery, for although sensitivity was high, specificity was low. We found that a comprehensive neuropsychological test battery provided good classification accuracy for predicting IADL capacity.

B-mode Ultrasound Versus Color Doppler Twinkling Artifact in Detecting Kidney Stones

PubMed Central

Harper, Jonathan D.; Hsi, Ryan S.; Shah, Anup R.; Dighe, Manjiri K.; Carter, Stephen J.; Moshiri, Mariam; Paun, Marla; Lu, Wei; Bailey, Michael R.

2013-01-01

Abstract Purpose To compare color Doppler twinkling artifact and B-mode ultrasonography in detecting kidney stones. Patients and Methods Nine patients with recent CT scans prospectively underwent B-mode and twinkling artifact color Doppler ultrasonography on a commercial ultrasound machine. Video segments of the upper pole, interpolar area, and lower pole were created, randomized, and independently reviewed by three radiologists. Receiver operator characteristics were determined. Results There were 32 stones in 18 kidneys with a mean stone size of 8.9±7.5 mm. B-mode ultrasonography had 71% sensitivity, 48% specificity, 52% positive predictive value, and 68% negative predictive value, while twinkling artifact Doppler ultrasonography had 56% sensitivity, 74% specificity, 62% positive predictive value, and 68% negative predictive value. Conclusions When used alone, B-mode is more sensitive, but twinkling artifact is more specific in detecting kidney stones. This information may help users employ twinkling and B-mode to identify stones and developers to improve signal processing to harness the fundamental acoustic differences to ultimately improve stone detection. PMID:23067207

Clinical Prediction Rule for Declines in Activities of Daily Living at 6 Months After Surgery for Hip Fracture Repair.

PubMed

Tanaka, Ryo; Umehara, Takuya; Fujimura, Takafumi; Ozawa, Junya

2016-12-01

To develop and assess a clinical prediction rule (CPR) to predict declines in activities of daily living (ADL) at 6 months after surgery for hip fracture repair. Prospective, cohort study. From hospital to home. Patients (N=104) with hip fractures after surgery. Not applicable. ADL were assessed using the Barthel Index at 6 months after surgery. At 6 months after surgery, 86 patients (82.6%) were known to be alive, 1 patient (1.0%) had died, and 17 (16.3%) were lost to follow-up. Thirty-two patients (37.2%) did not recover their ADL at 6 months after surgery to levels before fracture. The classification and regression trees methodology was used to develop 2 models to predict a decline in ADL: (1) model 1 included age, type of fracture, and care level before fracture (sensitivity=75.0%, specificity=81.5%, positive predictive value=70.6%, positive likelihood ratio=4.050); and (2) model 2 included the degree of independence 2 weeks postsurgery for ADL chair transfer, ADL ambulation, and age (sensitivity=65.6%, specificity=87.0%, positive predictive value=75.0%, positive likelihood ratio=5.063). The areas under the receiver operating characteristic curves of both CPR models were .825 (95% confidential interval, .728-.923) and .790 (95% confidence interval, .683-.897), respectively. CPRs with moderate accuracy were developed to predict declines in ADL at 6 months after surgery for hip fracture repair. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Skin prick testing predicts peanut challenge outcome in previously allergic or sensitized children with low serum peanut-specific IgE antibody concentration.

PubMed

Nolan, Richard C; Richmond, Peter; Prescott, Susan L; Mallon, Dominic F; Gong, Grace; Franzmann, Annkathrin M; Naidoo, Rama; Loh, Richard K S

2007-05-01

Peanut allergy is transient in some children but it is not clear whether quantitating peanut-specific IgE by Skin Prick Test (SPT) adds additional information to fluorescent-enzyme immunoassay (FEIA) in discriminating between allergic and tolerant children. To investigate whether SPT with a commercial extract or fresh foods adds additional predictive information for peanut challenge in children with a low FEIA (<10 k UA/L) who were previously sensitized, or allergic to peanuts. Children from a hospital-based allergy service who were previously sensitized or allergic to peanuts were invited to undergo a peanut challenge unless they had a serum peanut-specific IgE>10 k UA/L, a previous severe reaction, or a recent reaction to peanuts (within two years). SPT with a commercial extract, raw and roasted saline soaked peanuts was performed immediately prior to open challenge in hospital with increasing quantity of peanuts until total of 26.7 g of peanut was consumed. A positive challenge consisted of an objective IgE mediated reaction occurring during the observation period. 54 children (median age of 6.3 years) were admitted for a challenge. Nineteen challenges were positive, 27 negative, five were indeterminate and three did not proceed after SPT. Commercial and fresh food extracts provided similar diagnostic information. A wheal diameter of >or=7 mm of the commercial extract predicted an allergic outcome with specificity 97%, positive predictive value 93% and sensitivity 83%. There was a tendency for an increase in SPT wheal since initial diagnosis in children who remained allergic to peanuts while it decreased in those with a negative challenge. The outcome of a peanut challenge in peanut sensitized or previously allergic children with a low FEIA can be predicted by SPT. In this cohort, not challenging children with a SPT wheal of >or=7 mm would have avoided 15 of 18 positive challenges and denied a challenge to one out of 27 tolerant children.

Performance of blend sign in predicting hematoma expansion in intracerebral hemorrhage: A meta-analysis.

PubMed

Yu, Zhiyuan; Zheng, Jun; Guo, Rui; Ma, Lu; Li, Mou; Wang, Xiaoze; Lin, Sen; Li, Hao; You, Chao

2017-12-01

Hematoma expansion is independently associated with poor outcome in intracerebral hemorrhage (ICH). Blend sign is a simple predictor for hematoma expansion on non-contrast computed tomography. However, its accuracy for predicting hematoma expansion is inconsistent in previous studies. This meta-analysis is aimed to systematically assess the performance of blend sign in predicting hematoma expansion in ICH. A systematic literature search was conducted. Original studies about predictive accuracy of blend sign for hematoma expansion in ICH were included. Pooled sensitivity, specificity, positive and negative likelihood ratios were calculated. Summary receiver operating characteristics curve was constructed. Publication bias was assessed by Deeks' funnel plot asymmetry test. A total of 5 studies with 2248 patients were included in this meta-analysis. The pooled sensitivity, specificity, positive and negative likelihood ratios of blend sign for predicting hematoma expansion were 0.28, 0.92, 3.4 and 0.78, respectively. The area under the curve (AUC) was 0.85. No significant publication bias was found. This meta-analysis demonstrates that blend sign is a useful predictor with high specificity for hematoma expansion in ICH. Further studies with larger sample size are still necessary to verify the accuracy of blend sign for predicting hematoma expansion. Copyright © 2017 Elsevier B.V. All rights reserved.

Computational biomechanics to simulate the femoropopliteal intersection during knee flexion: a preliminary study.

PubMed

Diehm, Nicolas; Sin, Sangmun; Hoppe, Hanno; Baumgartner, Iris; Büchler, Philippe

2011-06-01

To assess if finite element (FE) models can be used to predict deformation of the femoropopliteal segment during knee flexion. Magnetic resonance angiography (MRA) images were acquired on the lower limbs of 8 healthy volunteers (5 men; mean age 28 ± 4 years). Images were taken in 2 natural positions, with the lower limb fully extended and with the knee bent at ~ 40°. Patient-specific FE models were developed and used to simulate the experimental situation. The displacements of the artery during knee bending as predicted by the numerical model were compared to the corresponding positions measured on the MRA images. The numerical predictions showed a good overall agreement between the calculated displacements of the motion measures from MRA images. The average position error comparing the calculated vs. actual displacements of the femoropopliteal intersection measured on the MRA was 8 ± 4 mm. Two of the 8 subjects showed large prediction errors (average 13 ± 5 mm); these 2 volunteers were the tallest subjects involved in the study and had a low body mass index (20.5 kg/m²). The present computational model is able to capture the gross mechanical environment of the femoropopliteal intersection during knee bending and provide a better understanding of the complex biomechanical behavior. However, results suggest that patient-specific mechanical properties and detailed muscle modeling are required to provide accurate patient-specific numerical predictions of arterial displacement. Further adaptation of this model is expected to provide an improved ability to predict the multiaxial deformation of this arterial segment during leg movements and to optimize future stent designs.

Cognitive and Social Processes Predicting Partner Psychological Adaptation to Early Stage Breast Cancer

PubMed Central

Manne, Sharon; Ostroff, Jamie; Fox, Kevin; Grana, Generosa; Winkel, Gary

2009-01-01

Introduction The diagnosis and subsequent treatment for early stage breast cancer is stressful for partners. Little is known about the role of cognitive and social processes predicting the longitudinal course of partners’ psychosocial adaptation. This study evaluated the role of cognitive and social processing in partner psychological adaptation to early stage breast cancer, evaluating both main and moderator effect models. Moderating effects for meaning-making, acceptance, and positive reappraisal on the predictive association of searching for meaning, emotional processing, and emotional expression on partner psychological distress were examined. Materials and Methods Partners of women diagnosed with early stage breast cancer were evaluated shortly after the ill partner’s diagnosis (n= 253), nine (n = 167), and 18 months (n = 149) later. Partners completed measures of emotional expression, emotional processing, acceptance, meaning-making, and general and cancer-specific distress at all time points. Results Lower satisfaction with partner support predicted greater global distress, and greater use of positive reappraisal was associated with greater distress. The predicted moderator effects for found meaning on the associations between the search for meaning and cancer-specific distress were found and similar moderating effects for positive reappraisal on the associations between emotional expression and global distress and for acceptance on the association between emotional processing and cancer-specific distress were found. Conclusions Results indicate several cognitive-social processes directly predict partner distress. However, moderator effect models in which the effects of partners’ processing depends upon whether these efforts result changes in perceptions of the cancer experience may add to the understanding of partners’ adaptation to cancer. PMID:18435865

Cognitive and social processes predicting partner psychological adaptation to early stage breast cancer.

PubMed

Manne, Sharon; Ostroff, Jamie; Fox, Kevin; Grana, Generosa; Winkel, Gary

2009-02-01

The diagnosis and subsequent treatment for early stage breast cancer is stressful for partners. Little is known about the role of cognitive and social processes predicting the longitudinal course of partners' psychosocial adaptation. This study evaluated the role of cognitive and social processing in partner psychological adaptation to early stage breast cancer, evaluating both main and moderator effect models. Moderating effects for meaning making, acceptance, and positive reappraisal on the predictive association of searching for meaning, emotional processing, and emotional expression on partner psychological distress were examined. Partners of women diagnosed with early stage breast cancer were evaluated shortly after the ill partner's diagnosis (N=253), 9 (N=167), and 18 months (N=149) later. Partners completed measures of emotional expression, emotional processing, acceptance, meaning making, and general and cancer-specific distress at all time points. Lower satisfaction with partner support predicted greater global distress, and greater use of positive reappraisal was associated with greater distress. The predicted moderator effects for found meaning on the associations between the search for meaning and cancer-specific distress were found and similar moderating effects for positive reappraisal on the associations between emotional expression and global distress and for acceptance on the association between emotional processing and cancer-specific distress were found. Results indicate several cognitive-social processes directly predict partner distress. However, moderator effect models in which the effects of partners' processing depends upon whether these efforts result in changes in perceptions of the cancer experience may add to the understanding of partners' adaptation to cancer.

Ability of a 5-minute electrocardiography (ECG) for predicting arrhythmias in Doberman Pinschers with cardiomyopathy in comparison with a 24-hour ambulatory ECG.

PubMed

Wess, G; Schulze, A; Geraghty, N; Hartmann, K

2010-01-01

Ventricular premature contractions (VPCs) are common in the occult stage of cardiomyopathy in Doberman Pinschers. Although the gold standard for detecting arrhythmia is the 24-hour ambulatory electrocardiography (ECG) (Holter), this method is more expensive, time-consuming and often not as readily available as common ECG. Comparison of 5-minute ECGs with Holter examinations. Eight hundred and seventy-five 5-minute ECGs and Holter examinations of 431 Doberman Pinschers. Each examination included a 5-minute ECG and Holter examination. A cut-off value of > 100 VPCs/24 hours using Holter was considered diagnostic for the presence of cardiomyopathy. Statistical evaluation included calculation of sensitivity, specificity, positive predictive value, and negative predictive value. Holter examinations revealed > 100 VPCs/24 hours in 204/875 examinations. At least 1 VPC during a 5-minute ECG was detected in 131 (64.2%) of these 204 examinations. No VPCs were found in the 5-minute ECG in 73 (35.8%) examinations of affected Doberman Pinschers. A 5-minute ECG with at least 1 VPC as cut-off had a sensitivity of 64.2%, a specificity of 96.7%, a positive predictive value of 85.6% and a negative predictive value of 89.9% for the presence of > 100 VPCs/24 hours. A 5-minute ECG is a rather insensitive method for detecting arrhythmias in Doberman Pinschers. However, the occurrence of at least 1 VPC in 5 minutes strongly warrants further examination of the dog, because specificity (96.7%) and positive predictive value (85.6%) are high and could suggest occult cardiomyopathy.

Use of the polymerase chain reaction to directly detect malaria parasites in blood samples from the Venezuelan Amazon.

PubMed

Laserson, K F; Petralanda, I; Hamlin, D M; Almera, R; Fuentes, M; Carrasquel, A; Barker, R H

1994-02-01

We have examined the reproducibility, sensitivity, and specificity of detecting Plasmodium falciparum using the polymerase chain reaction (PCR) and the species-specific probe pPF14 under field conditions in the Venezuelan Amazon. Up to eight samples were field collected from each of 48 consenting Amerindians presenting with symptoms of malaria. Sample processing and analysis was performed at the Centro Amazonico para la Investigacion y Control de Enfermedades Tropicales Simon Bolivar. A total of 229 samples from 48 patients were analyzed by PCR methods using four different P. falciparum-specific probes. One P. vivax-specific probe and by conventional microscopy. Samples in which results from PCR and microscopy differed were reanalyzed at a higher sensitivity by microscopy. Results suggest that microscopy-negative, PCR-positive samples are true positives, and that microscopy-positive and PCR-negative samples are true negatives. The sensitivity of the DNA probe/PCR method was 78% and its specificity was 97%. The positive predictive value of the PCR method was 88%, and the negative predictive value was 95%. Through the analysis of multiple blood samples from each individual, the DNA probe/PCR methodology was found to have an inherent reproducibility that was highly statistically significant.

Sensitivity, Specificity, PPV, and NPV for Predictive Biomarkers.

PubMed

Simon, Richard

2015-08-01

Molecularly targeted cancer drugs are often developed with companion diagnostics that attempt to identify which patients will have better outcome on the new drug than the control regimen. Such predictive biomarkers are playing an increasingly important role in precision oncology. For diagnostic tests, sensitivity, specificity, positive predictive value, and negative predictive are usually used as performance measures. This paper discusses these indices for predictive biomarkers, provides methods for their calculation with survival or response endpoints, and describes assumptions involved in their use. Published by Oxford University Press 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Diagnostic Performance of Ultrasonography for Pediatric Appendicitis: A Night and Day Difference?

PubMed

Mangona, Kate Louise M; Guillerman, R Paul; Mangona, Victor S; Carpenter, Jennifer; Zhang, Wei; Lopez, Monica; Orth, Robert C

2017-12-01

For imaging pediatric appendicitis, ultrasonography (US) is preferred because of its lack of ionizing radiation, but is limited by operator dependence. This study investigates the US diagnostic performance during night shifts covered by radiology trainees compared to day shifts covered by attending radiologists. Appy-Scores (1 = completely visualized normal appendix; 2 = partially visualized normal appendix; 3 = nonvisualized appendix with no inflammatory changes in the expected region of the appendix; 4 = equivocal; 5a = nonperforated appendicitis; 5b = perforated appendicitis) from 2935 US examinations (2161:774, day-to-night) from July 2013 to 2014 were correlated with the intraoperative diagnoses and the clinical follow-up. The diagnostic performance of trainees and attendings was compared with Fisher exact test. Interobserver agreement was measured by Cohen kappa coefficient. Appendicitis prevalence was 25.3% (day) and 22.5% (night). Sensitivity, specificity, accuracy, negative predictive value, and positive predictive vale were 94.0%, 93.7%, 93.8%, 97.9%, and 83.4% during the day and 92.0%, 91.2%, 91.3%, 97.5%, and 75.2% at night. Specificity (P = .048) and positive predictive value (P = .011) differed, with more false positives at night (7%) than during the day (4.7%). Trainee and attending agreement was high (k = 0.995), with Appy-Scores of 1, 4, and 5a most frequently discordant. US has a high diagnostic performance and interobserver agreement for pediatric appendicitis when interpreted by radiology trainees during night shifts or attending radiologists during day shifts. However, lower specificity and positive predictive value at night warrants a thorough trainee education to avoid false-positive examinations. Published by Elsevier Inc.

Evaluation of surveillance case definition in the diagnosis of leptospirosis, using the Microscopic Agglutination Test: a validation study.

PubMed

Dassanayake, Dinesh L B; Wimalaratna, Harith; Agampodi, Suneth B; Liyanapathirana, Veranja C; Piyarathna, Thibbotumunuwe A C L; Goonapienuwala, Bimba L

2009-04-22

Leptospirosis is endemic in both urban and rural areas of Sri Lanka and there had been many out breaks in the recent past. This study was aimed at validating the leptospirosis surveillance case definition, using the Microscopic Agglutination Test (MAT). The study population consisted of patients with undiagnosed acute febrile illness who were admitted to the medical wards of the Teaching Hospital Kandy, from 1st July 2007 to 31st July 2008. The subjects were screened to diagnose leptospirosis according to the leptospirosis case definition. MAT was performed on blood samples taken from each patient on the 7th day of fever. Leptospirosis case definition was evaluated in regard to sensitivity, specificity and predictive values, using a MAT titre >or= 1:800 for confirming leptospirosis. A total of 123 patients were initially recruited of which 73 had clinical features compatible with the surveillance case definition. Out of the 73 only 57 had a positive MAT result (true positives) leaving 16 as false positives. Out of the 50 who didn't have clinical features compatible with the case definition 45 had a negative MAT as well (true negatives), therefore 5 were false negatives. Total number of MAT positives was 62 out of 123. According to these results the test sensitivity was 91.94%, specificity 73.77%, positive predictive value and negative predictive values were 78.08% and 90% respectively. Diagnostic accuracy of the test was 82.93%. This study confirms that the surveillance case definition has a very high sensitivity and negative predictive value with an average specificity in diagnosing leptospirosis, based on a MAT titre of >or= 1: 800.

The Predictive Validity of the ABFM's In-Training Examination.

PubMed

O'Neill, Thomas R; Li, Zijia; Peabody, Michael R; Lybarger, Melanie; Royal, Kenneth; Puffer, James C

2015-05-01

Our objective was to examine the predictive validity of the American Board of Family Medicine's (ABFM) In-Training Examination (ITE) with regard to predicting outcomes on the ABFM certification examination. This study used a repeated measures design across three levels of medical training (PGY1--PGY2, PGY2--PGY3, and PGY3--initial certification) with three different cohorts (2010--2011, 2011--2012, and 2012--2013) to examine: (1) how well the residents' ITE scores correlated with their test scores in the following year, (2) what the typical score increase was across training years, and (3) what was the sensitivity, specificity, positive predictive value, and negative predictive value of the PGY3 scores with regard to predicting future results on the MC-FP Examination. ITE scores generally correlate at about .7 with the following year's ITE or with the following year's certification examination. The mean growth from PGY1 to PGY2 was 52 points, from PGY2 to PGY3 was 34 points, and from PGY3 to initial certification was 27 points. The sensitivity, specificity, positive predictive value, and negative predictive value were .91, .47, .96, and .27, respectively. The ITE is a useful predictor of future ITE and initial certification examination performance.

Vaginal symptoms and bacterial vaginosis (BV): how useful is self-report? Development of a screening tool for predicting BV status.

PubMed

Nelson, D B; Bellamy, S; Odibo, A; Nachamkin, I; Ness, R B; Allen-Taylor, L

2007-11-01

Vaginal complaints compel an evaluation of bacterial vaginosis (BV), however, many cases of BV are asymptomatic. We evaluated the sensitivity and specificity of vaginal symptoms in the diagnosis of BV and examined the utility of creating a BV screening tool using clinical, behavioural and demographic characteristics. A total of 1916 pregnant women were included in this analysis. In total, 757 women screened positive for BV and over one third of BV-positive women presented without any lower genital tract symptoms (39.4%). African American race, abnormal vaginal odour, and smoking were independently related to BV positivity. A BV screening tool including these three factors was fairly predictive of BV status with the area under the ROC curve equal to 0.669. This three-item prediction rule may be useful in identifying high- risk pregnant women in need of BV screening and, given the high specificity, accurately identify the group of BV-negative pregnant women.

Contrasting Five Different Theories of Letter Position Coding: Evidence from Orthographic Similarity Effects

ERIC Educational Resources Information Center

Davis, Colin J.; Bowers, Jeffrey S.

2006-01-01

Five theories of how letter position is coded are contrasted: position-specific slot-coding, Wickelcoding, open-bigram coding (discrete and continuous), and spatial coding. These theories make different predictions regarding the relative similarity of three different types of pairs of letter strings: substitution neighbors,…

Prediction of subjective ratings of emotional pictures by EEG features

NASA Astrophysics Data System (ADS)

McFarland, Dennis J.; Parvaz, Muhammad A.; Sarnacki, William A.; Goldstein, Rita Z.; Wolpaw, Jonathan R.

2017-02-01

Objective. Emotion dysregulation is an important aspect of many psychiatric disorders. Brain-computer interface (BCI) technology could be a powerful new approach to facilitating therapeutic self-regulation of emotions. One possible BCI method would be to provide stimulus-specific feedback based on subject-specific electroencephalographic (EEG) responses to emotion-eliciting stimuli. Approach. To assess the feasibility of this approach, we studied the relationships between emotional valence/arousal and three EEG features: amplitude of alpha activity over frontal cortex; amplitude of theta activity over frontal midline cortex; and the late positive potential over central and posterior mid-line areas. For each feature, we evaluated its ability to predict emotional valence/arousal on both an individual and a group basis. Twenty healthy participants (9 men, 11 women; ages 22-68) rated each of 192 pictures from the IAPS collection in terms of valence and arousal twice (96 pictures on each of 4 d over 2 weeks). EEG was collected simultaneously and used to develop models based on canonical correlation to predict subject-specific single-trial ratings. Separate models were evaluated for the three EEG features: frontal alpha activity; frontal midline theta; and the late positive potential. In each case, these features were used to simultaneously predict both the normed ratings and the subject-specific ratings. Main results. Models using each of the three EEG features with data from individual subjects were generally successful at predicting subjective ratings on training data, but generalization to test data was less successful. Sparse models performed better than models without regularization. Significance. The results suggest that the frontal midline theta is a better candidate than frontal alpha activity or the late positive potential for use in a BCI-based paradigm designed to modify emotional reactions.

Sensitivity and specificity of a CAD solution for lung nodule detection on chest radiograph with CTA correlation.

PubMed

Moore, William; Ripton-Snyder, Jennifer; Wu, George; Hendler, Craig

2011-06-01

The objective of this research was to determine the sensitivity and specificity of a commercially available computer-aided detection (CAD) system for detection of lung nodule on posterior-anterior (PA) chest radiograph in a varied patient population who are referred to computed tomographic angiogram (CTA) of the chest as a reference standard. Patients who had a PA chest radiograph with concomitant CTA of the chest were included in this retrospective study. The PA chest radiograph was analyzed by a CAD device, and results were recorded. A qualitative assessment of the CAD results was performed using a 5-point Likert scale. The CTA was then reviewed to determine if there were correlative nodules. The presence of a correlative nodule between 0.5 cm and 1.5 cm was considered a positive result. The baseline sensitivity of the system was determined to be 0.707 (95% CI = 0.52-0.86), with a specificity of 0.50 (95% CI = 0.38-0.76). Positive predictive value was 0.30 (95% CI = 0.24-0.49), with a negative predictive value of 0.858 (95% CI = 0.82-0.95), and accuracy of 0.555 (95% CI = 0.40-0.66). When excluding nodules that were qualitatively determined by a thoracic radiologist to be false positives, the specificity was 0.781 (95% CI = 0.764-0.839), the positive predictive value was 0.564 (95% CI = 0.491-0.654), the negative predictive value was 0.829 (95% CI = 0.819-0.878), and the accuracy was 0.737 (95% CI = 0.721-0.801). The use of CAD for lung nodule detection on chest radiograph, when used in conjunction with an experienced radiologist, has a very good sensitivity, specificity, and accuracy.

Bilirubin nomogram for prediction of significant hyperbilirubinemia in north Indian neonates.

PubMed

Pathak, Umesh; Chawla, Deepak; Kaur, Saranjit; Jain, Suksham

2013-04-01

(i) To construct hour-specific serum total bilirubin (STB) nomogram in neonates born at =35 weeks of gestation; (ii)To evaluate efficacy of pre-discharge bilirubin measurement in predicting hyperbilirubinemia needing treatment. Diagnostic test performance in a prospective cohort study. Teaching hospital in Northern India. Healthy neonates with gestation =35 weeks or birth weight =2000 g. Serum total bilirubin was measured in all enrolled neonates at 24 ± 6, 72-96 and 96-144 h of postnatal age and when indicated clinically. Neonates were followed up during hospital stay and after discharge till completion of 7th postnatal day. Key outcome was significant hyperbilirubinemia (SHB) defined as need of phototherapy based on modified American Academy of Pediatrics (AAP) guidelines. In neonates born at 38 or more weeks of gestation middle line and in neonates born at 37 or less completed weeks of gestation, lower line of phototherapy thresholds were used to initiate phototherapy. For construction of nomogram, STB values were clubbed in six-hour epochs (age ± 3 hours) for postnatal age up to 48 h and twelve-hour epochs (age ± 6 hours) for age beyond 48 h. Predictive ability of the nomogram was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio, by plotting receiver-operating characteristics (ROC) curve and calculating c-statistic. 997 neonates (birth weight: 2627 ± 536 g, gestation: 37.8 ± 1.5 weeks) were enrolled, of which 931 completed followup. Among enrolled neonates 344 (34.5%) were low birth weight. Rate of exclusive breastfeeding during hospital stay was more than 80%. Bilirubin nomogram was constructed using 40th, 75th and 95th percentile values of hour-specific bilirubin. Pre-discharge STB of =95th percentile was assigned to be in high-risk zone, between 75th and 94th centile in upper-intermediate risk zone, between 40th and 74th centile in lower-intermediate risk zone and below 40th percentile in low-risk zone. Among 49 neonates with pre-discharge STB in high risk zone. 34 developed SHB (positive predictive value: 69.4%, sensitivity: 17.1%, positive likelihood ratio: 8.26). Among 342 neonates with pre-discharge STB in low risk zone, 32 developed PHB (negative predictive value: 90.6% and specificity: 42.5%, positive likelihood ratio: 0.37). Area under curve for this risk assessment strategy was 0.73. Hour-specific bilirubin nomogram and STB measurement can be used for predicting subsequent need of phototherapy. Further studies are needed to validate performance of risk demarcation zones defined in this hour-specific bilirubin nomogram.

A health behavior screening tool for non-specific neck pain in office workers: a 1-year prospective cohort study.

PubMed

Areerak, Kantheera; van der Beek, Allard J; Janwantanakul, Prawit

2018-05-09

One effective strategy for management of musculoskeletal disorders is self-management based on the biopsychosocial model. Self-management requires patients to have adequate health literacy, defined as the individual's ability to seek, understand, and utilize health information. Recently, the neck pain-specific health behavior for office workers (NHBOW) questionnaire was developed based upon a conceptual framework of health literacy. The content in the NHBOW relates to the work and exercise behaviors of office workers. The primary aim of this study was to evaluate the predictive validity of the NHBOW. At baseline, 342 healthy participants filled out a series of questionnaires, including the NHBOW. The incidence of neck pain was prospectively recorded every month over a 12-month period. Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristics curve (AUC) were calculated. There were 103 (30.7%) incidents of non-specific neck pain among 335 office workers during the 12-month period, and seven participants were lost to follow-up. For the NHBOW, a cut-off score of less than or equal to 8 points (lower scores indicate poorer health behavior) had a sensitivity of 57.3% and a specificity of 96.6%. The positive and negative predictive values were 88.1% and 83.6%, respectively. The AUC was 0.769 (95% CI: 0.706 to 0.832). The NHBOW was an acceptable screening tool for predicting non-specific neck pain in office workers during the 1-year follow-up period, and can be used in occupational and primary care settings.

Sensitivity, Specificity, and Public-Health Utility of Clinical Case Definitions Based on the Signs and Symptoms of Cholera in Africa.

PubMed

Nadri, Johara; Sauvageot, Delphine; Njanpop-Lafourcade, Berthe-Marie; Baltazar, Cynthia S; Banla Kere, Abiba; Bwire, Godfrey; Coulibaly, Daouda; Kacou N'Douba, Adele; Kagirita, Atek; Keita, Sakoba; Koivogui, Lamine; Landoh, Dadja E; Langa, Jose P; Miwanda, Berthe N; Mutombo Ndongala, Guy; Mwakapeje, Elibariki R; Mwambeta, Jacob L; Mengel, Martin A; Gessner, Bradford D

2018-04-01

During 2014, Africa reported more than half of the global suspected cholera cases. Based on the data collected from seven countries in the African Cholera Surveillance Network (Africhol), we assessed the sensitivity, specificity, and positive and negative predictive values of clinical cholera case definitions, including that recommended by the World Health Organization (WHO) using culture confirmation as the gold standard. The study was designed to assess results in real-world field situations in settings with recent cholera outbreaks or endemicity. From June 2011 to July 2015, a total of 5,084 persons with suspected cholera were tested for Vibrio cholerae in seven different countries of which 35.7% had culture confirmation. For all countries combined, the WHO case definition had a sensitivity = 92.7%, specificity = 8.1%, positive predictive value = 36.1%, and negative predictive value = 66.6%. Adding dehydration, vomiting, or rice water stools to the case definition could increase the specificity without a substantial decrease in sensitivity. Future studies could further refine our findings primarily by using more sensitive methods for cholera confirmation.

The Ship Movement Trajectory Prediction Algorithm Using Navigational Data Fusion.

PubMed

Borkowski, Piotr

2017-06-20

It is essential for the marine navigator conducting maneuvers of his ship at sea to know future positions of himself and target ships in a specific time span to effectively solve collision situations. This article presents an algorithm of ship movement trajectory prediction, which, through data fusion, takes into account measurements of the ship's current position from a number of doubled autonomous devices. This increases the reliability and accuracy of prediction. The algorithm has been implemented in NAVDEC, a navigation decision support system and practically used on board ships.

The Ship Movement Trajectory Prediction Algorithm Using Navigational Data Fusion

PubMed Central

Borkowski, Piotr

2017-01-01

It is essential for the marine navigator conducting maneuvers of his ship at sea to know future positions of himself and target ships in a specific time span to effectively solve collision situations. This article presents an algorithm of ship movement trajectory prediction, which, through data fusion, takes into account measurements of the ship’s current position from a number of doubled autonomous devices. This increases the reliability and accuracy of prediction. The algorithm has been implemented in NAVDEC, a navigation decision support system and practically used on board ships. PMID:28632176

A standardized model for predicting flap failure using indocyanine green dye

NASA Astrophysics Data System (ADS)

Zimmermann, Terence M.; Moore, Lindsay S.; Warram, Jason M.; Greene, Benjamin J.; Nakhmani, Arie; Korb, Melissa L.; Rosenthal, Eben L.

2016-03-01

Techniques that provide a non-invasive method for evaluation of intraoperative skin flap perfusion are currently available but underutilized. We hypothesize that intraoperative vascular imaging can be used to reliably assess skin flap perfusion and elucidate areas of future necrosis by means of a standardized critical perfusion threshold. Five animal groups (negative controls, n=4; positive controls, n=5; chemotherapy group, n=5; radiation group, n=5; chemoradiation group, n=5) underwent pre-flap treatments two weeks prior to undergoing random pattern dorsal fasciocutaneous flaps with a length to width ratio of 2:1 (3 x 1.5 cm). Flap perfusion was assessed via laser-assisted indocyanine green dye angiography and compared to standard clinical assessment for predictive accuracy of flap necrosis. For estimating flap-failure, clinical prediction achieved a sensitivity of 79.3% and a specificity of 90.5%. When average flap perfusion was more than three standard deviations below the average flap perfusion for the negative control group at the time of the flap procedure (144.3+/-17.05 absolute perfusion units), laser-assisted indocyanine green dye angiography achieved a sensitivity of 81.1% and a specificity of 97.3%. When absolute perfusion units were seven standard deviations below the average flap perfusion for the negative control group, specificity of necrosis prediction was 100%. Quantitative absolute perfusion units can improve specificity for intraoperative prediction of viable tissue. Using this strategy, a positive predictive threshold of flap failure can be standardized for clinical use.

Can 3-dimensional power Doppler indices improve the prenatal diagnosis of a potentially morbidly adherent placenta in patients with placenta previa?

PubMed

Haidar, Ziad A; Papanna, Ramesha; Sibai, Baha M; Tatevian, Nina; Viteri, Oscar A; Vowels, Patricia C; Blackwell, Sean C; Moise, Kenneth J

2017-08-01

Traditionally, 2-dimensional ultrasound parameters have been used for the diagnosis of a suspected morbidly adherent placenta previa. More objective techniques have not been well studied yet. The objective of the study was to determine the ability of prenatal 3-dimensional power Doppler analysis of flow and vascular indices to predict the morbidly adherent placenta objectively. A prospective cohort study was performed in women between 28 and 32 gestational weeks with known placenta previa. Patients underwent a two-dimensional gray-scale ultrasound that determined management decisions. 3-Dimensional power Doppler volumes were obtained during the same examination and vascular, flow, and vascular flow indices were calculated after manual tracing of the viewed placenta in the sweep; data were blinded to obstetricians. Morbidly adherent placenta was confirmed by histology. Severe morbidly adherent placenta was defined as increta/percreta on histology, blood loss >2000 mL, and >2 units of PRBC transfused. Sensitivities, specificities, predictive values, and likelihood ratios were calculated. Student t and χ 2 tests, logistic regression, receiver-operating characteristic curves, and intra- and interrater agreements using Kappa statistics were performed. The following results were found: (1) 50 women were studied: 23 had morbidly adherent placenta, of which 12 (52.2%) were severe morbidly adherent placenta; (2) 2-dimensional parameters diagnosed morbidly adherent placenta with a sensitivity of 82.6% (95% confidence interval, 60.4-94.2), a specificity of 88.9% (95% confidence interval, 69.7-97.1), a positive predictive value of 86.3% (95% confidence interval, 64.0-96.4), a negative predictive value of 85.7% (95% confidence interval, 66.4-95.3), a positive likelihood ratio of 7.4 (95% confidence interval, 2.5-21.9), and a negative likelihood ratio of 0.2 (95% confidence interval, 0.08-0.48); (3) mean values of the vascular index (32.8 ± 7.4) and the vascular flow index (14.2 ± 3.8) were higher in morbidly adherent placenta (P < .001); (4) area under the receiver-operating characteristic curve for the vascular and vascular flow indices were 0.99 and 0.97, respectively; (5) the vascular index ≥21 predicted morbidly adherent placenta with a sensitivity and a specificity of 95% (95% confidence interval, 88.2-96.9) and 91%, respectively (95% confidence interval, 87.5-92.4), 92% positive predictive value (95% confidence interval, 85.5-94.3), 90% negative predictive value (95% confidence interval, 79.9-95.3), positive likelihood ratio of 10.55 (95% confidence interval, 7.06-12.75), and negative likelihood ratio of 0.05 (95% confidence interval, 0.03-0.13); and (6) for the severe morbidly adherent placenta, 2-dimensional ultrasound had a sensitivity of 33.3% (95% confidence interval, 11.3-64.6), a specificity of 81.8% (95% confidence interval, 47.8-96.8), a positive predictive value of 66.7% (95% confidence interval, 24.1-94.1), a negative predictive value of 52.9% (95% confidence interval, 28.5-76.1), a positive likelihood ratio of 1.83 (95% confidence interval, 0.41-8.11), and a negative likelihood ratio of 0.81 (95% confidence interval, 0.52-1.26). A vascular index ≥31 predicted the diagnosis of a severe morbidly adherent placenta with a 100% sensitivity (95% confidence interval, 72-100), a 90% specificity (95% confidence interval, 81.7-93.8), an 88% positive predictive value (95% confidence interval, 55.0-91.3), a 100% negative predictive value (95% confidence interval, 90.9-100), a positive likelihood ratio of 10.0 (95% confidence interval, 3.93-16.13), and a negative likelihood ratio of 0 (95% confidence interval, 0-0.34). Intrarater and interrater agreements were 94% (P < .001) and 93% (P < .001), respectively. The vascular index accurately predicts the morbidly adherent placenta in patients with placenta previa. In addition, 3-dimensional power Doppler vascular and vascular flow indices were more predictive of severe cases of morbidly adherent placenta compared with 2-dimensional ultrasound. This objective technique may limit the variations in diagnosing morbidly adherent placenta because of the subjectivity of 2-dimensional ultrasound interpretations. Copyright © 2017 Elsevier Inc. All rights reserved.

In-house PCR with DNA extracted directly from positive slides to confirm or exclude the diagnosis of tuberculosis: focus on biosafety.

PubMed

de Almeida, Isabela Neves; Aleixo, Agdemir Valéria; Carvalho, Wânia da Silva; de Miranda, Silvana Spindola

2015-01-01

The possibility to obtain DNA from smears is a valuable alternative to remedy the lack of samples when they are totally used for bacilloscopy; this technique solves the biosafety problem related to a possible accident with the transportation of flasks containing potentially transmissible clinical samples. Hence, the purpose of this study was to utilize the insertion sequence IS6110 for amplification of DNA from a smear-positive sample for tuberculosis (TB) diagnosis. Among the 52 positive bacilloscopies, sensitivity, specificity, positive predictive value and negative predictive value were 52.3%, 100%, 100% and 89.7%, respectively whereas accuracy was 90.7%. The IS6110-based PCR for TB diagnosis developed in DNA extracted from a positive smear is a fast, simple, specific, and safe method. Copyright © 2014 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.

Decision curve analysis and external validation of the postoperative Karakiewicz nomogram for renal cell carcinoma based on a large single-center study cohort.

PubMed

Zastrow, Stefan; Brookman-May, Sabine; Cong, Thi Anh Phuong; Jurk, Stanislaw; von Bar, Immanuel; Novotny, Vladimir; Wirth, Manfred

2015-03-01

To predict outcome of patients with renal cell carcinoma (RCC) who undergo surgical therapy, risk models and nomograms are valuable tools. External validation on independent datasets is crucial for evaluating accuracy and generalizability of these models. The objective of the present study was to externally validate the postoperative nomogram developed by Karakiewicz et al. for prediction of cancer-specific survival. A total of 1,480 consecutive patients with a median follow-up of 82 months (IQR 46-128) were included into this analysis with 268 RCC-specific deaths. Nomogram-estimated survival probabilities were compared with survival probabilities of the actual cohort, and concordance indices were calculated. Calibration plots and decision curve analyses were used for evaluating calibration and clinical net benefit of the nomogram. Concordance between predictions of the nomogram and survival rates of the cohort was 0.911 after 12, 0.909 after 24 months and 0.896 after 60 months. Comparison of predicted probabilities and actual survival estimates with calibration plots showed an overestimation of tumor-specific survival based on nomogram predictions of high-risk patients, although calibration plots showed a reasonable calibration for probability ranges of interest. Decision curve analysis showed a positive net benefit of nomogram predictions for our patient cohort. The postoperative Karakiewicz nomogram provides a good concordance in this external cohort and is reasonably calibrated. It may overestimate tumor-specific survival in high-risk patients, which should be kept in mind when counseling patients. A positive net benefit of nomogram predictions was proven.

LMethyR-SVM: Predict Human Enhancers Using Low Methylated Regions based on Weighted Support Vector Machines.

PubMed

Xu, Jingting; Hu, Hong; Dai, Yang

The identification of enhancers is a challenging task. Various types of epigenetic information including histone modification have been utilized in the construction of enhancer prediction models based on a diverse panel of machine learning schemes. However, DNA methylation profiles generated from the whole genome bisulfite sequencing (WGBS) have not been fully explored for their potential in enhancer prediction despite the fact that low methylated regions (LMRs) have been implied to be distal active regulatory regions. In this work, we propose a prediction framework, LMethyR-SVM, using LMRs identified from cell-type-specific WGBS DNA methylation profiles and a weighted support vector machine learning framework. In LMethyR-SVM, the set of cell-type-specific LMRs is further divided into three sets: reliable positive, like positive and likely negative, according to their resemblance to a small set of experimentally validated enhancers in the VISTA database based on an estimated non-parametric density distribution. Then, the prediction model is obtained by solving a weighted support vector machine. We demonstrate the performance of LMethyR-SVM by using the WGBS DNA methylation profiles derived from the human embryonic stem cell type (H1) and the fetal lung fibroblast cell type (IMR90). The predicted enhancers are highly conserved with a reasonable validation rate based on a set of commonly used positive markers including transcription factors, p300 binding and DNase-I hypersensitive sites. In addition, we show evidence that the large fraction of the LMethyR-SVM predicted enhancers are not predicted by ChromHMM in H1 cell type and they are more enriched for the FANTOM5 enhancers. Our work suggests that low methylated regions detected from the WGBS data are useful as complementary resources to histone modification marks in developing models for the prediction of cell-type-specific enhancers.

To branch out or stay focused? Affective shifts differentially predict organizational citizenship behavior and task performance.

PubMed

Yang, Liu-Qin; Simon, Lauren S; Wang, Lei; Zheng, Xiaoming

2016-06-01

We draw from personality systems interaction (PSI) theory (Kuhl, 2000) and regulatory focus theory (Higgins, 1997) to examine how dynamic positive and negative affective processes interact to predict both task and contextual performance. Using a twice-daily diary design over the course of a 3-week period, results from multilevel regression analysis revealed that distinct patterns of change in positive and negative affect optimally predicted contextual and task performance among a sample of 71 employees at a medium-sized technology company. Specifically, within persons, increases (upshifts) in positive affect over the course of a workday better predicted the subsequent day's organizational citizenship behavior (OCB) when such increases were coupled with decreases (downshifts) in negative affect. The optimal pattern of change in positive and negative affect differed, however, in predicting task performance. That is, upshifts in positive affect over the course of the workday better predicted the subsequent day's task performance when such upshifts were accompanied by upshifts in negative affect. The contribution of our findings to PSI theory and the broader affective and motivation regulation literatures, along with practical implications, are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Neither Single nor a Combination of Routine Laboratory Parameters can Discriminate between Gram-positive and Gram-negative Bacteremia

PubMed Central

Ratzinger, Franz; Dedeyan, Michel; Rammerstorfer, Matthias; Perkmann, Thomas; Burgmann, Heinz; Makristathis, Athanasios; Dorffner, Georg; Loetsch, Felix; Blacky, Alexander; Ramharter, Michael

2015-01-01

Adequate early empiric antibiotic therapy is pivotal for the outcome of patients with bloodstream infections. In clinical practice the use of surrogate laboratory parameters is frequently proposed to predict underlying bacterial pathogens; however there is no clear evidence for this assumption. In this study, we investigated the discriminatory capacity of predictive models consisting of routinely available laboratory parameters to predict the presence of Gram-positive or Gram-negative bacteremia. Major machine learning algorithms were screened for their capacity to maximize the area under the receiver operating characteristic curve (ROC-AUC) for discriminating between Gram-positive and Gram-negative cases. Data from 23,765 patients with clinically suspected bacteremia were screened and 1,180 bacteremic patients were included in the study. A relative predominance of Gram-negative bacteremia (54.0%), which was more pronounced in females (59.1%), was observed. The final model achieved 0.675 ROC-AUC resulting in 44.57% sensitivity and 79.75% specificity. Various parameters presented a significant difference between both genders. In gender-specific models, the discriminatory potency was slightly improved. The results of this study do not support the use of surrogate laboratory parameters for predicting classes of causative pathogens. In this patient cohort, gender-specific differences in various laboratory parameters were observed, indicating differences in the host response between genders. PMID:26522966

Diagnostic usefulness of MUC1 and MUC4 for distinguishing between metastatic adenocarcinoma cells and reactive mesothelial cells in effusion cell blocks.

PubMed

Cho, Jin Seong; Kim, Ga-Eon; Lee, Ji Shin; Lee, Jae Hyuk; Nam, Jong Hee; Choi, Chan

2013-01-01

The aim of our study was to determine the diagnostic value of MUC1 and MUC4 for distinguishing between metastatic adenocarcinoma cells (MAC) and reactive mesothelial cells (RMC) in effusion fluids. A total of 237 cell block specimens from pleural and peritoneal effusions, including 196 malignant effusions with MAC and 41 benign effusions with RMC, were stained with antibodies against MUC1 and MUC4. Membranous staining with or without cytoplasmic staining was considered to be positive. MUC1 immunoreactivity was observed in 194 (99.0%) of 196 cases of MAC and in 20 (48.8%) of 41 cases of RMC. MUC4 immunoreactivity was observed in 174 (88.8%) of 196 cases of MAC and in 4 (9.8%) of 41 cases of RMC. For distinguishing MAC from RMC, the MUC1 reactivity was found to be 99.0% sensitive and 51.2% specific with a positive predictive value of 90.7% and a negative predictive value of 91.3%. The sensitivity of MUC4 for MAC was 88.8%, the specificity was 90.2%, the negative predictive value was 62.7%, and the positive predictive value was 97.8%. Our data suggest that MUC4 appears to be a sensitive and specific marker for differentiating between MAC and RMC. Copyright © 2013 S. Karger AG, Basel.

Computational Prediction of Protein Epsilon Lysine Acetylation Sites Based on a Feature Selection Method.

PubMed

Gao, JianZhao; Tao, Xue-Wen; Zhao, Jia; Feng, Yuan-Ming; Cai, Yu-Dong; Zhang, Ning

2017-01-01

Lysine acetylation, as one type of post-translational modifications (PTM), plays key roles in cellular regulations and can be involved in a variety of human diseases. However, it is often high-cost and time-consuming to use traditional experimental approaches to identify the lysine acetylation sites. Therefore, effective computational methods should be developed to predict the acetylation sites. In this study, we developed a position-specific method for epsilon lysine acetylation site prediction. Sequences of acetylated proteins were retrieved from the UniProt database. Various kinds of features such as position specific scoring matrix (PSSM), amino acid factors (AAF), and disorders were incorporated. A feature selection method based on mRMR (Maximum Relevance Minimum Redundancy) and IFS (Incremental Feature Selection) was employed. Finally, 319 optimal features were selected from total 541 features. Using the 319 optimal features to encode peptides, a predictor was constructed based on dagging. As a result, an accuracy of 69.56% with MCC of 0.2792 was achieved. We analyzed the optimal features, which suggested some important factors determining the lysine acetylation sites. We developed a position-specific method for epsilon lysine acetylation site prediction. A set of optimal features was selected. Analysis of the optimal features provided insights into the mechanism of lysine acetylation sites, providing guidance of experimental validation. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Triple Test in Carcinoma Breast

PubMed Central

Sameer; Mukherjee, Arindam

2014-01-01

Introduction: The commonest clinical presentation in majority of breast pathology is a lump. A definite diagnosis of breast lump is very important for the surgeon to decide on the final course of treatment and also saves the patient from unnecessary physical, emotional and psychological trauma if there is a definite preoperative diagnosis of benign lesion. The present study was done to evaluate the effectiveness and relevance of “TRIPLE TEST”in diagnosis of carcinoma breast in rural labour class population. Materials and Methods: The present study was a prospective study conducted on patients over 35 years of age having palpable breast lumps presenting in the out patient department of general surgery, ESI Hospital Basaidarapur New Delhi, India. The duration of study was from May 2007 to June 2009 and a total of 100 cases were studied. Each patient was subjected to a detailed history, clinical breast examination ,diagnostic mammography and FNAC. In this study, the results of each modality was divided in three groups: benign, suspicious and malignant. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of each test was calculated individually and as combined. Result: Out of 100 patients enrolled in this study, 60 cases were benign and 40 cases were of malignant breast disease. The age of patients with carcinoma breast in the series varied from 35 years to 70 years. The highest incidence of malignancy noted was 30% in 41-50 years age group (4th decade) followed by 27.5% in 51-60 years age group (5th decade). The sensitivity of clinical examination was found to be 75%, specificity was 83.3%, positive predictive value (PPV) of 75% and diagnostic accuracy of 80%. The sensitivity, specificity, positive predictive value and diagnostic accuracy of mammography was calculated and was found to be 94.9% , 90% , 86% and 92% respectively. The sensitivity, specificity, positive predictive value and diagnostic accuracy of FNAC was 94.7%, 98.3%, 97.3% and 96.6% respectively. Out of 100 cases triple test was concordant (all three test either benign or malignant) in 80 cases, all the benign cases detected by triple test were benign on final biopsy i.e. 100% specificity and 100% negative predictive value. Conclusion: TTS is an accurate and least invasive diagnostic test based on which definitive treatment can be initiated. PMID:25478391

Using the Positive and Negative Syndrome Scale (PANSS) to Define Different Domains of Negative Symptoms

PubMed Central

Khan, Anzalee; Keefe, Richard S. E.

2017-01-01

Background: Reduced emotional experience and expression are two domains of negative symptoms. The authors assessed these two domains of negative symptoms using previously developed Positive and Negative Syndrome Scale (PANSS) factors. Using an existing dataset, the authors predicted three different elements of everyday functioning (social, vocational, and everyday activities) with these two factors, as well as with performance on measures of functional capacity. Methods: A large (n=630) sample of people with schizophrenia was used as the data source of this study. Using regression analyses, the authors predicted the three different aspects of everyday functioning, first with just the two Positive and Negative Syndrome Scale factors and then with a global negative symptom factor. Finally, we added neurocognitive performance and functional capacity as predictors. Results: The Positive and Negative Syndrome Scale reduced emotional experience factor accounted for 21 percent of the variance in everyday social functioning, while reduced emotional expression accounted for no variance. The total Positive and Negative Syndrome Scale negative symptom factor accounted for less variance (19%) than the reduced experience factor alone. The Positive and Negative Syndrome Scale expression factor accounted for, at most, one percent of the variance in any of the functional outcomes, with or without the addition of other predictors. Implications: Reduced emotional experience measured with the Positive and Negative Syndrome Scale, often referred to as “avolition and anhedonia,” specifically predicted impairments in social outcomes. Further, reduced experience predicted social impairments better than emotional expression or the total Positive and Negative Syndrome Scale negative symptom factor. In this cross-sectional study, reduced emotional experience was specifically related with social outcomes, accounting for essentially no variance in work or everyday activities, and being the sole meaningful predictor of impairment in social outcomes. PMID:29410933

Retrospective Review of Treponema pallidum PCR and Serology Results: Are Both Tests Necessary?

PubMed

Brischetto, Anna; Gassiep, Ian; Whiley, David; Norton, Robert

2018-05-01

There has been a resurgence of syphilis diagnoses in Australia. We investigated whether our Treponema pallidum PCR test provides any additional diagnostic information over syphilis serology (chemiluminescence immunoassay [CMIA], Treponema pallidum particle agglutination [TPPA] assay, and the rapid plasma reagin [RPR] flocculation test). A retrospective audit of all T. pallidum PCR requests that came through our laboratory from January 2010 to June 2017 was conducted; data collected included age, gender, site of swab, and results from T. pallidum PCR, syphilis serology, and herpes simplex virus 1 (HSV-1) and HSV-2 PCRs. A total of 441 T. pallidum PCR tests were performed; on average, 3 T. pallidum PCRs per month were requested in 2011, and this rate increased to 17.2 requests per month in 2017. A total of 323 patients had both T. pallidum PCR and syphilis serology performed, with 67% of swabs taken from the genitals. T. pallidum PCR gave positive results for 61/323 (19%) patients; of these 61 patients, 59 (97%) also had positive syphilis serology results ( T. pallidum PCR sensitivity, 68%; specificity, 99%; positive predictive value, 97%; negative predictive value, 89%). Syphilis serology was positive for 91/323 patients (28%); of these 91 patients, 61 (66%) were also T. pallidum PCR positive (syphilis serology sensitivity, 97%; specificity, 88%; positive predictive value, 60%; negative predictive value, 99%). The Cohen's kappa value was 0.74, indicating substantial agreement between the two tests. Our results show that most patients with positive T. pallidum PCR results also had positive syphilis serology. Therefore, T. pallidum PCR adds little clinical value over serology for the diagnosis of syphilis in certain clinical settings. Copyright © 2018 American Society for Microbiology.

A randomized and blinded comparison of qPCR and NGS-based detection of aneuploidy in a cell line mixture model of blastocyst biopsy mosaicism.

PubMed

Goodrich, David; Tao, Xin; Bohrer, Chelsea; Lonczak, Agnieszka; Xing, Tongji; Zimmerman, Rebekah; Zhan, Yiping; Scott, Richard T; Treff, Nathan R

2016-11-01

A subset of preimplantation stage embryos may possess mosaicism of chromosomal constitution, representing a possible limitation to the clinical predictive value of comprehensive chromosome screening (CCS) from a single biopsy. However, contemporary methods of CCS may be capable of predicting mosaicism in the blastocyst by detecting intermediate levels of aneuploidy within a trophectoderm biopsy. This study evaluates the sensitivity and specificity of aneuploidy detection by two CCS platforms using a cell line mixture model of a mosaic trophectoderm biopsy. Four cell lines with known karyotypes were obtained and mixed together at specific ratios of six total cells (0:6, 1:5, 2:4, 3:3, 4:2, 5:1, and 6:0). A female euploid and a male trisomy 18 cell line were used for one set, and a male trisomy 13 and a male trisomy 15 cell line were used for another. Replicates of each mixture were prepared, randomized, and blinded for analysis by one of two CCS platforms (quantitative polymerase chain reaction (qPCR) or VeriSeq next-generation sequencing (NGS)). Sensitivity and specificity of aneuploidy detection at each level of mosaicism was determined and compared between platforms. With the default settings for each platform, the sensitivity of qPCR and NGS were not statistically different, and 100 % specificity was observed (no false positives) at all levels of mosaicism. However, the use of previously published custom criteria for NGS increased sensitivity but also significantly decreased specificity (33 % false-positive prediction of aneuploidy). By demonstrating increased false-positive diagnoses when reducing the stringency of predicting an abnormality, these data illustrate the importance of preclinical evaluation of new testing paradigms before clinical implementation.

Establishing a sample-to cut-off ratio for lab-diagnosis of hepatitis C virus in Indian context.

PubMed

Tiwari, Aseem K; Pandey, Prashant K; Negi, Avinash; Bagga, Ruchika; Shanker, Ajay; Baveja, Usha; Vimarsh, Raina; Bhargava, Richa; Dara, Ravi C; Rawat, Ganesh

2015-01-01

Lab-diagnosis of hepatitis C virus (HCV) is based on detecting specific antibodies by enzyme immuno-assay (EIA) or chemiluminescence immuno-assay (CIA). Center for Disease Control reported that signal-to-cut-off (s/co) ratios in anti-HCV antibody tests like EIA/CIA can be used to predict the probable result of supplemental test; above a certain s/co value it is most likely to be true-HCV positive result and below that certain s/co it is most likely to be false-positive result. A prospective study was undertaken in patients in tertiary care setting for establishing this "certain" s/co value. The study was carried out in consecutive patients requiring HCV testing for screening/diagnosis and medical management. These samples were tested for anti-HCV on CIA (VITROS(®) Anti-HCV assay, Ortho-Clinical Diagnostics, New Jersey) for calculating s/co value. The supplemental nucleic acid test used was polymerase chain reaction (PCR) (Abbott). PCR test results were used to define true negatives, false negatives, true positives, and false positives. Performance of different putative s/co ratios versus PCR was measured using sensitivity, specificity, positive predictive value and negative predictive value and most appropriate s/co was considered on basis of highest specificity at sensitivity of at least 95%. An s/co ratio of ≥6 worked out to be over 95% sensitive and almost 92% specific in 438 consecutive patient samples tested. The s/co ratio of six can be used for lab-diagnosis of HCV infection; those with s/co higher than six can be diagnosed to have HCV infection without any need for supplemental assays.

An updated PREDICT breast cancer prognostication and treatment benefit prediction model with independent validation.

PubMed

Candido Dos Reis, Francisco J; Wishart, Gordon C; Dicks, Ed M; Greenberg, David; Rashbass, Jem; Schmidt, Marjanka K; van den Broek, Alexandra J; Ellis, Ian O; Green, Andrew; Rakha, Emad; Maishman, Tom; Eccles, Diana M; Pharoah, Paul D P

2017-05-22

PREDICT is a breast cancer prognostic and treatment benefit model implemented online. The overall fit of the model has been good in multiple independent case series, but PREDICT has been shown to underestimate breast cancer specific mortality in women diagnosed under the age of 40. Another limitation is the use of discrete categories for tumour size and node status resulting in 'step' changes in risk estimates on moving between categories. We have refitted the PREDICT prognostic model using the original cohort of cases from East Anglia with updated survival time in order to take into account age at diagnosis and to smooth out the survival function for tumour size and node status. Multivariable Cox regression models were used to fit separate models for ER negative and ER positive disease. Continuous variables were fitted using fractional polynomials and a smoothed baseline hazard was obtained by regressing the baseline cumulative hazard for each patients against time using fractional polynomials. The fit of the prognostic models were then tested in three independent data sets that had also been used to validate the original version of PREDICT. In the model fitting data, after adjusting for other prognostic variables, there is an increase in risk of breast cancer specific mortality in younger and older patients with ER positive disease, with a substantial increase in risk for women diagnosed before the age of 35. In ER negative disease the risk increases slightly with age. The association between breast cancer specific mortality and both tumour size and number of positive nodes was non-linear with a more marked increase in risk with increasing size and increasing number of nodes in ER positive disease. The overall calibration and discrimination of the new version of PREDICT (v2) was good and comparable to that of the previous version in both model development and validation data sets. However, the calibration of v2 improved over v1 in patients diagnosed under the age of 40. The PREDICT v2 is an improved prognostication and treatment benefit model compared with v1. The online version should continue to aid clinical decision making in women with early breast cancer.

Administrative database code accuracy did not vary notably with changes in disease prevalence.

PubMed

van Walraven, Carl; English, Shane; Austin, Peter C

2016-11-01

Previous mathematical analyses of diagnostic tests based on the categorization of a continuous measure have found that test sensitivity and specificity varies significantly by disease prevalence. This study determined if the accuracy of diagnostic codes varied by disease prevalence. We used data from two previous studies in which the true status of renal disease and primary subarachnoid hemorrhage, respectively, had been determined. In multiple stratified random samples from the two previous studies having varying disease prevalence, we measured the accuracy of diagnostic codes for each disease using sensitivity, specificity, and positive and negative predictive value. Diagnostic code sensitivity and specificity did not change notably within clinically sensible disease prevalence. In contrast, positive and negative predictive values changed significantly with disease prevalence. Disease prevalence had no important influence on the sensitivity and specificity of diagnostic codes in administrative databases. Copyright © 2016 Elsevier Inc. All rights reserved.

The effects of parental education and family income on mother-child relationships, father-child relationships, and family environments in the People's Republic of China.

PubMed

Zhang, Xiao

2012-12-01

Using a cross-sectional design with 407 Chinese children aged 3-5 years and their parents, this study examined the effects of socioeconomic status, specifically parents' education and family income, on the children's mother-child relationships, father-child relationships, and the social environment in their families. The results indicated that income negatively predicted conflict in father-child relationships and positively predicted family active-recreational environments. Income also positively predicted family cohesion among girls but not boys. Maternal education negatively predicted conflict in mother-child relationships and positively predicted closeness in mother-child and father-child relationships, family cohesion, and the intellectual-cultural and active-recreational environments in the family. Paternal education positively predicted family cohesion and intellectual-cultural and active-recreational environments. Income was found to partially mediate the effects of both maternal and paternal education on family active-recreational environments. Findings are discussed in the frameworks of the family stress model and the family investment model. © FPI, Inc.

Patent foramen ovale: comparison among diagnostic strategies in cryptogenic stroke and migraine.

PubMed

Zito, Concetta; Dattilo, Giuseppe; Oreto, Giuseppe; Di Bella, Gianluca; Lamari, Annalisa; Iudicello, Raffaella; Trio, Olimpia; Caracciolo, Giuseppe; Coglitore, Sebastiano; Arrigo, Francesco; Carerj, Scipione

2009-05-01

The aim of this study was to compare transthoracic echocardiography (TTE) and transcranial Doppler ultrasonography (TCD) with transesophageal echocardiography (TEE) in order to define the best clinical approach to patent foramen ovale (PFO) detection. In total, 72 consecutive patients (33 men) with a mean age of 49 +/- 13 years were prospectively enrolled. The TEE indication was cryptogenic stroke (36 patients) or migraine (36 patients, 22 with aura). All patients underwent standard TTE, TCD, and TEE examination. For any study, a contrast test was carried on using an agitated saline solution mixed with urea-linked gelatine (Haemaccel), injected as a rapid bolus via a right antecubital vein. A prolonged Valsalva maneuver was performed to improve test sensitivity. TEE identified a PFO in 65% of the whole population: 56.5% in the migraine cohort and 43.5% in the cryptogenic stroke cohort. TTE was able to detect a PFO in 55% of patients positive at TEE (54% negative predictive value, 100% positive predictive value, 55% sensitivity, and 100% specificity). TCD was able to identify a PFO in 97% of patients positive at TEE (89% negative predictive value, 98% positive predictive value, 94% sensitivity, and 96% specificity). In patients with cryptogenic stroke and migraine, there is a fair concordance (k = 0.89) between TCD and TEE in PFO recognition. Accordingly, TCD should be recommended as a simple, noninvasive, and reliable technique, whereas TEE indication should be restricted to selected patients. TTE is a very specific technique, whose major advantage is the ability to detect a large right-to-left shunt, particularly if associated with an atrial septal aneurysm.

Multistix 10 SG Leukocyte Esterage Dipstick Testing in Rapid Bedside Diagnosis of Spontaneous Bacterial Peritonitis: A Prospective Study.

PubMed

Jha, Ashish K; Kumawat, Dal C; Bolya, Yasvant K; Goenka, Mahesh K

2012-09-01

Spontaneous bacterial peritonitis (SBP) requires rapid diagnosis and the initiation of antibiotics. Diagnosis of SBP is usually based on cytobacteriological examination of ascitic fluid. These tests require good laboratory facilities and reporting time of few hours to 1-2 day. However, the 24 h laboratory facilities not widely available in country like India. We evaluated the diagnostic utility of reagent strip (Multistix 10 SG(®)) for rapid diagnosis of SBP. The study was prospectively carried out on patients of cirrhosis with ascites. Bedside leukocyte esterase reagent strip testing was performed on ascitic fluid. Cell count as determined by colorimetric scale of reagent strip was compared with counting chamber method. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Out of 100 patients with cirrhotic ascites, [72 males: 28 female; mean age 44.34 (SD 13.03) years] 18 patients were diagnosed to have SBP by counting chamber method as compared to 14 patients detected to have SBP by reagent strip test ≥++ positive. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of reagent strip ≥++ positive were 77.77%, 95.12%, 77.77%, 95.12% and 92% respectively compared to counting chamber method. Reagent strip to diagnose SBP is very specific but less sensitive as compared to counting chamber method. This can be performed rapidly, easily and efficiently even in remote area of developing countries. This bedside test could be a useful tool for the diagnosis of SBP in country like India.

Usefulness of Two Aspergillus PCR Assays and Aspergillus Galactomannan and β-d-Glucan Testing of Bronchoalveolar Lavage Fluid for Diagnosis of Chronic Pulmonary Aspergillosis.

PubMed

Urabe, Naohisa; Sakamoto, Susumu; Sano, Go; Suzuki, Junko; Hebisawa, Akira; Nakamura, Yasuhiko; Koyama, Kazuya; Ishii, Yoshikazu; Tateda, Kazuhiro; Homma, Sakae

2017-06-01

We evaluated the usefulness of an Aspergillus galactomannan (GM) test, a β-d-glucan (βDG) test, and two different Aspergillus PCR assays of bronchoalveolar lavage fluid (BALF) samples for the diagnosis of chronic pulmonary aspergillosis (CPA). BALF samples from 30 patients with and 120 patients without CPA were collected. We calculated the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for each test individually and in combination with other tests. The optical density index values, as determined by receiver operating characteristic analysis, for the diagnosis of CPA were 0.5 and 100 for GM and βDG testing of BALF, respectively. The sensitivity and specificity of the GM test, βDG test, and PCR assays 1 and 2 were 77.8% and 90.0%, 77.8% and 72.5%, 86.7% and 84.2%, and 66.7% and 94.2%, respectively. A comparison of the PCR assays showed that PCR assay 1 had a better sensitivity, a better negative predictive value, and a better negative likelihood ratio and PCR assay 2 had a better specificity, a better positive predictive value, and a better positive likelihood ratio. The combination of the GM and βDG tests had the highest diagnostic odds ratio. The combination of the GM and βDG tests on BALF was more useful than any single test for diagnosing CPA. Copyright © 2017 American Society for Microbiology.

NucPosPred: Predicting species-specific genomic nucleosome positioning via four different modes of general PseKNC.

PubMed

Jia, Cangzhi; Yang, Qing; Zou, Quan

2018-04-18

The nucleosome is the basic structure of chromatin in eukaryotic cells, with essential roles in the regulation of many biological processes, such as DNA transcription, replication and repair, and RNA splicing. Because of the importance of nucleosomes, the factors that determine their positioning within genomes should be investigated. High-resolution nucleosome-positioning maps are now available for organisms including Saccharomyces cerevisiae, Drosophila melanogaster and Caenorhabditis elegans, enabling the identification of nucleosome positioning by application of computational tools. Here, we describe a novel predictor called NucPosPred, which was specifically designed for large-scale identification of nucleosome positioning in C. elegans and D. melanogaster genomes. NucPosPred was separately optimized for each species for four types of DNA sequence feature extraction, with consideration of two classification algorithms (gradient-boosting decision tree and support vector machine). The overall accuracy obtained with NucPosPred was 92.29% for C. elegans and 88.26% for D. melanogaster, outperforming previous methods and demonstrating the potential for species-specific prediction of nucleosome positioning. For the convenience of most experimental scientists, a web-server for the predictor NucPosPred is available at http://121.42.167.206/NucPosPred/index.jsp. Copyright © 2018 Elsevier Ltd. All rights reserved.

Using the Positive and Negative Syndrome Scale (PANSS) to Define Different Domains of Negative Symptoms: Prediction of Everyday Functioning by Impairments in Emotional Expression and Emotional Experience.

PubMed

Harvey, Philip D; Khan, Anzalee; Keefe, Richard S E

2017-12-01

Background: Reduced emotional experience and expression are two domains of negative symptoms. The authors assessed these two domains of negative symptoms using previously developed Positive and Negative Syndrome Scale (PANSS) factors. Using an existing dataset, the authors predicted three different elements of everyday functioning (social, vocational, and everyday activities) with these two factors, as well as with performance on measures of functional capacity. Methods: A large (n=630) sample of people with schizophrenia was used as the data source of this study. Using regression analyses, the authors predicted the three different aspects of everyday functioning, first with just the two Positive and Negative Syndrome Scale factors and then with a global negative symptom factor. Finally, we added neurocognitive performance and functional capacity as predictors. Results: The Positive and Negative Syndrome Scale reduced emotional experience factor accounted for 21 percent of the variance in everyday social functioning, while reduced emotional expression accounted for no variance. The total Positive and Negative Syndrome Scale negative symptom factor accounted for less variance (19%) than the reduced experience factor alone. The Positive and Negative Syndrome Scale expression factor accounted for, at most, one percent of the variance in any of the functional outcomes, with or without the addition of other predictors. Implications: Reduced emotional experience measured with the Positive and Negative Syndrome Scale, often referred to as "avolition and anhedonia," specifically predicted impairments in social outcomes. Further, reduced experience predicted social impairments better than emotional expression or the total Positive and Negative Syndrome Scale negative symptom factor. In this cross-sectional study, reduced emotional experience was specifically related with social outcomes, accounting for essentially no variance in work or everyday activities, and being the sole meaningful predictor of impairment in social outcomes.

Characterization and prediction of residues determining protein functional specificity.

PubMed

Capra, John A; Singh, Mona

2008-07-01

Within a homologous protein family, proteins may be grouped into subtypes that share specific functions that are not common to the entire family. Often, the amino acids present in a small number of sequence positions determine each protein's particular functional specificity. Knowledge of these specificity determining positions (SDPs) aids in protein function prediction, drug design and experimental analysis. A number of sequence-based computational methods have been introduced for identifying SDPs; however, their further development and evaluation have been hindered by the limited number of known experimentally determined SDPs. We combine several bioinformatics resources to automate a process, typically undertaken manually, to build a dataset of SDPs. The resulting large dataset, which consists of SDPs in enzymes, enables us to characterize SDPs in terms of their physicochemical and evolutionary properties. It also facilitates the large-scale evaluation of sequence-based SDP prediction methods. We present a simple sequence-based SDP prediction method, GroupSim, and show that, surprisingly, it is competitive with a representative set of current methods. We also describe ConsWin, a heuristic that considers sequence conservation of neighboring amino acids, and demonstrate that it improves the performance of all methods tested on our large dataset of enzyme SDPs. Datasets and GroupSim code are available online at http://compbio.cs.princeton.edu/specificity/. Supplementary data are available at Bioinformatics online.

Understanding the link between social and emotional well-being and peer relations in early adolescence: gender-specific predictors of peer acceptance.

PubMed

Oberle, Eva; Schonert-Reichl, Kimberly A; Thomson, Kimberly C

2010-11-01

Past studies have investigated relationships between peer acceptance and peer-rated social behaviors. However, relatively little is known about the manner in which indices of well-being such as optimism and positive affect may predict peer acceptance above and beyond peer ratings of antisocial and prosocial behaviors. Early adolescence-roughly between the ages of 9 and 14-is a time in the life span in which individuals undergo a myriad of changes at many different levels, such as changes due to cognitive development, pubertal development, and social role redefinitions. The present study investigated the relationship of self-reported affective empathy, optimism, anxiety (trait measures), and positive affect (state measure) to peer-reported peer acceptance in 99 (43% girls) 4th and 5th grade early adolescents. Because our preliminary analyses revealed gender-specific patterns, hierarchical regression analyses were conducted to investigate the predictors of peer acceptance separately for boys and for girls. Girls' acceptance of peers was significantly predicted by higher levels of empathy and optimism, and lower positive affect. For boys, higher positive affect, lower empathy, and lower anxiety significantly predicted peer acceptance. The results emphasize the importance of including indices of social and emotional well-being in addition to peer-ratings in understanding peer acceptance in early adolescence, and urge for more research on gender-specific peer acceptance.

Prediction of venous wound healing with laser speckle imaging.

PubMed

van Vuuren, Timme Maj; Van Zandvoort, Carina; Doganci, Suat; Zwiers, Ineke; tenCate-Hoek, Arina J; Kurstjens, Ralph Lm; Wittens, Cees Ha

2017-12-01

Introduction Laser speckle imaging is used for noninvasive assessment of blood flow of cutaneous wounds. The aim of this study was to assess if laser speckle imaging can be used as a predictor of venous ulcer healing. Methods After generating the flux speckle images, three regions of interest (ROI) were identified to measure the flow. Sensitivity, specificity, negative predictive value, and positive predictive value for ulcer healing were calculated. Results In total, 17 limbs were included. A sensitivity of 92.3%, specificity of 75.0%, PPV of 80.0%, and NPV 75.0% were found in predicting wound healing based on laser speckle images. Mean flux values were lowest in the center (ROI I) and showed an increase at the wound edge (ROI II, p = 0.03). Conclusion Laser speckle imaging shows acceptable sensitivity and specificity rates in predicting venous ulcer healing. The wound edge proved to be the best probability for the prediction of wound healing.

Positive surgical margins after robotic assisted radical prostatectomy: a multi-institutional study.

PubMed

Patel, Vipul R; Coelho, Rafael F; Rocco, Bernardo; Orvieto, Marcelo; Sivaraman, Ananthakrishnan; Palmer, Kenneth J; Kameh, Darien; Santoro, Luigi; Coughlin, Geoff D; Liss, Michael; Jeong, Wooju; Malcolm, John; Stern, Joshua M; Sharma, Saurabh; Zorn, Kevin C; Shikanov, Sergey; Shalhav, Arieh L; Zagaja, Gregory P; Ahlering, Thomas E; Rha, Koon H; Albala, David M; Fabrizio, Michael D; Lee, David I; Chauhan, Sanket

2011-08-01

Positive surgical margins are an independent predictive factor for biochemical recurrence after radical prostatectomy. We analyzed the incidence of and associative factors for positive surgical margins in a multi-institutional series of 8,418 robotic assisted radical prostatectomies. We analyzed the records of 8,418 patients who underwent robotic assisted radical prostatectomy at 7 institutions. Of the patients 323 had missing data on margin status. Positive surgical margins were categorized into 4 groups, including apex, bladder neck, posterolateral and multifocal. The records of 6,169 patients were available for multivariate analysis. The variables entered into the logistic regression models were age, body mass index, preoperative prostate specific antigen, biopsy Gleason score, prostate weight and pathological stage. A second model was built to identify predictive factors for positive surgical margins in the subset of patients with organ confined disease (pT2). The overall positive surgical margin rate was 15.7% (1,272 of 8,095 patients). The positive surgical margin rate for pT2 and pT3 disease was 9.45% and 37.2%, respectively. On multivariate analysis pathological stage (pT2 vs pT3 OR 4.588, p<0.001) and preoperative prostate specific antigen (4 or less vs greater than 10 ng/ml OR 2.918, p<0.001) were the most important independent predictive factors for positive surgical margins after robotic assisted radical prostatectomy. Increasing prostate weight was associated with a lower risk of positive surgical margins after robotic assisted radical prostatectomy (OR 0.984, p<0.001) and a higher body mass index was associated with a higher risk of positive surgical margins (OR 1.032, p<0.001). For organ confined disease preoperative prostate specific antigen was the most important factor that independently correlated with positive surgical margins (4 or less vs greater than 10 ng/ml OR 3.8, p<0.001). The prostatic apex followed by a posterolateral site was the most common location of positive surgical margins after robotic assisted radical prostatectomy. Factors that correlated with cancer aggressiveness, such as pathological stage and preoperative prostate specific antigen, were the most important factors independently associated with an increased risk of positive surgical margins after robotic assisted radical prostatectomy. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Diagnostic value of the basophil activation test in evaluating Hymenoptera venom sensitization.

PubMed

Peternelj, Andreja; Silar, Mira; Bajrovic, Nissera; Adamic, Katja; Music, Ema; Kosnik, Mitja; Korosec, Peter

2009-01-01

Diagnosis of allergy to Hymenoptera venom is usually confirmed with skin testing and measurement of specific serum IgE antibody, tests which are sometimes inconclusive. In these cases, additional in vitro tests are necessary. The aim of this study was to show the applicability of the basophil activation test in detecting sensitization to Hymenoptera venom and to compare the test sensitivity and clinical positive-predictive value with skin prick tests and measurement of allergen-specific serum IgE. This prospective study was conducted between June 2004 and December 2007 and included a large group of 204 patients. All patients had a history of at least one systemic allergic reaction of Müller grades II-IV after a Hymenoptera sting. We compared results of the basophil activation test, specific serum IgE and skin prick tests with patients' clinical history and data on culprit insects. The overall clinical sensitivities of the basophil activation test, specific serum IgE and skin prick tests were 90%, 76% and 64%, respectively; the clinical positive-predictive values of the three tests were 79%, 73% and 78% for bee venom, 86%, 59% and 43% for wasp venom; and 84%, 77% and 22% for both venoms. Our results revealed a higher clinical sensitivity and comparable or better clinical positive-predictive value of basophil activation tests than skin prick tests and allergen-specific serum IgE in the detection of allergy to Hymenoptera venom.

Differential effects of self-esteem and interpersonal competence on humor styles

PubMed Central

McCosker, Bernadette; Moran, Carmen C

2012-01-01

Background In contrast with an early implicit “facilitative hypothesis” of humor, a revised specificity hypothesis predicts that the benefits of humor depend on the specific style of humor used. Information on predictors of these humor styles in turn enhances the ability to predict the effect on well-being. Methods We examined the relationships between interpersonal competence, self-esteem, and different styles of humor, while also examining the contributions of age and gender. Participants (n = 201) aged 18–63 years completed the Rosenberg Self-Esteem Inventory, the Interpersonal Competence Questionnaire, and the Humor Styles Questionnaire, and gave demographic information. Results High self-esteem was associated with higher use of affiliative, aggressive, and self-enhancing humor styles, but lower use of self-defeating humor. High interpersonal competence predicted greater use of affiliative humor, whereas low interpersonal competence predicted greater use of aggressive humor. Further analyses showed that initiation competence predicted affiliative humor (positively) but both initiation competence (positively) and conflict management competence (negatively) predicted aggressive humor. Conclusion The findings that both self-esteem and initiation competence contribute to use of aggressive humor add to knowledge of who is likely to use this potentially harmful humor style. We conclude that a readiness to initiate humorous interactions is not on its own a general and positive attribute contributing to “good” humor. PMID:23180973

Accuracy of ultrasound in the detection of liver fibrosis in chronic viral hepatitis.

PubMed

D'Onofrio, Mirko; Martone, Enrico; Brunelli, Silvia; Faccioli, Niccolò; Zamboni, Giulia; Zagni, Irene; Fattovich, Giovanna; Pozzi Mucelli, Roberto

2005-10-01

To assess the accuracy of ultrasonography (US) in the identification and grading of hepatic fibrosis in patients afflicted with chronic viral liver disease, compared to histological examination as a gold standard. We prospectively studied 105 patients (32 F, 73 M) affected by chronic viral liver disease in 36 months. Patients were studied with B-mode US and then underwent US-guided liver biopsy. All the patients were studied with conventional US with a Sequoia 512, 6.0 (Acuson, Mountain View CA, USA). We evaluated the following US parameters: liver margins, parenchymal echotexture, portal vein caliber and spleen diameter. The four B-mode US parameters were used for the US grading (from 0 to 4). Scheuer's grading (from 0 to 4) was used for the histological score. Grades 3 and 4 were considered as positive for fibrosis. Sensitivity, specificity, positive and negative predictive values and accuracy were calculated in the case of absence, positivity of one or all the US parameters. The correlation between US and histological scores was evaluated with Spearman's test. At histology seventy-seven patients (73%) had absent grade 0 (1 patient; 1%), low-moderate grade 1 (35 patients; 33%) or grade 2 (41 patients; 39%) liver fibrosis. Twenty-eight patients (27%) had severe grade 3 (16 patients; 15%) or grade 4 (12 patients; 11%) fibrosis. In the case of absence of US parameters sensitivity was 32%, specificity 32%, positive predictive value 15%, negative predictive value 57% and accuracy 32%. In the case of positivity of at least one of the US parameters the values were 68%, 68%, 43%, 84% and 69%. In the case of presence of all the US signs the results were 25%, 100%, 100%, 79% and 80%. None of the 77 patients with a healthy liver or with low-grade fibrosis was positive for all the US parameters. All the patients positive for all of the ultrasonographic parameters had high-grade fibrosis or cirrhosis at liver biopsy. Correlation between B-mode and histological scores was not statistically significant (Rs=0.45; p=0.0001). US identification of liver fibrosis in chronic liver disease is possible with 25% sensitivity, 100% specificity, 100% positive predictive value and 79% negative predictive value, with an 80% diagnostic accuracy.

Association between Gallbladder Ultrasound Findings and Bacterial Culture of Bile in 70 Cats and 202 Dogs.

PubMed

Policelli Smith, R; Gookin, J L; Smolski, W; Di Cicco, M F; Correa, M; Seiler, G S

2017-09-01

Bacterial cholecystitis often is diagnosed by combination of gallbladder ultrasound (US) findings and positive results of bile culture. The value of gallbladder US in determining the likelihood of bile bacterial infection in cats and dogs with suspected biliary disease is unknown. To determine the value of gallbladder US in predicting bile bacterial culture results, identify most common bacterial isolates from bile, and describe complications after cholecystocentesis in cats and dogs with suspected hepatobiliary disease. Cats (70) and dogs (202) that underwent an abdominal US and submission of bile for culture were included in the study. A cross-sectional study design was used to determine the association of gallbladder US abnormalities and the results of bile cultures, and complications of cholecystocentesis. Abnormal gallbladder US had high sensitivity (96%) but low specificity (49%) in cats with positive and negative results of bile bacterial culture, respectively. Cats with normal gallbladder US findings were unlikely to have positive bile bacterial culture (negative predictive value of 96%). Gallbladder US had lower sensitivity (81%), specificity (31%), positive predictive value (20%), and negative predictive value (88%) in dogs. The most common bacterial isolates were of enteric origin, the prevalence being higher in cats. Incidence of complications after cholecystocentesis was 3.4%. Gallbladder US has a high negative predictive value for bile culture results in cats. This modality is less predictive of infection in dogs. Percutaneous US-guided cholecystocentesis has a low complication rate. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Pride attenuates nonconscious mimicry.

PubMed

Dickens, Leah; DeSteno, David

2014-02-01

Positive affect has been associated with increased nonconscious mimicry-an association that is quite logical given ties between positive mood and desires for social bonding. Yet positive emotions vary with respect to function, leading to the prediction that not all positive states might similarly increase mimicry. Pride, due to its association with higher status and self-focus, could be expected to attenuate affiliative behaviors such as mimicry. Participants in the present study were induced to experience one of three affective states (neutral, pride, general positivity), after which they interacted with a confederate who expressed a specific, neutral nonverbal behavior (i.e., foot shaking). Supporting past research, participants experiencing general positive affect evidenced greater mimicry as compared to participants in a neutral mood. In accord with predictions, participants experiencing pride mimicked the confederate's behavior significantly less than did those experiencing general positive affect or a neutral state. Regression analyses also confirmed that increasing intensities of pride predicted decreasing mimicry. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Validation of diabetes mellitus and hypertension diagnosis in computerized medical records in primary health care

PubMed Central

2011-01-01

Background Computerized Clinical Records, which are incorporated in primary health care practice, have great potential for research. In order to use this information, data quality and reliability must be assessed to prevent compromising the validity of the results. The aim of this study is to validate the diagnosis of hypertension and diabetes mellitus in the computerized clinical records of primary health care, taking the diagnosis criteria established in the most prominently used clinical guidelines as the gold standard against which what measure the sensitivity, specificity, and determine the predictive values. The gold standard for diabetes mellitus was the diagnostic criteria established in 2003 American Diabetes Association Consensus Statement for diabetic subjects. The gold standard for hypertension was the diagnostic criteria established in the Joint National Committee published in 2003. Methods A cross-sectional multicentre validation study of diabetes mellitus and hypertension diagnoses in computerized clinical records of primary health care was carried out. Diagnostic criteria from the most prominently clinical practice guidelines were considered for standard reference. Sensitivity, specificity, positive and negative predictive values, and global agreement (with kappa index), were calculated. Results were shown overall and stratified by sex and age groups. Results The agreement for diabetes mellitus with the reference standard as determined by the guideline was almost perfect (κ = 0.990), with a sensitivity of 99.53%, a specificity of 99.49%, a positive predictive value of 91.23% and a negative predictive value of 99.98%. Hypertension diagnosis showed substantial agreement with the reference standard as determined by the guideline (κ = 0.778), the sensitivity was 85.22%, the specificity 96.95%, the positive predictive value 85.24%, and the negative predictive value was 96.95%. Sensitivity results were worse in patients who also had diabetes and in those aged 70 years or over. Conclusions Our results substantiate the validity of using diagnoses of diabetes and hypertension found within the computerized clinical records for epidemiologic studies. PMID:22035202

Utility of prior cultures in predicting antibiotic resistance of bloodstream infections due to Gram-negative pathogens: a multicentre observational cohort study.

PubMed

MacFadden, D R; Coburn, B; Shah, N; Robicsek, A; Savage, R; Elligsen, M; Daneman, N

2018-05-01

Appropriate empiric antibiotic therapy in patients with bloodstream infections due to Gram-negative pathogens can improve outcomes. We evaluated the utility of prior microbiologic results for guiding empiric treatment in Gram-negative bloodstream infections. We conducted a multicentre observational cohort study in two large health systems in Canada and the United States, including 1832 hospitalized patients with Gram-negative bloodstream infection (community, hospital and intensive care unit acquired) from April 2010 to March 2015. Among 1832 patients with Gram-negative bloodstream infection, 28% (n = 504) of patients had a documented prior Gram-negative organism from a nonscreening culture within the previous 12 months. A most recent prior Gram-negative organism resistant to a given antibiotic was strongly predictive of the current organism's resistance to the same antibiotic. The overall specificity was 0.92 (95% confidence interval (CI) 0.91-0.93), and positive predictive value was 0.66 (95% CI 0.61-0.70) for predicting antibiotic resistance. Specificities and positive predictive values ranged from 0.77 to 0.98 and 0.43 to 0.78, respectively, across different antibiotics, organisms and patient subgroups. Increasing time between cultures was associated with a decrease in positive predictive value but not specificity. An heuristic based on a prior resistant Gram-negative pathogen could have been applied to one in four patients and in these patients would have changed therapy in one in five. In patients with a bloodstream infection with a Gram-negative organism, identification of a most recent prior Gram-negative organism resistant to a drug of interest (within the last 12 months) is highly specific for resistance and should preclude use of that antibiotic. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

The efficacy of the reverse contrast mode in digital radiography for the detection of proximal dentinal caries

PubMed Central

Miri, Shimasadat; Mehralizadeh, Sandra; Sadri, Donya; Motamedi, Mahmood Reza Kalantar

2015-01-01

Purpose This study evaluated the diagnostic accuracy of the reverse contrast mode in intraoral digital radiography for the detection of proximal dentinal caries, in comparison with the original digital radiographs. Materials and Methods Eighty extracted premolars with no clinically apparent caries were selected, and digital radiographs of them were taken separately in standard conditions. Four observers examined the original radiographs and the same radiographs in the reverse contrast mode with the goal of identifying proximal dentinal caries. Microscopic sections 5 µm in thickness were prepared from the teeth in the mesiodistal direction. Four slides prepared from each sample used as the diagnostic gold standard. The data were analyzed using SPSS (α=0.05). Results Our results showed that the original radiographs in order to identify proximal dentinal caries had the following values for sensitivity, specificity, positive predictive value, negative predictive value, and accuracy, respectively: 72.5%, 90%, 87.2%, 76.5%, and 80.9%. For the reverse contrast mode, however, the corresponding values were 63.1%, 89.4%, 87.1%, 73.5%, and 78.8%, respectively. The sensitivity of original digital radiograph for detecting proximal dentinal caries was significantly higher than that of reverse contrast mode (p<0.05). However, no statistically significant differences were found regarding specificity, positive predictive value, negative predictive value, or accuracy (p>0.05). Conclusion The sensitivity of the original digital radiograph for detecting proximal dentinal caries was significantly higher than that of the reversed contrast images. However, no statistically significant differences were found between these techniques regarding specificity, positive predictive value, negative predictive value, or accuracy. PMID:26389055

Diagnostic performance of dual-energy CT stress myocardial perfusion imaging: direct comparison with cardiovascular MRI.

PubMed

Ko, Sung Min; Song, Meong Gun; Chee, Hyun Kun; Hwang, Hweung Kon; Feuchtner, Gudrun Maria; Min, James K

2014-12-01

The purpose of this study was to assess the diagnostic performance of stress perfusion dual-energy CT (DECT) and its incremental value when used with coronary CT angiography (CTA) for identifying hemodynamically significant coronary artery disease. One hundred patients with suspected or known coronary artery disease without chronic myocardial infarction detected with coronary CTA underwent stress perfusion DECT, stress cardiovascular perfusion MRI, and invasive coronary angiography (ICA). Stress perfusion DECT and cardiovascular stress perfusion MR images were used for detecting perfusion defects. Coronary CTA and ICA were evaluated in the detection of ≥50% coronary stenosis. The diagnostic performance of coronary CTA for detecting hemo-dynamically significant stenosis was assessed before and after stress perfusion DECT on a per-vessel basis with ICA and cardiovascular stress perfusion MRI as the reference standard. The performance of stress perfusion DECT compared with cardiovascular stress perfusion MRI on a per-vessel basis in the detection of perfusion defects was sensitivity, 89%; specificity, 74%; positive predictive value, 73%; negative predictive value, 90%. Per segment, these values were sensitivity, 76%; specificity, 80%; positive predictive value, 63%; and negative predictive value, 88%. Compared with ICA and cardiovascular stress perfusion MRI per vessel territory the sensitivity, specificity, positive predictive value, and negative predictive value of coronary CTA were 95%, 61%, 61%, and 95%. The values for stress perfusion DECT were 92%, 72%, 68%, and 94%. The values for coronary CTA and stress perfusion DECT were 88%, 79%, 73%, and 91%. The ROC AUC increased from 0.78 to 0.84 (p=0.02) with the use of coronary CTA and stress perfusion DECT compared with coronary CTA alone. Stress perfusion DECT plays a complementary role in enhancing the accuracy of coronary CTA for identifying hemodynamically significant coronary stenosis.

THE PANC 3 SCORE PREDICTING SEVERITY OF ACUTE PANCREATITIS.

PubMed

Beduschi, Murilo Gamba; Mello, André Luiz Parizi; VON-Mühlen, Bruno; Franzon, Orli

2016-03-01

About 20% of cases of acute pancreatitis progress to a severe form, leading to high mortality rates. Several studies suggested methods to identify patients that will progress more severely. However, most studies present problems when used on daily practice. To assess the efficacy of the PANC 3 score to predict acute pancreatitis severity and its relation to clinical outcome. Acute pancreatitis patients were assessed as to sex, age, body mass index (BMI), etiology of pancreatitis, intensive care need, length of stay, length of stay in intensive care unit and mortality. The PANC 3 score was determined within the first 24 hours after diagnosis and compared to acute pancreatitis grade of the Revised Atlanta classification. Out of 64 patients diagnosed with acute pancreatitis, 58 met the inclusion criteria. The PANC 3 score was positive in five cases (8.6%), pancreatitis progressed to a severe form in 10 cases (17.2%) and five patients (8.6%) died. Patients with a positive score and severe pancreatitis required intensive care more often, and stayed for a longer period in intensive care units. The PANC 3 score showed sensitivity of 50%, specificity of 100%, accuracy of 91.4%, positive predictive value of 100% and negative predictive value of 90.6% in prediction of severe acute pancreatitis. The PANC 3 score is useful to assess acute pancreatitis because it is easy and quick to use, has high specificity, high accuracy and high predictive value in prediction of severe acute pancreatitis.

THE PANC 3 SCORE PREDICTING SEVERITY OF ACUTE PANCREATITIS

PubMed Central

BEDUSCHI, Murilo Gamba; MELLO, André Luiz Parizi; VON-MÜHLEN, Bruno; FRANZON, Orli

2016-01-01

Background : About 20% of cases of acute pancreatitis progress to a severe form, leading to high mortality rates. Several studies suggested methods to identify patients that will progress more severely. However, most studies present problems when used on daily practice. Objective : To assess the efficacy of the PANC 3 score to predict acute pancreatitis severity and its relation to clinical outcome. Methods : Acute pancreatitis patients were assessed as to sex, age, body mass index (BMI), etiology of pancreatitis, intensive care need, length of stay, length of stay in intensive care unit and mortality. The PANC 3 score was determined within the first 24 hours after diagnosis and compared to acute pancreatitis grade of the Revised Atlanta classification. Results : Out of 64 patients diagnosed with acute pancreatitis, 58 met the inclusion criteria. The PANC 3 score was positive in five cases (8.6%), pancreatitis progressed to a severe form in 10 cases (17.2%) and five patients (8.6%) died. Patients with a positive score and severe pancreatitis required intensive care more often, and stayed for a longer period in intensive care units. The PANC 3 score showed sensitivity of 50%, specificity of 100%, accuracy of 91.4%, positive predictive value of 100% and negative predictive value of 90.6% in prediction of severe acute pancreatitis. Conclusion : The PANC 3 score is useful to assess acute pancreatitis because it is easy and quick to use, has high specificity, high accuracy and high predictive value in prediction of severe acute pancreatitis. PMID:27120730

Prediction of obeche wood-induced asthma by specific skin prick testing.

PubMed

Hannu, T; Lindström, I; Palmroos, P; Kuuliala, O; Sauni, R

2013-09-01

It has previously been shown that a positive skin prick test (SPT) result is a good predictor of a positive specific inhalation challenge (SIC) in patients with occupational asthma (OA) related to wheat or rye flours. This association has not been previously studied in OA attributable to obeche wood. To describe a clinical series of patients with OA induced by obeche wood. To investigate if the SPT result can be used as a predictor for the outcome of SIC tests. OA was diagnosed according to patient history, lung function examinations and SIC tests, as well as the determination of obeche SPTs. We analysed sensitivity, specificity and positive (PPV) and negative predictive values (NPV) at different wheal sizes of the SPTs and drew receiver-operating characteristic plots using the SIC test result as the gold standard. Obeche wood SIC tests were performed on 34 symptomatic workers. Of these, 27 workers had a positive test result and were diagnosed as having OA. The minimal cut-off value with a PPV of 100% was an SPT wheal of 3.5 mm from obeche wood. This means that all workers with a wheal size of ≥ 3.5 mm from obeche wood had a positive SIC. Positive SPT results in symptomatic workers were good predictors of a positive SIC. SIC with obeche wood may be unnecessary in strongly sensitized workers.

A Multivariate Model of Stakeholder Preference for Lethal Cat Management

PubMed Central

Wald, Dara M.; Jacobson, Susan K.

2014-01-01

Identifying stakeholder beliefs and attitudes is critical for resolving management conflicts. Debate over outdoor cat management is often described as a conflict between two groups, environmental advocates and animal welfare advocates, but little is known about the variables predicting differences among these critical stakeholder groups. We administered a mail survey to randomly selected stakeholders representing both of these groups (n = 1,596) in Florida, where contention over the management of outdoor cats has been widespread. We used a structural equation model to evaluate stakeholder intention to support non-lethal management. The cognitive hierarchy model predicted that values influenced beliefs, which predicted general and specific attitudes, which in turn, influenced behavioral intentions. We posited that specific attitudes would mediate the effect of general attitudes, beliefs, and values on management support. Model fit statistics suggested that the final model fit the data well (CFI = 0.94, RMSEA = 0.062). The final model explained 74% of the variance in management support, and positive attitudes toward lethal management (humaneness) had the largest direct effect on management support. Specific attitudes toward lethal management and general attitudes toward outdoor cats mediated the relationship between positive (p<0.05) and negative cat-related impact beliefs (p<0.05) and support for management. These results supported the specificity hypothesis and the use of the cognitive hierarchy to assess stakeholder intention to support non-lethal cat management. Our findings suggest that stakeholders can simultaneously perceive both positive and negative beliefs about outdoor cats, which influence attitudes toward and support for non-lethal management. PMID:24736744

A multivariate model of stakeholder preference for lethal cat management.

PubMed

Wald, Dara M; Jacobson, Susan K

2014-01-01

Identifying stakeholder beliefs and attitudes is critical for resolving management conflicts. Debate over outdoor cat management is often described as a conflict between two groups, environmental advocates and animal welfare advocates, but little is known about the variables predicting differences among these critical stakeholder groups. We administered a mail survey to randomly selected stakeholders representing both of these groups (n=1,596) in Florida, where contention over the management of outdoor cats has been widespread. We used a structural equation model to evaluate stakeholder intention to support non-lethal management. The cognitive hierarchy model predicted that values influenced beliefs, which predicted general and specific attitudes, which in turn, influenced behavioral intentions. We posited that specific attitudes would mediate the effect of general attitudes, beliefs, and values on management support. Model fit statistics suggested that the final model fit the data well (CFI=0.94, RMSEA=0.062). The final model explained 74% of the variance in management support, and positive attitudes toward lethal management (humaneness) had the largest direct effect on management support. Specific attitudes toward lethal management and general attitudes toward outdoor cats mediated the relationship between positive (p<0.05) and negative cat-related impact beliefs (p<0.05) and support for management. These results supported the specificity hypothesis and the use of the cognitive hierarchy to assess stakeholder intention to support non-lethal cat management. Our findings suggest that stakeholders can simultaneously perceive both positive and negative beliefs about outdoor cats, which influence attitudes toward and support for non-lethal management.

Frictionless segmented mechanics for controlled space closure

PubMed Central

Andrade, Ildeu

2017-01-01

ABSTRACT Extraction spaces may be needed to achieve specific orthodontic goals of positioning the dentition in harmony with the craniofacial complex. However, the fundamental reality that determines the occlusion final position is the control exerted by the orthodontist while closing the extraction spaces. A specific treatment objective may require the posterior teeth to remain in a constant position anteroposteriorly as well as vertically, while the anterior teeth occupy the entire extraction site. Another treatment objective may require the opposite, or any number of intentional alternatives of extraction site closure. The present case report describes a simple controlled segmented mechanic system that permitted definable and predictable force systems to be applied and allowed to predict the treatment outcome with confidence. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) in partial fulfillment of the requirements for Diplomate certification. PMID:28444016

Heart imaging: the accuracy of the 64-MSCT in the detection of coronary artery disease.

PubMed

Alessandri, N; Di Matteo, A; Rondoni, G; Petrassi, M; Tufani, F; Ferrari, R; Laghi, A

2009-01-01

At present, coronary angiography represents the gold standard technique for the diagnosis of coronary artery disease. Our aim is to compare the conventional coronary angiography to the coronary 64-multislice spiral computed tomography (64-MSCT), a new and non-invasive cardiac imaging technique. The last generation of MSCT scanners show a better imaging quality, due to a greater spatial and temporal resolution. Four expert observers (two cardiologists and two radiologists) have compared the angiographic data with the accuracy of the 64-MSCT in the detection and evaluation of coronary vessels stenoses. From the data obtained, the sensibility, the specificity and the accuracy of the coronary 64-MSCT have been defined. We have enrolled 75 patients (57 male, 18 female, mean age 61.83 +/- 10.38; range 30-80 years) with known or suspected coronary artery disease. The above population has been divided into 3 groups: Group A (Gr. A) with 40 patients (mean age 60.7 +/- 12.5) affected by both non-significant and significant coronary artery disease; Group B (Gr. B) with 25 patients (mean age 60.3 +/- 14.6) who underwent to percutaneous coronary intervention (PCI); Group C (Gr. C) with 10 patients (mean age 54.20 +/- 13.7) without any coronary angiographic stenoses. All the patients underwent non-invasive exams, conventional coronary angiography and coronary 64-MSCT. The comparison of the data obtained has been carried out according to a per group analysis, per patient analysis and per segment analysis. Moreover, the accuracy of the 64-MSCT has been defined for the detection of >75%, 50-75% and <50% coronary stenoses. Coronary angiography has identified significant coronary artery disease in 75% of the patients in the Gr. A and in 73% of the patients in the Gr. B. No coronary stenoses have been detected in Gr. C. According to a per segment analysis, in Gr. A, 36% of the segments analysed have shown a coronary stenosis (37% stenoses >75%, 32% stenoses 50-75% and 31% stenoses <50%). In Gr. B, 32% of the segments have shown a coronary stenosis (33% stenoses >75%, 29% stenoses 50-75% and 38% stenoses <50%). In-stent disease has been shown in only 4 of the 29 coronary stents identified. In Gr. A, coronary 64-MSCT has confirmed the angiographic results in the 93% of cases (sensibility 93%, specificity 100%, positive predictive value 100% and negative predictive value 83%) while, in Gr. B, this confirm has been obtained only in 64% of cases (sensibility 64%, specificity 100%, positive predictive value 100% and negative predictive value 50%). In Gr. C, we have observed a complete agreement between angiographic and CT data (sensibility, specificity, positive predictive value and negative predictive value 100%). According to a per segment analysis, the angiographic results have been confirmed in 98% of cases in Gr. A (sensibility 98%, specificity 94%, positive predictive value 90% and negative predictive value 94%) but only in 55% of cases in Gr. B (sensibility 55%, specificity 90%, positive predictive value 71% and negative predictive value 81%). Moreover, only 1 of the 4 in-stent restenoses has been detected (sensibility 25%, specificity 100%, positive predictive value 100% and negative predictive value 77%). Coronary angiography has detected a greater number of coronary stenoses than the 64-MSCT. 64-MSCT has demonstrated better accuracy in the study of coronary vessels wider than 2 mm, while its accuracy is lower for smaller vessels (diameter < 2.5 mm) and for the identification of in-stent restenosis, because there is a reduced image quality for these vessels and therefore a lower accuracy in the coronary stenosis detection. Nevertheless, 64-MSCT shows high accuracy and it can be considered a comparative but not a substitutive exam of the coronary angiography. Several technical limitations of the 64-MSCT are responsible of its lower accuracy versus the conventional coronary angiography, but solving these technical problems could give us a new non-invasive imaging technique for the study of coronary stents.

Classification and regression tree (CART) model to predict pulmonary tuberculosis in hospitalized patients.

PubMed

Aguiar, Fabio S; Almeida, Luciana L; Ruffino-Netto, Antonio; Kritski, Afranio Lineu; Mello, Fernanda Cq; Werneck, Guilherme L

2012-08-07

Tuberculosis (TB) remains a public health issue worldwide. The lack of specific clinical symptoms to diagnose TB makes the correct decision to admit patients to respiratory isolation a difficult task for the clinician. Isolation of patients without the disease is common and increases health costs. Decision models for the diagnosis of TB in patients attending hospitals can increase the quality of care and decrease costs, without the risk of hospital transmission. We present a predictive model for predicting pulmonary TB in hospitalized patients in a high prevalence area in order to contribute to a more rational use of isolation rooms without increasing the risk of transmission. Cross sectional study of patients admitted to CFFH from March 2003 to December 2004. A classification and regression tree (CART) model was generated and validated. The area under the ROC curve (AUC), sensitivity, specificity, positive and negative predictive values were used to evaluate the performance of model. Validation of the model was performed with a different sample of patients admitted to the same hospital from January to December 2005. We studied 290 patients admitted with clinical suspicion of TB. Diagnosis was confirmed in 26.5% of them. Pulmonary TB was present in 83.7% of the patients with TB (62.3% with positive sputum smear) and HIV/AIDS was present in 56.9% of patients. The validated CART model showed sensitivity, specificity, positive predictive value and negative predictive value of 60.00%, 76.16%, 33.33%, and 90.55%, respectively. The AUC was 79.70%. The CART model developed for these hospitalized patients with clinical suspicion of TB had fair to good predictive performance for pulmonary TB. The most important variable for prediction of TB diagnosis was chest radiograph results. Prospective validation is still necessary, but our model offer an alternative for decision making in whether to isolate patients with clinical suspicion of TB in tertiary health facilities in countries with limited resources.

Testing Moral Foundation Theory: Are Specific Moral Emotions Elicited by Specific Moral Transgressions?

ERIC Educational Resources Information Center

Landmann, Helen; Hess, Ursula

2018-01-01

Moral foundation theory posits that specific moral transgressions elicit specific moral emotions. To test this claim, participants (N = 195) were asked to rate their emotions in response to moral violation vignettes. We found that compassion and disgust were associated with care and purity respectively as predicted by moral foundation theory.…

miREE: miRNA recognition elements ensemble

PubMed Central

2011-01-01

Background Computational methods for microRNA target prediction are a fundamental step to understand the miRNA role in gene regulation, a key process in molecular biology. In this paper we present miREE, a novel microRNA target prediction tool. miREE is an ensemble of two parts entailing complementary but integrated roles in the prediction. The Ab-Initio module leverages upon a genetic algorithmic approach to generate a set of candidate sites on the basis of their microRNA-mRNA duplex stability properties. Then, a Support Vector Machine (SVM) learning module evaluates the impact of microRNA recognition elements on the target gene. As a result the prediction takes into account information regarding both miRNA-target structural stability and accessibility. Results The proposed method significantly improves the state-of-the-art prediction tools in terms of accuracy with a better balance between specificity and sensitivity, as demonstrated by the experiments conducted on several large datasets across different species. miREE achieves this result by tackling two of the main challenges of current prediction tools: (1) The reduced number of false positives for the Ab-Initio part thanks to the integration of a machine learning module (2) the specificity of the machine learning part, obtained through an innovative technique for rich and representative negative records generation. The validation was conducted on experimental datasets where the miRNA:mRNA interactions had been obtained through (1) direct validation where even the binding site is provided, or through (2) indirect validation, based on gene expression variations obtained from high-throughput experiments where the specific interaction is not validated in detail and consequently the specific binding site is not provided. Conclusions The coupling of two parts: a sensitive Ab-Initio module and a selective machine learning part capable of recognizing the false positives, leads to an improved balance between sensitivity and specificity. miREE obtains a reasonable trade-off between filtering false positives and identifying targets. miREE tool is available online at http://didattica-online.polito.it/eda/miREE/ PMID:22115078

Prediction of occult lymph node metastasis in squamous cell carcinoma of the oral cavity and the oropharynx using peritumoral Prospero homeobox protein 1 lymphatic nuclear quantification.

PubMed

Mermod, Maxime; Bongiovanni, Massimo; Petrova, Tatiana V; Dubikovskaya, Elena A; Simon, Christian; Tolstonog, Genrich; Monnier, Yan

2016-09-01

The use of lymphatic vessel density as a predictor of occult lymph node metastasis (OLNM) in head and neck squamous cell carcinoma (HNSCC) has never been reported. Staining of the specific lymphatic endothelial cells nuclear marker, PROX1, as an indicator of lymphatic vessel density was determined by counting the number of positive cells in squamous cell carcinomas (SCCs) of the oral cavity and the oropharynx with clinically negative necks. Correlation with histopathological data was established. Peritumoral PROX1 lymphatic nuclear count significantly correlated with the detection of OLNM in multivariate analysis (p < .005). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this parameter was 60%, 95%, 85%, and 90%, respectively. Peritumoral PROX1 lymphatic nuclear count in primary SCCs of the oral cavity and the oropharynx allows accurate prediction of occult lymph node metastasis. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1407-1415, 2016. © 2016 Wiley Periodicals, Inc.

[Validity and concordance of electronic health records in primary care (AP-Madrid) for surveillance of diabetes mellitus. PREDIMERC study].

PubMed

Gil Montalbán, Elisa; Ortiz Marrón, Honorato; López-Gay Lucio-Villegas, Dulce; Zorrilla Torrás, Belén; Arrieta Blanco, Francisco; Nogales Aguado, Pedro

2014-01-01

To assess the validity and concordance of diabetes data in the electronic health records of primary care (Madrid-PC) by comparing with those from the PREDIMERC study. The sensitivity, specificity, positive predictive value, negative predictive value and kappa index of diabetes cases recorded in the health records of Madrid-PC were calculated by using data from PREDIMERC as the gold standard. The prevalence of diabetes was also determined according to each data source. The sensitivity of diabetes recorded in Madrid-PC was 74%, the specificity was 98.8%, the positive predictive value was 87.9%, the negative predictive value was 97.3%, and the kappa index was 0.78. The prevalence of diabetes recorded in Madrid-PC was 6.7% versus 8.1% by PREDIMERC, where known diabetes was 6.3%. The electronic health records of primary care are a valid source for epidemiological surveillance of diabetes in Madrid. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

Ghosts, UFOs, and magic: positive affect and the experiential system.

PubMed

King, Laura A; Burton, Chad M; Hicks, Joshua A; Drigotas, Stephen M

2007-05-01

Three studies examined the potential interactions of the experiential system and positive affect (PA) in predicting superstitious beliefs and sympathetic magic. In Study 1, experientiality and induced positive mood interacted to predict the emergence of belief in videos purporting to show unidentified flying objects or ghosts. In Study 2, naturally occurring PA interacted with experientiality to predict susceptibility to sympathetic magic, specifically difficulty in throwing darts at a picture of a baby (demonstrating the law of similarity). In Study 3, induced mood interacted with experientiality to predict sitting farther away from, and expressing less liking for, a partner who had stepped in excrement (demonstrating the law of contagion). Results are interpreted as indicating that PA promotes experiential processing. Implications for the psychology of nonrational beliefs and behaviors are discussed. ((c) 2007 APA, all rights reserved).

Pneumatosis in canine gastric dilatation-volvulus syndrome.

PubMed

Fischetti, Anthony J; Saunders, H Mark; Drobatz, Kenneth J

2004-01-01

Retrospectively, 243 dogs with radiographic evidence of gastric dilatation-volvulus (GDV) were studied for radiographic signs of pneumatosis (intramural gas), pneumoperitoneum, splenomegaly, and severity of gastric distention. The sensitivity, specificity, and predictive value of these imaging signs as predictors of gastric wall necrosis, as determined by visual inspection at surgery or necropsy, were determined. The sensitivity and specificity of gastric pneumatosis were 14.1% and 92.7%, respectively. The prevalence of gastric wall necrosis was 26.6%. The positive and negative predictive values of gastric pneumatosis for predicting gastric necrosis were 40.9% and 74.9%, respectively. Gastric pneumatosis and pneumoperitoneum were identified together in four dogs. Pneumoperitoneum, either alone or in conjunction with pneumatosis, yielded similar results as a test for gastric necrosis. Splenomegaly and severity of gastric distention were insensitive and nonspecific for gastric wall necrosis. Splenomegaly did not predict the need for splenectomy at surgery. Although pneumatosis and pneumoperitoneum are relatively specific signs of gastric wall necrosis, the utility of these signs as a test for gastric necrosis is limited in clinical practice. The significance of pneumatosis should be taken into consideration with previous treatments for gastric decompression, as percutaneous gastric trocharization or orogastric intubation may increase the number of false-positive results.

Diagnostic accuracy and reproducibility of pleural and lung ultrasound in discriminating cardiogenic causes of acute dyspnea in the emergency department.

PubMed

Cibinel, Gian Alfonso; Casoli, Giovanna; Elia, Fabrizio; Padoan, Monica; Pivetta, Emanuele; Lupia, Enrico; Goffi, Alberto

2012-02-01

Dyspnea is a common symptom in patients admitted to the Emergency Department (ED), and discriminating between cardiogenic and non-cardiogenic dyspnea is often a clinical dilemma. The initial diagnostic work-up may be inaccurate in defining the etiology and the underlying pathophysiology. The aim of this study was to evaluate the diagnostic accuracy and reproducibility of pleural and lung ultrasound (PLUS), performed by emergency physicians at the time of a patient's initial evaluation in the ED, in identifying cardiac causes of acute dyspnea. Between February and July 2007, 56 patients presenting to the ED with acute dyspnea were prospectively enrolled in this study. In all patients, PLUS was performed by emergency physicians with the purpose of identifying the presence of diffuse alveolar-interstitial syndrome (AIS) or pleural effusion. All scans were later reviewed by two other emergency physicians, expert in PLUS and blinded to clinical parameters, who were the ultimate judges of positivity for diffuse AIS and pleural effusion. A random set of 80 recorded scannings were also reviewed by two inexperienced observers to assess inter-observer variability. The entire medical record was independently reviewed by two expert physicians (an emergency medicine physician and a cardiologist) blinded to the ultrasound (US) results, in order to determine whether, for each patient, dyspnea was due to heart failure, or not. Sensitivity, specificity, and positive/negative predictive values were obtained; likelihood ratio (LR) test was used. Cohen's kappa was used to assess inter-observer agreement. The presence of diffuse AIS was highly predictive for cardiogenic dyspnea (sensitivity 93.6%, specificity 84%, positive predictive value 87.9%, negative predictive value 91.3%). On the contrary, US detection of pleural effusion was not helpful in the differential diagnosis (sensitivity 83.9%, specificity 52%, positive predictive value 68.4%, negative predictive value 72.2%). Finally, the coexistence of diffuse AIS and pleural effusion is less accurate than diffuse AIS alone for cardiogenic dyspnea (sensitivity 81.5%, specificity 82.8%, positive predictive value 81.5%, negative predictive value 82.8%). The positive LR was 5.8 for AIS [95% confidence interval (CI) 4.8-7.1] and 1.7 (95% CI 1.2-2.6) for pleural effusion, negative LR resulted 0.1 (95% CI 0.0-0.4) for AIS and 0.3 (95% CI 0.1-0.8) for pleural effusion. Agreement between experienced and inexperienced operators was 92.2% (p < 0.01) and 95% (p < 0.01) for diagnosis of AIS and pleural effusion, respectively. In early evaluation of patients presenting to the ED with dyspnea, PLUS, performed with the purpose of identifying diffuse AIS, may represent an accurate and reproducible bedside tool in discriminating between cardiogenic and non-cardiogenic dyspnea. On the contrary, US detection of pleural effusions does not allow reliable discrimination between different causes of acute dyspnea in unselected ED patients.

Poly(A) code analyses reveal key determinants for tissue-specific mRNA alternative polyadenylation

PubMed Central

Weng, Lingjie; Li, Yi; Xie, Xiaohui; Shi, Yongsheng

2016-01-01

mRNA alternative polyadenylation (APA) is a critical mechanism for post-transcriptional gene regulation and is often regulated in a tissue- and/or developmental stage-specific manner. An ultimate goal for the APA field has been to be able to computationally predict APA profiles under different physiological or pathological conditions. As a first step toward this goal, we have assembled a poly(A) code for predicting tissue-specific poly(A) sites (PASs). Based on a compendium of over 600 features that have known or potential roles in PAS selection, we have generated and refined a machine-learning algorithm using multiple high-throughput sequencing-based data sets of tissue-specific and constitutive PASs. This code can predict tissue-specific PASs with >85% accuracy. Importantly, by analyzing the prediction performance based on different RNA features, we found that PAS context, including the distance between alternative PASs and the relative position of a PAS within the gene, is a key feature for determining the susceptibility of a PAS to tissue-specific regulation. Our poly(A) code provides a useful tool for not only predicting tissue-specific APA regulation, but also for studying its underlying molecular mechanisms. PMID:27095026

Predicting HIV RNA virologic outcome at 52-weeks follow-up in antiretroviral clinical trials. The INCAS and AVANTI Study Groups.

PubMed

Raboud, J M; Rae, S; Montaner, J S

2000-08-15

To determine the ability of intermediate plasma viral load (pVL) measurements to predict virologic outcome at 52 weeks of follow-up in clinical trials of antiretroviral therapy. Individual patient data from three clinical trials (INCAS, AVANTI-2 and AVANTI-3) were combined into a single database. Virologic success was defined to be plasma viral load (pVL) <500 copies/ml at week 52. The sensitivity and specificity of intermediate pVL measurements below the limit of detection, 100, 500, 1000, and 5000 copies/ml to predict virologic success were calculated. The sensitivity, specificity, and positive and negative predictive values of a pVL measurement <1000 copies/ml at week 16 to predict virologic outcome at week 52 were 74%, 74%, 48%, and 90%, respectively, for patients on double therapy. For patients on triple therapy, the sensitivity, specificity, and positive and negative predictive values of a pVL measurement <50 copies/ml at week 16 to predict virologic outcome were 68%, 68%, 80%, and 47%, respectively. For patients receiving double therapy, a poor virologic result at an intermediate week of follow-up is a strong indicator of virologic failure at 52 weeks whereas intermediate virologic success is no guarantee of success at 1 year. For patients on triple therapy, disappointing intermediate results do not preclude virologic success at 1 year and intermediate successes are more likely to be sustained.

Predictive value and construct validity of the work functioning screener-healthcare (WFS-H).

PubMed

Boezeman, Edwin J; Nieuwenhuijsen, Karen; Sluiter, Judith K

2016-05-25

To test the predictive value and convergent construct validity of a 6-item work functioning screener (WFS-H). Healthcare workers (249 nurses) completed a questionnaire containing the work functioning screener (WFS-H) and a work functioning instrument (NWFQ) measuring the following: cognitive aspects of task execution and general incidents, avoidance behavior, conflicts and irritation with colleagues, impaired contact with patients and their family, and level of energy and motivation. Productivity and mental health were also measured. Negative and positive predictive values, AUC values, and sensitivity and specificity were calculated to examine the predictive value of the screener. Correlation analysis was used to examine the construct validity. The screener had good predictive value, since the results showed that a negative screener score is a strong indicator of work functioning not hindered by mental health problems (negative predictive values: 94%-98%; positive predictive values: 21%-36%; AUC:.64-.82; sensitivity: 42%-76%; and specificity 85%-87%). The screener has good construct validity due to moderate, but significant (p<.001), associations with productivity (r=.51), mental health (r=.48), and distress (r=.47). The screener (WFS-H) had good predictive value and good construct validity. Its score offers occupational health professionals a helpful preliminary insight into the work functioning of healthcare workers.

Health Communication in Social Media: Message Features Predicting User Engagement on Diabetes-Related Facebook Pages.

PubMed

Rus, Holly M; Cameron, Linda D

2016-10-01

Social media provides unprecedented opportunities for enhancing health communication and health care, including self-management of chronic conditions such as diabetes. Creating messages that engage users is critical for enhancing message impact and dissemination. This study analyzed health communications within ten diabetes-related Facebook pages to identify message features predictive of user engagement. The Common-Sense Model of Illness Self-Regulation and established health communication techniques guided content analyses of 500 Facebook posts. Each post was coded for message features predicted to engage users and numbers of likes, shares, and comments during the week following posting. Multi-level, negative binomial regressions revealed that specific features predicted different forms of engagement. Imagery emerged as a strong predictor; messages with images had higher rates of liking and sharing relative to messages without images. Diabetes consequence information and positive identity predicted higher sharing while negative affect, social support, and crowdsourcing predicted higher commenting. Negative affect, crowdsourcing, and use of external links predicted lower sharing while positive identity predicted lower commenting. The presence of imagery weakened or reversed the positive relationships of several message features with engagement. Diabetes control information and negative affect predicted more likes in text-only messages, but fewer likes when these messages included illustrative imagery. Similar patterns of imagery's attenuating effects emerged for the positive relationships of consequence information, control information, and positive identity with shares and for positive relationships of negative affect and social support with comments. These findings hold promise for guiding communication design in health-related social media.

Preoperative Serum Thyrotropin to Thyroglobulin Ratio Is Effective for Thyroid Nodule Evaluation in Euthyroid Patients.

PubMed

Wang, Lina; Li, Hao; Yang, Zhongyuan; Guo, Zhuming; Zhang, Quan

2015-07-01

This study was designed to assess the efficiency of the serum thyrotropin to thyroglobulin ratio for thyroid nodule evaluation in euthyroid patients. Cross-sectional study. Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China. Retrospective analysis was performed for 400 previously untreated cases presenting with thyroid nodules. Thyroid function was tested with commercially available radioimmunoassays. The receiver operating characteristic curves were constructed to determine cutoff values. The efficacy of the thyrotropin:thyroglobulin ratio and thyroid-stimulating hormone for thyroid nodule evaluation was evaluated in terms of sensitivity, specificity, positive predictive value, positive likelihood ratio, negative likelihood ratio, and odds ratio. In receiver operating characteristic curve analysis, the area under the curve was 0.746 for the thyrotropin:thyroglobulin ratio and 0.659 for thyroid-stimulating hormone. With a cutoff point value of 24.97 IU/g for the thyrotropin:thyroglobulin ratio, the sensitivity, specificity, positive predictive value, positive likelihood ratio, and negative likelihood ratio were 78.9%, 60.8%, 75.5%, 2.01, and 0.35, respectively. The odds ratio for the thyrotropin:thyroglobulin ratio indicating malignancy was 5.80. With a cutoff point value of 1.525 µIU/mL for thyroid-stimulating hormone, the sensitivity, specificity, positive predictive value, positive likelihood ratio, and negative likelihood ratio were 74.0%, 53.2%, 70.8%, 1.58, and 0.49, respectively. The odds ratio indicating malignancy for thyroid-stimulating hormone was 3.23. Increasing preoperative serum thyrotropin:thyroglobulin ratio is a risk factor for thyroid carcinoma, and the correlation of the thyrotropin:thyroglobulin ratio to malignancy is higher than that for serum thyroid-stimulating hormone. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Exercise testing after beta-blockade: improved specificity and predictive value in detecting coronary heart disease.

PubMed Central

Marcomichelakis, J; Donaldson, R; Green, J; Joseph, S; Kelly, H B; Taggart, P; Somerville, W

1980-01-01

The value of exercise testing in detecting myocardial ischaemia resulting from coronary atheroma remains controversial. In order to increase the reliability of exercise testing, all its components (asymptomatic, haemodynamic, and electrocardiographic) have been scrutinised. In this study, concerned only with the electrocardiographic response to exercise, the incorporation of beta-blockade into the standard exercise procedure has improved specificity and predictive value without affecting sensitivity. Fifty patients with anginal pain and 50 asymptomatic subjects with an abnormal electrocardiogram were investigated by exercise testing before and after beta-blockade (oxprenolol). All subjects had coronary arteriograms and left ventriculograms, and the results of exercise testing were related to the presence or absence of obstructive coronary artery disease. Possible causes of false positive exercise tests were eliminated by echocardiography. Though beta-blockade was unreliable in distinguishing ischaemic from non-ischaemic resting electrocardiograms, it eliminated all the false positive electrocardiographic responses to exercise in both groups and did not abolish any of the true positive electrocardiographic responses. Thus, specificity and predictive value were improved without reduction in sensitivity. This technique may not necessarily be applicable to other groups of patients or to a random population, but the results of this study suggest it will be a useful additional routine procedure in the investigation of coronary heart disease. PMID:7437172

Evaluation and comparison of statistical methods for early temporal detection of outbreaks: A simulation-based study

PubMed Central

Le Strat, Yann

2017-01-01

The objective of this paper is to evaluate a panel of statistical algorithms for temporal outbreak detection. Based on a large dataset of simulated weekly surveillance time series, we performed a systematic assessment of 21 statistical algorithms, 19 implemented in the R package surveillance and two other methods. We estimated false positive rate (FPR), probability of detection (POD), probability of detection during the first week, sensitivity, specificity, negative and positive predictive values and F1-measure for each detection method. Then, to identify the factors associated with these performance measures, we ran multivariate Poisson regression models adjusted for the characteristics of the simulated time series (trend, seasonality, dispersion, outbreak sizes, etc.). The FPR ranged from 0.7% to 59.9% and the POD from 43.3% to 88.7%. Some methods had a very high specificity, up to 99.4%, but a low sensitivity. Methods with a high sensitivity (up to 79.5%) had a low specificity. All methods had a high negative predictive value, over 94%, while positive predictive values ranged from 6.5% to 68.4%. Multivariate Poisson regression models showed that performance measures were strongly influenced by the characteristics of time series. Past or current outbreak size and duration strongly influenced detection performances. PMID:28715489

PreCisIon: PREdiction of CIS-regulatory elements improved by gene's positION.

PubMed

Elati, Mohamed; Nicolle, Rémy; Junier, Ivan; Fernández, David; Fekih, Rim; Font, Julio; Képès, François

2013-02-01

Conventional approaches to predict transcriptional regulatory interactions usually rely on the definition of a shared motif sequence on the target genes of a transcription factor (TF). These efforts have been frustrated by the limited availability and accuracy of TF binding site motifs, usually represented as position-specific scoring matrices, which may match large numbers of sites and produce an unreliable list of target genes. To improve the prediction of binding sites, we propose to additionally use the unrelated knowledge of the genome layout. Indeed, it has been shown that co-regulated genes tend to be either neighbors or periodically spaced along the whole chromosome. This study demonstrates that respective gene positioning carries significant information. This novel type of information is combined with traditional sequence information by a machine learning algorithm called PreCisIon. To optimize this combination, PreCisIon builds a strong gene target classifier by adaptively combining weak classifiers based on either local binding sequence or global gene position. This strategy generically paves the way to the optimized incorporation of any future advances in gene target prediction based on local sequence, genome layout or on novel criteria. With the current state of the art, PreCisIon consistently improves methods based on sequence information only. This is shown by implementing a cross-validation analysis of the 20 major TFs from two phylogenetically remote model organisms. For Bacillus subtilis and Escherichia coli, respectively, PreCisIon achieves on average an area under the receiver operating characteristic curve of 70 and 60%, a sensitivity of 80 and 70% and a specificity of 60 and 56%. The newly predicted gene targets are demonstrated to be functionally consistent with previously known targets, as assessed by analysis of Gene Ontology enrichment or of the relevant literature and databases.

Do MCI criteria in drug trials accurately identify subjects with predementia Alzheimer's disease?

PubMed Central

Visser, P; Scheltens, P; Verhey, F

2005-01-01

Background: Drugs effective in Alzheimer-type dementia have been tested in subjects with mild cognitive impairment (MCI) because these are supposed to have Alzheimer's disease in the predementia stage. Objectives: To investigate whether MCI criteria used in these drug trials can accurately diagnose subjects with predementia Alzheimer's disease. Methods: MCI criteria of the Gal-Int 11 study, InDDEx study, ADCS memory impairment study, ampakine CX 516 study, piracetam study, and Merck rofecoxib study were applied retrospectively in a cohort of 150 non-demented subjects from a memory clinic. Forty two had progressed to Alzheimer type dementia during a five year follow up period and were considered to have predementia Alzheimer's disease at baseline. Outcome measures were the odds ratio, sensitivity, specificity, and positive and negative predictive value. Results: The odds ratio of the MCI criteria for predementia Alzheimer's disease varied between 0.84 and 11. Sensitivity varied between 0.46 and 0.83 and positive predictive value between 0.43 and 0.76. None of the criteria combined a high sensitivity with a high positive predictive value. Exclusion criteria for depression led to an increase in positive predictive value and specificity at the cost of sensitivity. In subjects older than 65 years the positive predictive value was higher than in younger subjects. Conclusions: The diagnostic accuracy of MCI criteria used in trials for predementia Alzheimer's disease is low to moderate. Their use may lead to inclusion of many patients who do not have predementia Alzheimer's disease or to exclusion of many who do. Subjects with moderately severe depression should not be excluded from trials in order not to reduce the sensitivity. PMID:16170074

In vivo serial MRI-based models and statistical methods to quantify sensitivity and specificity of mechanical predictors for carotid plaque rupture: location and beyond.

PubMed

Wu, Zheyang; Yang, Chun; Tang, Dalin

2011-06-01

It has been hypothesized that mechanical risk factors may be used to predict future atherosclerotic plaque rupture. Truly predictive methods for plaque rupture and methods to identify the best predictor(s) from all the candidates are lacking in the literature. A novel combination of computational and statistical models based on serial magnetic resonance imaging (MRI) was introduced to quantify sensitivity and specificity of mechanical predictors to identify the best candidate for plaque rupture site prediction. Serial in vivo MRI data of carotid plaque from one patient was acquired with follow-up scan showing ulceration. 3D computational fluid-structure interaction (FSI) models using both baseline and follow-up data were constructed and plaque wall stress (PWS) and strain (PWSn) and flow maximum shear stress (FSS) were extracted from all 600 matched nodal points (100 points per matched slice, baseline matching follow-up) on the lumen surface for analysis. Each of the 600 points was marked "ulcer" or "nonulcer" using follow-up scan. Predictive statistical models for each of the seven combinations of PWS, PWSn, and FSS were trained using the follow-up data and applied to the baseline data to assess their sensitivity and specificity using the 600 data points for ulcer predictions. Sensitivity of prediction is defined as the proportion of the true positive outcomes that are predicted to be positive. Specificity of prediction is defined as the proportion of the true negative outcomes that are correctly predicted to be negative. Using probability 0.3 as a threshold to infer ulcer occurrence at the prediction stage, the combination of PWS and PWSn provided the best predictive accuracy with (sensitivity, specificity) = (0.97, 0.958). Sensitivity and specificity given by PWS, PWSn, and FSS individually were (0.788, 0.968), (0.515, 0.968), and (0.758, 0.928), respectively. The proposed computational-statistical process provides a novel method and a framework to assess the sensitivity and specificity of various risk indicators and offers the potential to identify the optimized predictor for plaque rupture using serial MRI with follow-up scan showing ulceration as the gold standard for method validation. While serial MRI data with actual rupture are hard to acquire, this single-case study suggests that combination of multiple predictors may provide potential improvement to existing plaque assessment schemes. With large-scale patient studies, this predictive modeling process may provide more solid ground for rupture predictor selection strategies and methods for image-based plaque vulnerability assessment.

Evaluating the predictive accuracy and the clinical benefit of a nomogram aimed to predict survival in node-positive prostate cancer patients: External validation on a multi-institutional database.

PubMed

Bianchi, Lorenzo; Schiavina, Riccardo; Borghesi, Marco; Bianchi, Federico Mineo; Briganti, Alberto; Carini, Marco; Terrone, Carlo; Mottrie, Alex; Gacci, Mauro; Gontero, Paolo; Imbimbo, Ciro; Marchioro, Giansilvio; Milanese, Giulio; Mirone, Vincenzo; Montorsi, Francesco; Morgia, Giuseppe; Novara, Giacomo; Porreca, Angelo; Volpe, Alessandro; Brunocilla, Eugenio

2018-04-06

To assess the predictive accuracy and the clinical value of a recent nomogram predicting cancer-specific mortality-free survival after surgery in pN1 prostate cancer patients through an external validation. We evaluated 518 prostate cancer patients treated with radical prostatectomy and pelvic lymph node dissection with evidence of nodal metastases at final pathology, at 10 tertiary centers. External validation was carried out using regression coefficients of the previously published nomogram. The performance characteristics of the model were assessed by quantifying predictive accuracy, according to the area under the curve in the receiver operating characteristic curve and model calibration. Furthermore, we systematically analyzed the specificity, sensitivity, positive predictive value and negative predictive value for each nomogram-derived probability cut-off. Finally, we implemented decision curve analysis, in order to quantify the nomogram's clinical value in routine practice. External validation showed inferior predictive accuracy as referred to in the internal validation (65.8% vs 83.3%, respectively). The discrimination (area under the curve) of the multivariable model was 66.7% (95% CI 60.1-73.0%) by testing with receiver operating characteristic curve analysis. The calibration plot showed an overestimation throughout the range of predicted cancer-specific mortality-free survival rates probabilities. However, in decision curve analysis, the nomogram's use showed a net benefit when compared with the scenarios of treating all patients or none. In an external setting, the nomogram showed inferior predictive accuracy and suboptimal calibration characteristics as compared to that reported in the original population. However, decision curve analysis showed a clinical net benefit, suggesting a clinical implication to correctly manage pN1 prostate cancer patients after surgery. © 2018 The Japanese Urological Association.

Diagnostic performance of influenza viruses and RSV rapid antigen detection tests in children in tertiary care.

PubMed

Moesker, F M; van Kampen, J J A; Aron, G; Schutten, M; van de Vijver, D A M C; Koopmans, M P G; Osterhaus, A D M E; Fraaij, P L A

2016-06-01

Rapid antigen detection tests (RADTs) are increasingly used to detect influenza viruses and respiratory syncytial virus (RSV). However, their sensitivity and specificity are a matter of debate, challenging their clinical usefulness. Comparing diagnostic performances of BinaxNow Influenza AB(®) (BNI) and BinaxNow RSV(®) (BNR), to those of real-time reverse transcriptase PCR (RT-PCR), virus isolation and direct immunofluorescence (D-IF) in paediatric patients. Between November 2005 and September 2013, 521 nasal washings from symptomatic children (age <5 years) attending our tertiary care centre were tested, with a combination of the respective assays using RT-PCR as gold standard. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BNI were 69% (confidence interval [CI] [51-83]), 96% [94-97], 55% [39-70] and 98% [96-99] respectively. Of eleven false-negative samples, RT-PCR Ct-values were higher than all RT-PCR positive test results (27 vs 22, p=0.012). Of twenty false-positive samples, none were culture positive and two tested positive in D-IF. Sensitivity, specificity, PPV and NPV for BNR were 79% [73-85], 98% [96-99], 97% [93-99] and 88% [84-91]. Of the 42 false-negative samples the median Ct-value was higher than that of all RT-PCR positive samples (31 vs 23, p<0.0001). Five false-positive samples were detected. Three of these tested positive for RSV in virus isolation and D-IF. RADTs have a high specificity with BNR being superior to BNI. However, their relative low sensitivity limits their usefulness for clinical decision making in a tertiary care paediatric hospital. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

[Prognosis of acute pancreatitis by PANC 3 score].

PubMed

Fukuda, James Ken; Franzon, Orli; Resende-Filho, Fernando de Oliveira; Kruel, Nicolau Fernandes; Ferri, Thiago Alessandro

2013-06-01

Acute pancreatitis is a disease of great importance in clinical practice, defined as an inflammatory process of the pancreas that may involve local tissues or affect other organs in a systemic manner, requiring, in such cases, an intensive care. To analyze the simplified stratification system of the PANC 3 score, correlating it with the Ranson score, for the prognostic definition of cases of acute pancreatitis. Was conducted a prospective, observational study in which were evaluated 65 patients who were diagnosed with acute pancreatitis. PANC 3 showed sensitivity, 31.25%; specificity,100%; positive predictive value, 100%; negative predictive value, 81.66% and accuracy, 83.07%. The PANC 3 criteria are applicable to define the severity and the prognosis of acute pancreatitis, and are not a substitute method, but rather a method to be associated with the Ranson criteria, mainly due to its high accuracy, positive predictive value and specificity.

Two-question depression-screeners - the solution to all problems?

PubMed

Albani, Cornelia; Bailer, Harald; Blaser, Gerd; Brähler, Elmar; Geyer, Michael; Grulke, Norbert

2006-04-01

Depression constitutes a considerable issue in medicine and it is anticipated that the amount of people suffering from affective disorders will increase significantly. It would be useful to have a simple, fast screening procedure which would help detect depression. In four recently published articles a two-question depression-screener is recommended. Sensitivity, specificity, likelihood ratios, negative and positive predictive values were compared. For four different clinical samples and one sample that was representative of the German population the prevalence for depression ranged from 6.9 % to 18.1 %. Sensitivity and specificity reached values from 72.6 % to 96.6 % and from 56.9 % to 90.0 % respectively. All negative predictive values were high (< 97 %) opposed to positive predictive values (17.8 % to 38.5 %). Overall, it seems that the two-question screenings are well suited for the exclusion of a major depression. It is possible that regular screening could further lower the percentage of undiagnosed cases.

Magnetic resonance spectroscopy and brain volumetry in mild cognitive impairment. A prospective study.

PubMed

Fayed, Nicolás; Modrego, Pedro J; García-Martí, Gracián; Sanz-Requena, Roberto; Marti-Bonmatí, Luis

2017-05-01

To assess the accuracy of magnetic resonance spectroscopy (1H-MRS) and brain volumetry in mild cognitive impairment (MCI) to predict conversion to probable Alzheimer's disease (AD). Forty-eight patients fulfilling the criteria of amnestic MCI who underwent a conventional magnetic resonance imaging (MRI) followed by MRS, and T1-3D on 1.5 Tesla MR unit. At baseline the patients underwent neuropsychological examination. 1H-MRS of the brain was carried out by exploring the left medial occipital lobe and ventral posterior cingulated cortex (vPCC) using the LCModel software. A high resolution T1-3D sequence was acquired to carry out the volumetric measurement. A cortical and subcortical parcellation strategy was used to obtain the volumes of each area within the brain. The patients were followed up to detect conversion to probable AD. After a 3-year follow-up, 15 (31.2%) patients converted to AD. The myo-inositol in the occipital cortex and glutamate+glutamine (Glx) in the posterior cingulate cortex predicted conversion to probable AD at 46.1% sensitivity and 90.6% specificity. The positive predictive value was 66.7%, and the negative predictive value was 80.6%, with an overall cross-validated classification accuracy of 77.8%. The volume of the third ventricle, the total white matter and entorhinal cortex predict conversion to probable AD at 46.7% sensitivity and 90.9% specificity. The positive predictive value was 70%, and the negative predictive value was 78.9%, with an overall cross-validated classification accuracy of 77.1%. Combining volumetric measures in addition to the MRS measures the prediction to probable AD has a 38.5% sensitivity and 87.5% specificity, with a positive predictive value of 55.6%, a negative predictive value of 77.8% and an overall accuracy of 73.3%. Either MRS or brain volumetric measures are markers separately of cognitive decline and may serve as a noninvasive tool to monitor cognitive changes and progression to dementia in patients with amnestic MCI, but the results do not support the routine use in the clinical settings. Copyright © 2016 Elsevier Inc. All rights reserved.

3-D sonography for diagnosis of disk dislocation of the temporomandibular joint compared with MRI.

PubMed

Landes, Constantin A; Goral, Wojciech A; Sader, Robert; Mack, Martin G

2006-05-01

This study determines the value of three-dimensional (3-D) sonography for the assessment of disk dislocation of the temporomandibular joint (TMJ). Sixty-eight patients (i.e.,136 TMJ) with clinical dysfunction were examined by 272 sonographic 3-D scans. An 8- to 12.5-MHz transducer, angulated by step-motor, was used after picking a volume box on 2-D scan; magnetic resonance imaging followed immediately. Every TMJ was scrutinized in closed- and open-mouth position for normal or dislocated disk position. Fifty-three patients had complete data sets, i.e., 106 TMJ, 212 examinations. Sonographic examination took 5 min, with 74% specificity (62% closed-mouth; 85% open-mouth); sensitivity 53% (62/43%); accuracy 70% (62/77%); positive predictive value 49% (57/41%); and negative predictive value 77% (67/86%). This study encourages more research on the diagnostic capacity of 3-D TMJ sonography, with the advantage of multidimensional joint visualization. Although fair in specificity and negative predictive value, sensitivity and accuracy may ameliorate with future higher-sound frequency, real-time 3-D viewing and automated image analysis.

Computed tomography arthrography using a radial plane view for the detection of triangular fibrocartilage complex foveal tears.

PubMed

Moritomo, Hisao; Arimitsu, Sayuri; Kubo, Nobuyuki; Masatomi, Takashi; Yukioka, Masao

2015-02-01

To classify triangular fibrocartilage complex (TFCC) foveal lesions on the basis of computed tomography (CT) arthrography using a radial plane view and to correlate the CT arthrography results with surgical findings. We also tested the interobserver and intra-observer reliability of the radial plane view. A total of 33 patients with a suspected TFCC foveal tear who had undergone wrist CT arthrography and subsequent surgical exploration were enrolled. We classified the configurations of TFCC foveal lesions into 5 types on the basis of CT arthrography with the radial plane view in which the image slices rotate clockwise centered on the ulnar styloid process. Sensitivity, specificity, and positive predictive values were calculated for each type of foveal lesion in CT arthrography to detect foveal tears. We determined interobserver and intra-observer agreements using kappa statistics. We also compared accuracies with the radial plane views with those with the coronal plane views. Among the tear types on CT arthrography, type 3, a roundish defect at the fovea, and type 4, a large defect at the overall ulnar insertion, had high specificity and positive predictive value for the detection of foveal tears. Specificity and positive predictive values were 90% and 89% for type 3 and 100% and 100% for type 4, respectively, whereas sensitivity was 35% for type 3 and 22% for type 4. Interobserver and intra-observer agreement was substantial and almost perfect, respectively. The radial plane view identified foveal lesion of each palmar and dorsal radioulnar ligament separately, but accuracy results with the radial plane views were not statistically different from those with the coronal plane views. Computed tomography arthrography with a radial plane view exhibited enhanced specificity and positive predictive value when a type 3 or 4 lesion was identified in the detection of a TFCC foveal tear compared with historical controls. Diagnostic II. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Perceived parenting dimensions and identity styles: exploring the socialization of adolescents' processing of identity-relevant information.

PubMed

Smits, Ilse; Soenens, Bart; Luyckx, Koen; Duriez, Bart; Berzonsky, Michael; Goossens, Luc

2008-04-01

This study examined the relationships between crucial dimensions of perceived parenting (support, behavioral control, and psychological control) and the three identity styles defined by Berzonsky [Berzonsky, M. D. (1990). Self-construction over the life span: A process perspective on identity formation. Advances in Personal Construct Psychology, 1, 155-186.]. Each identity style was hypothesized to relate to a specific pattern of perceived parenting dimensions. Hypotheses were examined in a sample of middle and late adolescents (n=674). An information-oriented style was positively predicted by parental support. Contrary to expectations, however, an information-oriented style was also positively predicted by psychological control. A normative identity style was positively predicted by support and behavioral control. In line with expectations, a diffuse-avoidant identity style was positively predicted by psychological control and negatively by maternal (but not paternal) behavioral control. Findings are discussed in light of the literature on the socialization of identity formation and directions for future research are outlined.

Results of the two incidence screenings in the National Lung Screening Trial.

PubMed

Aberle, Denise R; DeMello, Sarah; Berg, Christine D; Black, William C; Brewer, Brenda; Church, Timothy R; Clingan, Kathy L; Duan, Fenghai; Fagerstrom, Richard M; Gareen, Ilana F; Gatsonis, Constantine A; Gierada, David S; Jain, Amanda; Jones, Gordon C; Mahon, Irene; Marcus, Pamela M; Rathmell, Joshua M; Sicks, JoRean

2013-09-05

The National Lung Screening Trial was conducted to determine whether three annual screenings (rounds T0, T1, and T2) with low-dose helical computed tomography (CT), as compared with chest radiography, could reduce mortality from lung cancer. We present detailed findings from the first two incidence screenings (rounds T1 and T2). We evaluated the rate of adherence of the participants to the screening protocol, the results of screening and downstream diagnostic tests, features of the lung-cancer cases, and first-line treatments, and we estimated the performance characteristics of both screening methods. At the T1 and T2 rounds, positive screening results were observed in 27.9% and 16.8% of participants in the low-dose CT group and in 6.2% and 5.0% of participants in the radiography group, respectively. In the low-dose CT group, the sensitivity was 94.4%, the specificity was 72.6%, the positive predictive value was 2.4%, and the negative predictive value was 99.9% at T1; at T2, the positive predictive value increased to 5.2%. In the radiography group, the sensitivity was 59.6%, the specificity was 94.1%, the positive predictive value was 4.4%, and the negative predictive value was 99.8% at T1; both the sensitivity and the positive predictive value increased at T2. Among lung cancers of known stage, 87 (47.5%) were stage IA and 57 (31.1%) were stage III or IV in the low-dose CT group at T1; in the radiography group, 31 (23.5%) were stage IA and 78 (59.1%) were stage III or IV at T1. These differences in stage distribution between groups persisted at T2. Low-dose CT was more sensitive in detecting early-stage lung cancers, but its measured positive predictive value was lower than that of radiography. As compared with radiography, the two annual incidence screenings with low-dose CT resulted in a decrease in the number of advanced-stage cancers diagnosed and an increase in the number of early-stage lung cancers diagnosed. (Funded by the National Cancer Institute; NLST ClinicalTrials.gov number, NCT00047385.).

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.

Comparison between the two-step and the three-step algorithms for the detection of toxigenic Clostridium difficile.

PubMed

Qutub, M O; AlBaz, N; Hawken, P; Anoos, A

2011-01-01

To evaluate usefulness of applying either the two-step algorithm (Ag-EIAs and CCNA) or the three-step algorithm (all three assays) for better confirmation of toxigenic Clostridium difficile. The antigen enzyme immunoassays (Ag-EIAs) can accurately identify the glutamate dehydrogenase antigen of toxigenic and nontoxigenic Clostridium difficile. Therefore, it is used in combination with a toxin-detecting assay [cell line culture neutralization assay (CCNA), or the enzyme immunoassays for toxins A and B (TOX-A/BII EIA)] to provide specific evidence of Clostridium difficile-associated diarrhoea. A total of 151 nonformed stool specimens were tested by Ag-EIAs, TOX-A/BII EIA, and CCNA. All tests were performed according to the manufacturer's instructions and the results of Ag-EIAs and TOX-A/BII EIA were read using a spectrophotometer at a wavelength of 450 nm. A total of 61 (40.7%), 38 (25.3%), and 52 (34.7%) specimens tested positive with Ag-EIA, TOX-A/BII EIA, and CCNA, respectively. Overall, the sensitivity, specificity, negative predictive value, and positive predictive value for Ag-EIA were 94%, 87%, 96.6%, and 80.3%, respectively. Whereas for TOX-A/BII EIA, the sensitivity, specificity, negative predictive value, and positive predictive value were 73.1%, 100%, 87.5%, and 100%, respectively. With the two-step algorithm, all 61 Ag-EIAs-positive cases required 2 days for confirmation. With the three-step algorithm, 37 (60.7%) cases were reported immediately, and the remaining 24 (39.3%) required further testing by CCNA. By applying the two-step algorithm, the workload and cost could be reduced by 28.2% compared with the three-step algorithm. The two-step algorithm is the most practical for accurately detecting toxigenic Clostridium difficile, but it is time-consuming.

Diagnostic accuracy of 3D-transvaginal ultrasound in detecting uterine cavity abnormalities in infertile patients as compared with hysteroscopy.

PubMed

Apirakviriya, Chayanis; Rungruxsirivorn, Tassawan; Phupong, Vorapong; Wisawasukmongchol, Wirach

2016-05-01

To assess diagnostic accuracy of 3D transvaginal ultrasound (3D-TVS) compared with hysteroscopy in detecting uterine cavity abnormalities in infertile women. This prospective observational cross-sectional study was conducted during the July 2013 to December 2013 study period. Sixty-nine women with infertility were enrolled. In the mid to late follicular phase of each subject's menstrual cycle, 3D transvaginal ultrasound and hysteroscopy were performed on the same day in each patient. Hysteroscopy is widely considered to be the gold standard method for investigation of the uterine cavity. Uterine cavity characteristics and abnormalities were recorded. Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios were evaluated. Hysteroscopy was successfully performed in all subjects. Hysteroscopy diagnosed pathological findings in 22 of 69 cases (31.8%). There were 18 endometrial polyps, 3 submucous myomas, and 1 septate uterus. Three-dimensional transvaginal ultrasound in comparison with hysteroscopy had 84.1% diagnostic accuracy, 68.2% sensitivity, 91.5% specificity, 79% positive predictive value, and 86% negative predictive value. The positive and negative likelihood ratios were 8.01 and 0.3, respectively. 3D-TVS successfully detected every case of submucous myoma and uterine anomaly. For detection of endometrial polyps, 3D-TVS had 61.1% sensitivity, 91.5% specificity, and 83.1% diagnostic accuracy. 3D-TVS demonstrated 84.1% diagnostic accuracy for detecting uterine cavity abnormalities in infertile women. A significant percentage of infertile patients had evidence of uterine cavity pathology. Hysteroscopy is, therefore, recommended for accurate detection and diagnosis of uterine cavity lesion. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Validity of administrative database code algorithms to identify vascular access placement, surgical revisions, and secondary patency.

PubMed

Al-Jaishi, Ahmed A; Moist, Louise M; Oliver, Matthew J; Nash, Danielle M; Fleet, Jamie L; Garg, Amit X; Lok, Charmaine E

2018-03-01

We assessed the validity of physician billing codes and hospital admission using International Classification of Diseases 10th revision codes to identify vascular access placement, secondary patency, and surgical revisions in administrative data. We included adults (≥18 years) with a vascular access placed between 1 April 2004 and 31 March 2013 at the University Health Network, Toronto. Our reference standard was a prospective vascular access database (VASPRO) that contains information on vascular access type and dates of placement, dates for failure, and any revisions. We used VASPRO to assess the validity of different administrative coding algorithms by calculating the sensitivity, specificity, and positive predictive values of vascular access events. The sensitivity (95% confidence interval) of the best performing algorithm to identify arteriovenous access placement was 86% (83%, 89%) and specificity was 92% (89%, 93%). The corresponding numbers to identify catheter insertion were 84% (82%, 86%) and 84% (80%, 87%), respectively. The sensitivity of the best performing coding algorithm to identify arteriovenous access surgical revisions was 81% (67%, 90%) and specificity was 89% (87%, 90%). The algorithm capturing arteriovenous access placement and catheter insertion had a positive predictive value greater than 90% and arteriovenous access surgical revisions had a positive predictive value of 20%. The duration of arteriovenous access secondary patency was on average 578 (553, 603) days in VASPRO and 555 (530, 580) days in administrative databases. Administrative data algorithms have fair to good operating characteristics to identify vascular access placement and arteriovenous access secondary patency. Low positive predictive values for surgical revisions algorithm suggest that administrative data should only be used to rule out the occurrence of an event.

The reliability, validity, sensitivity, specificity and predictive values of the Chinese version of the Rowland Universal Dementia Assessment Scale.

PubMed

Chen, Chia-Wei; Chu, Hsin; Tsai, Chia-Fen; Yang, Hui-Ling; Tsai, Jui-Chen; Chung, Min-Huey; Liao, Yuan-Mei; Chi, Mei-Ju; Chou, Kuei-Ru

2015-11-01

The purpose of this study was to translate the Rowland Universal Dementia Assessment Scale into Chinese and to evaluate the psychometric properties (reliability and validity) and the diagnostic properties (sensitivity, specificity and predictive values) of the Chinese version of the Rowland Universal Dementia Assessment Scale. The accurate detection of early dementia requires screening tools with favourable cross-cultural linguistic and appropriate sensitivity, specificity, and predictive values, particularly for Chinese-speaking populations. This was a cross-sectional, descriptive study. Overall, 130 participants suspected to have cognitive impairment were enrolled in the study. A test-retest for determining reliability was scheduled four weeks after the initial test. Content validity was determined by five experts, whereas construct validity was established by using contrasted group technique. The participants' clinical diagnoses were used as the standard in calculating the sensitivity, specificity, positive predictive value and negative predictive value. The study revealed that the Chinese version of the Rowland Universal Dementia Assessment Scale exhibited a test-retest reliability of 0.90, an internal consistency reliability of 0.71, an inter-rater reliability (kappa value) of 0.88 and a content validity index of 0.97. Both the patients and healthy contrast group exhibited significant differences in their cognitive ability. The optimal cut-off points for the Chinese version of the Rowland Universal Dementia Assessment Scale in the test for mild cognitive impairment and dementia were 24 and 22, respectively; moreover, for these two conditions, the sensitivities of the scale were 0.79 and 0.76, the specificities were 0.91 and 0.81, the areas under the curve were 0.85 and 0.78, the positive predictive values were 0.99 and 0.83 and the negative predictive values were 0.96 and 0.91 respectively. The Chinese version of the Rowland Universal Dementia Assessment Scale exhibited sound reliability, validity, sensitivity, specificity and predictive values. This scale can help clinical staff members to quickly and accurately diagnose cognitive impairment and provide appropriate treatment as early as possible. © 2015 John Wiley & Sons Ltd.

A Machine Learning Approach to Predict Gene Regulatory Networks in Seed Development in Arabidopsis

PubMed Central

Ni, Ying; Aghamirzaie, Delasa; Elmarakeby, Haitham; Collakova, Eva; Li, Song; Grene, Ruth; Heath, Lenwood S.

2016-01-01

Gene regulatory networks (GRNs) provide a representation of relationships between regulators and their target genes. Several methods for GRN inference, both unsupervised and supervised, have been developed to date. Because regulatory relationships consistently reprogram in diverse tissues or under different conditions, GRNs inferred without specific biological contexts are of limited applicability. In this report, a machine learning approach is presented to predict GRNs specific to developing Arabidopsis thaliana embryos. We developed the Beacon GRN inference tool to predict GRNs occurring during seed development in Arabidopsis based on a support vector machine (SVM) model. We developed both global and local inference models and compared their performance, demonstrating that local models are generally superior for our application. Using both the expression levels of the genes expressed in developing embryos and prior known regulatory relationships, GRNs were predicted for specific embryonic developmental stages. The targets that are strongly positively correlated with their regulators are mostly expressed at the beginning of seed development. Potential direct targets were identified based on a match between the promoter regions of these inferred targets and the cis elements recognized by specific regulators. Our analysis also provides evidence for previously unknown inhibitory effects of three positive regulators of gene expression. The Beacon GRN inference tool provides a valuable model system for context-specific GRN inference and is freely available at https://github.com/BeaconProjectAtVirginiaTech/beacon_network_inference.git. PMID:28066488

Laboratory tests for diagnosis of food allergy: advantages, disadvantages and future perspectives.

PubMed

Moneret-Vautrin, D A; Kanny, G; Frémont, S

2003-04-01

Numerous biological tests point to the diagnosis of food sensitization: detection of specific IgEs by Rast techniques, multi-detection assays, immunoblotting, screening of basophil activation (BAT or FAST), assays for leukotriene LTC4 release (CAST), measurement of plasma histamine, serum tryptase, serum ECP, urinary EDN, completed by mannitol-lactulose test evaluating intestinal permeability, assay of fecal IgEs, Rast for specific IgG4. Primary screening for anti-food IgEs by multi-detection assays seeks justification from insufficient clinical data and false positive tests are common in patients sensitized to pollens or latex, on account of in vitro cross reactivities (CR). Multiple CR explain positive Rast to vegetal food allergens in such patients. Biological tests should not be performed as the first line of diagnosis. In vivo sensitisation is assessed by positive prick-tests, demonstrating the bivalence of allergens, as well as the affinity of specific IgEs, two conditions necessary to bridge membrane bound specific IgEs, leading to the release of mediators. Prick-tests are closer to clinical symptoms than biological tests. However, the diagnosis of food allergy is based on standardised oral challenges. Exceptions are high levels of specific IgEs to egg (> 6 kUl/l), peanut (> 15 kUl/l), fish (> 20 kUl/l) and milk (> 32 kUl/l), reaching a 95% predictive positive value. Rast inhibition tests are useful to identify masked allergens in foods. Research developments will have impact on the development of new diagnostic tools: allergen mixes reinforcing a food extract by associated recombinant major allergens, multiple combination of recombinant allergens (chips) or tests with synthetic epitopes aimed a the prediction of recovery. Laboratory tests take place in the decision free for the diagnosis for the food allergy and the follow-up of the levels specific IgEs is a tool to assess outcome and contributes to predict recovery or persistent allergy. Up to now the significance of positive laboratory tests showing the implication of IgEs is at the crossroads of the allergist's and biologist's expertise.

Reliving emotional personal memories: affective biases linked to personality and sex-related differences.

PubMed

Denkova, Ekaterina; Dolcos, Sanda; Dolcos, Florin

2012-06-01

Although available evidence suggests that the emotional valence and recollective properties of autobiographical memories (AMs) may be influenced by personality- and sex-related differences, overall these relationships remain poorly understood. The present study investigated these issues by comparing the effect of general personality traits (extraversion and neuroticism) and specific traits linked to emotion regulation (ER) strategies (reappraisal and suppression) on the retrieval of emotional AMs and on the associated postretrieval emotional states, in men and women. First, extraversion predicted recollection of positive AMs in both men and women, whereas neuroticism predicted the proportion of negative AMs in men and the frequency of rehearsing negative AMs in women. Second, reappraisal predicted positive AMs in men, and suppression predicted negative AMs in women. Third, while reliving of positive memories had an overall indirect effect on postretrieval positive mood through extraversion, reliving of negative AMs had a direct effect on postretrieval negative mood, which was linked to inefficient engagement of suppression in women. Our findings suggest that personality traits associated with positive affect predict recollection of positive AMs and maintenance of a positive mood, whereas personality traits associated with negative affect, along with differential engagement of habitual ER strategies in men and women, predict sex-related differences in the recollection and experiencing of negative AMs. These findings provide insight into the factors that influence affective biases in reliving AMs, and into their possible link to sex-related differences in the susceptibility to affective disorders.

Time-to-positivity, type of culture media and oxidase test performed on positive blood culture vials to predict Pseudomonas aeruginosa in patients with Gram-negative bacilli bacteraemia.

PubMed

Cobos-Triguero, N; Zboromyrska, Y; Morata, L; Alejo, I; De La Calle, C; Vergara, A; Cardozo, C; Arcas, M P; Soriano, A; Marco, F; Mensa, J; Almela, M; Martínez, J A

2017-02-01

The aim of this study was to determine the usefulness of oxidase test and time-to-positivity (TTP) in aerobic and anaerobic blood culture vials to detect the presence of Pseudomonas aeruginosa in patients with Gram-negative bacilli (GNB) bacteraemia. TTP was recorded for each aerobic and anaerobic blood culture vial of monomicrobial bacteraemia due to GNB. Oxidase test was performed in a pellet of the centrifuged content of the positive blood culture. An algorithm was developed in order to perform the oxidase test efficiently taking into account TTP and type of vial. A total of 341 episodes of GNB bacteraemia were analysed. Sensitivity, specificity, positive predictive value and negative predictive value of the oxidase test performed on positive vials with GNB to predict P. aeruginosa were 95%, 99%, 91%, and 99%, respectively. When growth was first or exclusively detected in anaerobic vials, P. aeruginosa was never identified hence the performance of the oxidase test could be avoided. When growth was only or first detected in aerobic vials, a TTP≥8h predicted P. aeruginosa in 37% or cases (63 of 169), therefore oxidase test is highly recommended. Oxidase test performed onto positive blood culture vials previously selected by TTP and type of vials is an easy and inexpensive way to predict P. aeruginosa. In most cases, this can lead to optimization of treatment in less than 24 hours.

Performance of an HRP-2 Rapid Diagnostic Test in Nigerian Children Less Than 5 Years of Age

PubMed Central

Ajumobi, Olufemi; Sabitu, Kabir; Nguku, Patrick; Kwaga, Jacob; Ntadom, Godwin; Gitta, Sheba; Elizeus, Rutebemberwa; Oyibo, Wellington; Nsubuga, Peter; Maire, Mark; Poggensee, Gabriele

2015-01-01

The diagnostic performance of histidine-rich protein 2 (HRP-2)–based malaria rapid diagnostic test (RDT) was evaluated in a mesoendemic area for malaria, Kaduna, Nigeria. We compared RDT results with expert microscopy results of blood samples from 295 febrile children under 5 years. Overall, 11.9% (35/295) tested positive with RDT compared with 10.5% (31/295) by microscopy: sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 100%, 98.5%, 88.6%, and 100%, respectively. The RDT sensitivity was not affected by transmission season, parasite density, and age. Specificity and positive PV decreased slightly during the high-transmission season (97.5% and 83.3%). The RDT test positivity rates in the low- and high-transmission seasons were 9.4% and 13.5%, respectively. Overall, the test performance of this RDT was satisfactory. The findings of a low proportion of RDT false positives, no invalid and no false-negative results should validate the performance of RDTs in this context. PMID:25711608

Accuracy of clinical diagnosis and malaria rapid diagnostic test and its influence on the management of children with fever under reduced malaria burden in Misungwi district, Mwanza Tanzania.

PubMed

Nkonya, Daniel Ndaki; Tarimo, Donath Samuel; Kishimba, Rogath Saika

2016-01-01

Malaria diagnosis is known to be non-specific because of the overlap of symptoms of malaria with other infectious diseases that is made worse with declining malaria burden. Though the use of malaria rapid diagnostic test (mRDT) for malaria confirmation has universally been adopted, malaria decline may alter performance of mRDT. This study examined accuracy of clinical diagnosis and mRDT and its influence on prescription for febrile underfives. A cross-sectional study of 600 underfives was carried out in 6 randomly selected health facilities in Misungwi district, Mwanza; from November - December 2014. Consecutive underfives with a fever consultation were recruited: for each fever and the clinical diagnosis entertained were recorded. Parasitological confirmation of malaria was done by mRDT and microscopic examination of finger prick blood samples. Treatment was based on mRDT results, drugs prescribed recorded. Accuracy of clinical diagnosis and mRDT in predicting malaria was assessed by performance indices against microscopy. Antimalarial and antibiotics prescriptions were assessed against parasitological findings. Clinically, 37.2% had malaria; 32.8% were mRDTpositive and 17.0% microscopically positive. Sensitivity of clinical diagnosis was very high (97.0% [95%CI: 91.0-99.2]); specificity 66.7% [95%CI: 62.3-70.8], and positive predictive value 37.4% (95%CI: 31.6-43.5). Sensitivity of mRDTwas very high (99.0% [95%CI: 93.9-99.9]), specificity (80.7% [95%CI: 76.9-84.0]), positive predictive value 51.3% [95% CI: 44.1-58.4]) and negative predictive 99.75% [95%CI: 99.4-100.0]. Those receiving antimalarial prescription, 75.0% were mRDT positive; 39.4% microscopically positive. Those receiving antibiotic, 78.8% were mRDT negative; 90.1% microscopically negative. Decline in malaria lowered specificity of mRDT to < 95% against WHO recommendation. Though adherence to mRDT results was high, there was over prescription of antibiotics.

Accuracy of clinical diagnosis and malaria rapid diagnostic test and its influence on the management of children with fever under reduced malaria burden in Misungwi district, Mwanza Tanzania

PubMed Central

Nkonya, Daniel Ndaki; Tarimo, Donath Samuel; Kishimba, Rogath Saika

2016-01-01

Introduction Malaria diagnosis is known to be non-specific because of the overlap of symptoms of malaria with other infectious diseases that is made worse with declining malaria burden. Though the use of malaria rapid diagnostic test (mRDT) for malaria confirmation has universally been adopted, malaria decline may alter performance of mRDT. This study examined accuracy of clinical diagnosis and mRDT and its influence on prescription for febrile underfives. Methods A cross-sectional study of 600 underfives was carried out in 6 randomly selected health facilities in Misungwi district, Mwanza; from November - December 2014. Consecutive underfives with a fever consultation were recruited: for each fever and the clinical diagnosis entertained were recorded. Parasitological confirmation of malaria was done by mRDT and microscopic examination of finger prick blood samples. Treatment was based on mRDT results, drugs prescribed recorded. Accuracy of clinical diagnosis and mRDT in predicting malaria was assessed by performance indices against microscopy. Antimalarial and antibiotics prescriptions were assessed against parasitological findings. Results Clinically, 37.2% had malaria; 32.8% were mRDTpositive and 17.0% microscopically positive. Sensitivity of clinical diagnosis was very high (97.0% [95%CI: 91.0-99.2]); specificity 66.7% [95%CI: 62.3-70.8], and positive predictive value 37.4% (95%CI: 31.6-43.5). Sensitivity of mRDTwas very high (99.0% [95%CI: 93.9-99.9]), specificity (80.7% [95%CI: 76.9-84.0]), positive predictive value 51.3% [95% CI: 44.1-58.4]) and negative predictive 99.75% [95%CI: 99.4-100.0]. Those receiving antimalarial prescription, 75.0% were mRDT positive; 39.4% microscopically positive. Those receiving antibiotic, 78.8% were mRDT negative; 90.1% microscopically negative. Conclusion Decline in malaria lowered specificity of mRDT to < 95% against WHO recommendation. Though adherence to mRDT results was high, there was over prescription of antibiotics. PMID:28250872

Sensitivity and specificity of intrathecal fluorescein and white light excitation for detecting intraoperative cerebrospinal fluid leak in endoscopic skull base surgery: a prospective study.

PubMed

Raza, Shaan M; Banu, Matei A; Donaldson, Angela; Patel, Kunal S; Anand, Vijay K; Schwartz, Theodore H

2016-03-01

The intraoperative detection of CSF leaks during endonasal endoscopic skull base surgery is critical to preventing postoperative CSF leaks. Intrathecal fluorescein (ITF) has been used at varying doses to aid in the detection of intraoperative CSF leaks. However, the sensitivity and specificity of ITF at certain dosages is unknown. A prospective database of all endoscopic endonasal procedures was reviewed. All patients received 25 mg ITF diluted in 10 ml CSF and were pretreated with dexamethasone and Benadryl. Immediately after surgery, the operating surgeon prospectively noted if there was an intraoperative CSF leak and fluorescein was identified. The sensitivity, specificity, and positive and negative predictive power of ITF for detecting intraoperative CSF leak were calculated. Factors correlating with postoperative CSF leak were determined. Of 419 patients, 35.8% of patients did not show a CSF leak. Fluorescein-tinted CSF (true positive) was noted in 59.7% of patients and 0 false positives were encountered. CSF without fluorescein staining (false negative) was noted in 4.5% of patients. The sensitivity and specificity of ITF were 92.9% and 100%, respectively. The negative and positive predictive values were 88.8% and 100%, respectively. Postoperative CSF leaks only occurred in true positives at a rate of 2.8%. ITF is extremely specific and very sensitive for detecting intraoperative CSF leaks. Although false negatives can occur, these patients do not appear to be at risk for postoperative CSF leak. The use of ITF may help surgeons prevent postoperative CSF leaks by intraoperatively detecting and confirming a watertight repair.

ROC-ing along: Evaluation and interpretation of receiver operating characteristic curves.

PubMed

Carter, Jane V; Pan, Jianmin; Rai, Shesh N; Galandiuk, Susan

2016-06-01

It is vital for clinicians to understand and interpret correctly medical statistics as used in clinical studies. In this review, we address current issues and focus on delivering a simple, yet comprehensive, explanation of common research methodology involving receiver operating characteristic (ROC) curves. ROC curves are used most commonly in medicine as a means of evaluating diagnostic tests. Sample data from a plasma test for the diagnosis of colorectal cancer were used to generate a prediction model. These are actual, unpublished data that have been used to describe the calculation of sensitivity, specificity, positive predictive and negative predictive values, and accuracy. The ROC curves were generated to determine the accuracy of this plasma test. These curves are generated by plotting the sensitivity (true-positive rate) on the y axis and 1 - specificity (false-positive rate) on the x axis. Curves that approach closest to the coordinate (x = 0, y = 1) are more highly predictive, whereas ROC curves that lie close to the line of equality indicate that the result is no better than that obtained by chance. The optimum sensitivity and specificity can be determined from the graph as the point where the minimum distance line crosses the ROC curve. This point corresponds to the Youden index (J), a function of sensitivity and specificity used commonly to rate diagnostic tests. The area under the curve is used to quantify the overall ability of a test to discriminate between 2 outcomes. By following these simple guidelines, interpretation of ROC curves will be less difficult and they can then be interpreted more reliably when writing, reviewing, or analyzing scientific papers. Copyright © 2016 Elsevier Inc. All rights reserved.

Accuracy of a Mouse Bioassay for the Diagnosis of Botulism in Horses.

PubMed

Johnson, A L; McAdams-Gallagher, S C; Aceto, H

2016-07-01

The laboratory diagnosis of botulism in horses traditionally has relied upon the mouse bioassay (MBA). The accuracy of this test for the diagnosis of botulism in horses is unknown. Our goal was to determine the sensitivity, specificity, positive predictive value, and negative predictive value of the MBA on laboratory-processed fecal and gastrointestinal samples for foals and adult horses. Cases included all horses with a final clinical diagnosis of botulism that were admitted between 1986 and 2011 and had MBA testing performed. Controls included horses without botulism that were admitted during the same time period and had MBA testing performed. Retrospective study. Horses suspected of having botulism had fecal or (less commonly) gastrointestinal content samples tested using MBA. For every hospitalized botulism suspect, control samples were obtained from ≥1 additional hospitalized horses not suspected to have botulism. One hundred and twenty-nine adult horses and 253 adult controls were identified. Overall sensitivity of the MBA was only 32% but specificity was 97%. Forty-three foal cases and 21 foal controls were evaluated; sensitivity of the MBA was 53% and specificity was 100%. Positive predictive value was substantially higher (100% for foals and 89% for adults) than negative predictive value (51% for foals and 67% for adults). Mouse bioassay has low sensitivity but high specificity for the diagnosis of botulism in horses. Positive results are highly suggestive of botulism but negative results do not exclude the diagnosis. Unaffected horses and foals rarely shed C. botulinum in their feces. Copyright © 2016 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Gram staining of protected pulmonary specimens in the early diagnosis of ventilator-associated pneumonia.

PubMed

Mimoz, O; Karim, A; Mazoit, J X; Edouard, A; Leprince, S; Nordmann, P

2000-11-01

We evaluated prospectively the use of Gram staining of protected pulmonary specimens to allow the early diagnosis of ventilator-associated pneumonia (VAP), compared with the use of 60 bronchoscopic protected specimen brushes (PSB) and 126 blinded plugged telescopic catheters (PTC) obtained from 134 patients. Gram stains were from Cytospin slides; they were studied for the presence of microorganisms in 10 and 50 fields by two independent observers and classified according to their Gram stain morphology. Quantitative cultures were performed after serial dilution and plating on appropriate culture medium. A final diagnosis of VAP, based on a culture of > or = 10(3) c.f.u. ml-1, was established after 81 (44%) samplings. When 10 fields were analysed, a strong relationship was found between the presence of bacteria on Gram staining and the final diagnosis of VAP (for PSB and PTC respectively: sensitivity 74 and 81%, specificity 94 and 100%, positive predictive value 91 and 100%, negative predictive value 82 and 88%). The correlation was less when we compared the morphology of microorganisms observed on Gram staining with those of bacteria obtained from quantitative cultures (for PSB and PTC respectively: sensitivity 54 and 69%, specificity 86 and 89%, positive predictive value 72 and 78%, negative predictive value 74 and 84%). Increasing the number of fields read to 50 was associated with a slight decrease in specificity and positive predictive value of Gram staining, but with a small increase in its sensitivity and negative predictive value. The results obtained by the two observers were similar to each other for both numbers of fields analysed. Gram staining of protected pulmonary specimens performed on 10 fields predicted the presence of VAP and partially identified (using Gram stain morphology) the microorganisms growing at significant concentrations, and could help in the early choice of the treatment of VAP. Increasing the number of fields read or having the Gram stain analysed by two independent individuals did not improve the results.

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.

[Efficacy of stool antigen and serologic tests in the diagnosis of Helicobacter pylori in Ecuadorian population].

PubMed

Gómez, Néstor A; Alvarez, Ludwig R; Zapatier, Jorge A; Vargas, Paola E

2005-01-01

To assess the effectiveness in the Ecuadorian population of 2 non-invasive methods for the detection of the Helicobacter pylori: the stool antigens immunoassay (HpSAg) and the determination IgG serum of'antibodies. Eighty six dyspeptic patients were evaluated. In each, Helicobacter pylori presence was investigated with three methods: histology, HpSAg and serology. Sensibility and specificity values were obtained, as well as the positive and negative predictive values. The prevalence of Helicobacter pylori with the 3 tests was 89.53%. The sensibility, specificity, positive predictive value, and negative predictive value were: 42.5%, 69.2%, 88.6% and 17.6% with histology; 69.2%, 42.9%, 78.9% and 31% with HpSAg; 64.2%, 47.7%, 81.1% and 27.3% with serology. In the highly prevalent Ecuadorian setting, HpSAg and serology have relative low sensibility and specificity values. Based on our results, it is necessary to assess for conditions that could alter their results, and strategies to increase the sensibility of these tests, including the histology.

Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system.

PubMed

Rehem, Tania Cristina Morais Santa Barbara; de Oliveira, Maria Regina Fernandes; Ciosak, Suely Itsuko; Egry, Emiko Yoshikawa

2013-01-01

To estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. The hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. The sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH) was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. There are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

Application of Mycobacterium Leprae-specific cellular and serological tests for the differential diagnosis of leprosy from confounding dermatoses.

PubMed

Freitas, Aline Araújo; Hungria, Emerith Mayra; Costa, Maurício Barcelos; Sousa, Ana Lúcia Osório Maroccolo; Castilho, Mirian Lane Oliveira; Gonçalves, Heitor Sá; Pontes, Maria Araci Andrade; Duthie, Malcolm S; Stefani, Mariane Martins Araújo

2016-10-01

Mycobacterium leprae-specific serological and cell-mediated-immunity/CMI test were evaluated for the differential diagnosis of multibacillary/MB, and paucibacillary/PB leprosy from other dermatoses. Whole-blood assay/WBA/IFNγ stimulated with LID-1 antigen and ELISA tests for IgG to LID-1 and IgM to PGL-I were performed. WBA/LID-1/IFNγ production was observed in 72% PB, 11% MB leprosy, 38% dermatoses, 40% healthy endemic controls/EC. The receiver operating curve/ROC for WBA/LID-1 in PB versus other dermatoses showed 72.5% sensitivity, 61.5% specificity and an area-under-the-curve/AUC=0.75; 74% positive predictive value/PPV, 59% negative predictive value/NPV. Anti PGL-I serology was positive in 67% MB, 8% PB leprosy, 6% of other dermatoses; its sensitivity for MB=66%, specificity=93%, AUC=0.89; PPV=91%, NPV=72%. Anti-LID-1 serology was positive in 87% MB, 7% PB leprosy, all other participants were seronegative; 87.5% sensitivity for MB, 100% specificity, AUC=0.97; PPV=100%, NPV=88%. In highly endemic areas anti-LID-1/PGL-I serology and WBA/LID-1-represent useful tools for the differential diagnosis of leprosy from other confounding dermatoses. Copyright © 2016 Elsevier Inc. All rights reserved.

Carotid bruit for detection of hemodynamically significant carotid stenosis: the Northern Manhattan Study

PubMed Central

Ratchford, Elizabeth V.; Jin, Zhezhen; Di Tullio, Marco R.; Salameh, Maya J.; Homma, Shunichi; Gan, Robert; Boden-Albala, Bernadette; Sacco, Ralph L.; Rundek, Tatjana

2009-01-01

Objective The prevalence of carotid bruits and the utility of auscultation for predicting carotid stenosis are not well known. We aimed to establish the prevalence of carotid bruits and the diagnostic accuracy of auscultation for detection of hemodynamically significant carotid stenosis, using carotid duplex as the gold standard. Methods The Northern Manhattan Study (NOMAS) is a prospective multiethnic community-based cohort designed to examine the incidence of stroke and other vascular events and the association between various vascular risk factors and subclinical atherosclerosis. Of the stroke-free cohort (n=3298), 686 were examined for carotid bruits and underwent carotid duplex. Main outcome measures included prevalence of carotid bruits and sensitivity, specificity, positive predictive value, negative predictive value and accuracy of auscultation for prediction of ipsilateral carotid stenosis. Results Among 686 subjects with a mean age of 68.2 ± 9.4 years, the prevalence of ≥60% carotid stenosis as detected by ultrasound was 2.2% and the prevalence of carotid bruits was 4.1%. For detection of carotid stenosis, sensitivity of auscultation was 56%, specificity was 98%, positive predictive value was 25%, negative predictive value was 99% and overall accuracy was 97.5%. Discussion In this ethnically diverse cohort, the prevalence of carotid bruits and hemodynamically significant carotid stenosis was low. Sensitivity and positive predictive value were also low, and the 44% false-negative rate suggests that auscultation is not sufficient to exclude carotid stenosis. While the presence of a bruit may still warrant further evaluation with carotid duplex, ultrasonography may be considered in high-risk asymptomatic patients, irrespective of findings on auscultation. PMID:19133168

Predictive Value of Matrix Metalloproteinases and Their Inhibitors for Mortality in Septic Patients: A Cohort Study.

PubMed

Serrano-Gomez, Sergio; Burgos-Angulo, Gabriel; Niño-Vargas, Daniela Camila; Niño, María Eugenia; Cárdenas, María Eugenia; Chacón-Valenzuela, Estephania; McCosham, Diana Margarita; Peinado-Acevedo, Juan Sebastián; Lopez, M Marcos; Cunha, Fernando; Pazin-Filho, Antonio; Ilarraza, Ramses; Schulz, Richard; Torres-Dueñas, Diego

2017-01-01

Over 170 biomarkers are being investigated regarding their prognostic and diagnostic accuracy in sepsis in order to find new tools to reduce morbidity and mortality. Matrix metalloproteinases (MMPs) and their inhibitors have been recently studied as promising new prognostic biomarkers in patients with sepsis. This study is aimed at determining the utility of several cutoff points of these biomarkers to predict mortality in patients with sepsis. A multicenter, prospective, analytic cohort study was performed in the metropolitan area of Bucaramanga, Colombia. A total of 289 patients with sepsis and septic shock were included. MMP-9, MMP-2, tissue inhibitor of metalloproteinase 1 (TIMP-1), TIMP-2, TIMP-1/MMP-9 ratio, and TIMP-2/MMP-2 ratio were determined in blood samples. Value ranges were correlated with mortality to estimate sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiving operating characteristic curve. Sensitivity ranged from 33.3% (MMP-9/TIMP-1 ratio) to 60.6% (TIMP-1) and specificity varied from 38.8% (MMP-2/TIMP-2 ratio) to 58.5% (TIMP-1). As for predictive values, positive predictive value range was from 17.5% (MMP-9/TIMP-1 ratio) to 70.4% (MMP-2/TIMP-2 ratio), whereas negative predictive values were between 23.2% (MMP-2/TIMP-2 ratio) and 80.9% (TIMP-1). Finally, area under the curve scores ranged from 0.31 (MMP-9/TIMP-1 ratio) to 0.623 (TIMP-1). Although TIMP-1 showed higher sensitivity, specificity, and negative predictive value, with a representative population sample, we conclude that none of the evaluated biomarkers had significant predictive value for mortality.

Enhanced sensitivity of CpG island search and primer design based on predicted CpG island position.

PubMed

Park, Hyun-Chul; Ahn, Eu-Ree; Jung, Ju Yeon; Park, Ji-Hye; Lee, Jee Won; Lim, Si-Keun; Kim, Won

2018-05-01

DNA methylation has important biological roles, such as gene expression regulation, as well as practical applications in forensics, such as in body fluid identification and age estimation. DNA methylation often occurs in the CpG site, and methylation within the CpG islands affects various cellular functions and is related to tissue-specific identification. Several programs have been developed to identify CpG islands; however, the size, location, and number of predicted CpG islands are not identical due to different search algorithms. In addition, they only provide structural information for predicted CpG islands without experimental information, such as primer design. We developed an analysis pipeline package, CpGPNP, to integrate CpG island prediction and primer design. CpGPNP predicts CpG islands more accurately and sensitively than other programs, and designs primers easily based on the predicted CpG island locations. The primer design function included standard, bisulfite, and methylation-specific PCR to identify the methylation of particular CpG sites. In this study, we performed CpG island prediction on all chromosomes and compared CpG island search performance of CpGPNP with other CpG island prediction programs. In addition, we compared the position of primers designed for a specific region within the predicted CpG island using other bisulfite PCR primer programs. The primers designed by CpGPNP were used to experimentally verify the amplification of the target region of markers for body fluid identification and age estimation. CpGPNP is freely available at http://forensicdna.kr/cpgpnp/. Copyright © 2018 Elsevier B.V. All rights reserved.

Rapid MRSA PCR on respiratory specimens from ventilated patients with suspected pneumonia: a tool to facilitate antimicrobial stewardship.

PubMed

Trevino, S E; Pence, M A; Marschall, J; Kollef, M H; Babcock, H M; Burnham, C-A D

2017-05-01

Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of pneumonia in ventilated patients. Our objective was to evaluate the GeneXpert MRSA/SA SSTI Assay (Xpert MRSA/SA) (Cepheid, Sunnyvale, CA) for use in lower respiratory tract (LRT) specimens for rapid MRSA detection and to determine the potentially saved antibiotic-days if a culture-based identification method was replaced by this assay. Remnant LRT samples from ventilated patients submitted to the microbiology laboratory for routine culture were tested using conventional culture and Xpert MRSA/SA. One hundred of 310 LRT specimens met the inclusion criteria. Ten samples were positive for MRSA by Xpert MRSA/SA, while six were positive by routine culture methods. Xpert MRSA/SA correctly identified 5/6 positive and 89/94 negative MRSA specimens, for a sensitivity of 83.3%, specificity of 94.7%, positive predictive value of 45.6%, and negative predictive value of 98.9%. The assay also correctly detected 3/3 positive and 90/97 negative methicillin-susceptible S. aureus (MSSA) specimens, for a sensitivity of 100%, specificity of 92.8%, positive predictive value of 30%, and negative predictive value of 100%. A total of 748 vancomycin and 305 linezolid antibiotic-days were associated with the enrolled specimens. Vancomycin and linezolid utilization could decrease by 68.4% and 83%, respectively, if discontinued 1 day after negative polymerase chain reaction (PCR) results. The Xpert MRSA/SA SSTI rapid MRSA PCR assay performed well in respiratory samples from ventilated patients with suspected pneumonia and has the potential to facilitate stewardship efforts such as reducing empiric vancomycin and linezolid therapy.

Comparison of ultrasound versus computed tomography for the detection of kidney stones in the pediatric population: a clinical effectiveness study.

PubMed

Roberson, Nathaniel P; Dillman, Jonathan R; O'Hara, Sara M; DeFoor, William R; Reddy, Pramod P; Giordano, Richard M; Trout, Andrew T

2018-07-01

The incidence of pediatric nephrolithiasis in the United States is increasing. There is a paucity of literature comparing the diagnostic performance of computed ultrasound (US) to tomography (CT) in the pediatric population. To determine the diagnostic performance of renal US for nephrolithiasis in children using a clinical effectiveness approach. Institutional review board approval with a waiver of informed consent was obtained for this retrospective, HIPAA-complaint investigation. Billing records and imaging reports were used to identify children (≤18 years old) evaluated for nephrolithiasis by both US and unenhanced CT within 24 h between March 2012 and March 2017. Imaging reports were reviewed for presence, number, size and location of kidney stones. Diagnostic performance of US (reference standard=CT) was calculated per renal unit (left/right kidney) and per renal sector (four sectors per kidney). For sector analysis, US was considered truly positive if a stone was identified at CT in the same or an adjacent sector. There were 68 renal stones identified by CT in 30/69 patients (43%). Mean patient age was 14.7±3.6 years, and 35 were boys. For detecting nephrolithiasis in any kidney, US was 66.7% (48.8-80.8%) sensitive and 97.4% (86.8-99.9%) specific (positive predictive value=95.2% [77.3-99.8%], negative predictive value=79.2% [65.7-88.3%], positive likelihood ratio=26.0). Per renal sector, US was 59.7% (46.7-71.4%) sensitive and 97.4% (95.5-98.5%) specific (positive predictive value=72.3% [58.2-83.1%], negative predictive value=95.4% [93.2-96.9%], positive likelihood ratio=22.5). Of the 30 stones not detected by US, only 3 were >3 mm at CT. In clinical practice, US has high specificity for detecting nephrolithiasis in children but only moderate sensitivity and false negatives are common.

Sensitivity, specificity and predictive probability values of serum agglutination test titres for the diagnosis of Salmonella Dublin culture-positive bovine abortion and stillbirth.

PubMed

Sánchez-Miguel, C; Crilly, J; Grant, J; Mee, J F

2018-06-01

The objective of this study was to determine the diagnostic value of maternal serology for the diagnosis of Salmonella Dublin bovine abortion and stillbirth. A retrospective, unmatched, case-control study was carried out using twenty year's data (1989-2009) from bovine foetal submissions to an Irish government veterinary laboratory. Cases (n = 214) were defined as submissions with a S. Dublin culture-positive foetus from a S. Dublin unvaccinated dam where results of maternal S. Dublin serology were available. Controls (n = 415) were defined as submissions where an alternative diagnosis other than S. Dublin was made in a foetus from an S. Dublin unvaccinated dam where the results of maternal S. Dublin serology were available. A logistic regression model was fitted to the data: the dichotomous dependent variable was the S. Dublin foetal culture result, and the independent variables were the maternal serum agglutination test (SAT) titre results. Salmonella serology correctly classified 87% of S. Dublin culture-positive foetuses at a predicted probability threshold of 0.44 (cut-off at which sensitivity and specificity are at a maximum, J = 0.67). The sensitivity of the SAT at the same threshold was 73.8% (95% CI: 67.4%-79.5%), and the specificity was 93.2% (95% CI: 90.3%-95.4%). The positive and negative predictive values were 84.9% (95% CI: 79.3%-88.6%) and 87.3% (95% CI: 83.5%-91.3%), respectively. This study illustrates that the use of predicted probability values, rather than the traditional arbitrary breakpoints of negative, inconclusive and positive, increases the diagnostic value of the maternal SAT. Veterinary laboratory diagnosticians and veterinary practitioners can recover from the test results, information previously categorized, particularly from those results declared to be inconclusive. © 2017 Blackwell Verlag GmbH.

Cross-national comparison of screening mammography accuracy measures in U.S., Norway, and Spain.

PubMed

Domingo, Laia; Hofvind, Solveig; Hubbard, Rebecca A; Román, Marta; Benkeser, David; Sala, Maria; Castells, Xavier

2016-08-01

To compare accuracy measures for mammographic screening in Norway, Spain, and the US. Information from women aged 50-69 years who underwent mammographic screening 1996-2009 in the US (898,418 women), Norway (527,464), and Spain (517,317) was included. Screen-detected cancer, interval cancer, and the false-positive rates, sensitivity, specificity, positive predictive value (PPV) for recalls (PPV-1), PPV for biopsies (PPV-2), 1/PPV-1 and 1/PPV-2 were computed for each country. Analyses were stratified by age, screening history, time since last screening, calendar year, and mammography modality. The rate of screen-detected cancers was 4.5, 5.5, and 4.0 per 1000 screening exams in the US, Norway, and Spain respectively. The highest sensitivity and lowest specificity were reported in the US (83.1 % and 91.3 %, respectively), followed by Spain (79.0 % and 96.2 %) and Norway (75.5 % and 97.1 %). In Norway, Spain and the US, PPV-1 was 16.4 %, 9.8 %, and 4.9 %, and PPV-2 was 39.4 %, 38.9 %, and 25.9 %, respectively. The number of women needed to recall to detect one cancer was 20.3, 6.1, and 10.2 in the US, Norway, and Spain, respectively. Differences were found across countries, suggesting that opportunistic screening may translate into higher sensitivity at the cost of lower specificity and PPV. • Positive predictive value is higher in population-based screening programmes in Spain and Norway. • Opportunistic mammography screening in the US has lower positive predictive value. • Screening settings in the US translate into higher sensitivity and lower specificity. • The clinical burden may be higher for women screened opportunistically.

Accuracy of FDG-PET to diagnose lung cancer in a region of endemic granulomatous disease.

PubMed

Deppen, Stephen; Putnam, Joe B; Andrade, Gabriela; Speroff, Theodore; Nesbitt, Jonathan C; Lambright, Eric S; Massion, Pierre P; Walker, Ron; Grogan, Eric L

2011-08-01

The 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) is used to evaluate suspicious pulmonary lesions due to its diagnostic accuracy. The southeastern United States has a high prevalence of infectious granulomatous lung disease, and the accuracy of FDG-PET may be reduced in this population. We examined the diagnostic accuracy of FDG-PET in patients with known or suspected non-small cell lung cancer treated at our institution. A total of 279 patients, identified through our prospective database, underwent an operation for known or suspected lung cancer. Preoperative FDG-PET in 211 eligible patients was defined by standardized uptake value greater than 2.5 or by description ("moderate" or "intense") as avid. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and decision diagrams were calculated for FDG-PET in all patients and in patients with indeterminate nodules. In all eligible patients (n=211), sensitivity and specificity of FDG-PET were 92% and 40%, respectively. Positive and negative predictive values were 86% and 55%. Overall FDG-PET accuracy to diagnose lung cancer was 81%. Preoperative positive likelihood ratio for FDG-PET diagnosis of lung cancer in this population was 1.5 compared with previously published values of 7.1. In 113 indeterminate lesions, 65% had lung cancer and the sensitivity and specificity were 89% and 40%, respectively. Twenty-four benign nodules (60%) had false positive FDG-PET scans. Twenty-two of 43 benign nodules (51%) were granulomas. In a region with endemic granulomatous diseases, the specificity of FDG-PET for diagnosis of lung cancer was 40%. Clinical decisions and future clinical predictive models for lung cancer must accommodate regional variation of FDG-PET scan results. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Comparison between presepsin and procalcitonin in early diagnosis of neonatal sepsis.

PubMed

Iskandar, Agustin; Arthamin, Maimun Z; Indriana, Kristin; Anshory, Muhammad; Hur, Mina; Di Somma, Salvatore

2018-05-09

Neonatal sepsis remains worldwide one of the leading causes of morbidity and mortality in both term and preterm infants. Lower mortality rates are related to timely diagnostic evaluation and prompt initiation of empiric antibiotic therapy. Blood culture, as gold standard examination for sepsis, has several limitations for early diagnosis, so that sepsis biomarkers could play an important role in this regard. This study was aimed to compare the value of the two biomarkers presepsin and procalcitonin in early diagnosis of neonatal sepsis. This was a prospective cross-sectional study performed, in Saiful Anwar General Hospital Malang, Indonesia, in 51 neonates that fulfill the criteria of systemic inflammatory response syndrome (SIRS) with blood culture as diagnostic gold standard for sepsis. At reviewer operating characteristic (ROC) curve analyses, using a presepsin cutoff of 706,5 pg/mL, the obtained area under the curve (AUCs) were: sensitivity = 85.7%, specificity = 68.8%, positive predictive value = 85.7%, negative predictive value = 68.8%, positive likelihood ratio = 2.75, negative likelihood ratio = 0.21, and accuracy = 80.4%. On the other hand, with a procalcitonin cutoff value of 161.33 pg/mL the obtained AUCs showed: sensitivity = 68.6%, specificity = 62.5%, positive predictive value = 80%, negative predictive value = 47.6%, positive likelihood ratio = 1.83, the odds ratio negative = 0.5, and accuracy = 66.7%. In early diagnosis of neonatal sepsis, compared with procalcitonin, presepsin seems to provide better early diagnostic value with consequent possible faster therapeutical decision making and possible positive impact on outcome of neonates.

Goal striving, goal attainment, and well-being: adapting and testing the self-concordance model in sport.

PubMed

Smith, Alison; Ntoumanis, Nikos; Duda, Joan

2007-12-01

Grounded in self-determination theory (Deci & Ryan, 1985) and the self-concordance model (Sheldon & Elliot, 1999), this study examined the motivational processes underlying goal striving in sport as well as the role of perceived coach autonomy support in the goal process. Structural equation modeling with a sample of 210 British athletes showed that autonomous goal motives positively predicted effort, which, in turn, predicted goal attainment. Goal attainment was positively linked to need satisfaction, which, in turn, predicted psychological well-being. Effort and need satisfaction were found to mediate the associations between autonomous motives and goal attainment and between attainment and well-being, respectively. Controlled motives negatively predicted well-being, and coach autonomy support positively predicted both autonomous motives and need satisfaction. Associations of autonomous motives with effort were not reducible to goal difficulty, goal specificity, or goal efficacy. These findings support the self-concordance model as a framework for further research on goal setting in sport.

Combining the Suicide Intent Scale and the Karolinska Interpersonal Violence Scale in suicide risk assessments.

PubMed

Stefansson, J; Nordström, P; Runeson, B; Åsberg, M; Jokinen, J

2015-09-23

High suicide intent, childhood trauma, and violent behavior are risk factors for suicide in suicide attempters. The aim of this study was to investigate whether the combined assessment of suicide intent and interpersonal violence would provide a better prediction of suicide risk than an assessment of only suicide intent or interpersonal violence. This is a cohort study involving 81 suicide attempters included in the study between 1993 and 1998. Patients were assessed with both the Suicide Intent Scale (SIS) and the Karolinska Interpersonal Violence Scale (KIVS). Through the unique personal identification number in Sweden, patients were linked to the Cause of Death Register maintained by the Swedish National Board of Health and Welfare. Suicides were ascertained from the death certificates. Seven of 14 patients who had died before April 2013 had committed suicide. The positive predictive value for the Suicide Intent Scale alone was 16.7 %, with a specificity of 52 % and an area under the curve of 0.74. A combined assessment with the KIVS gave higher specificity (63 %) and a positive predictive value of 18.8 % with an AUC of 0.83. Combined use of SIS and KIVS expressed interpersonal violence as an adult subscale gave a sensitivity of 83.3 %, a specificity of 80.3 %, and a positive predictive value of 26 % with an AUC of 0.85. The correlation between KIVS and SIS scores was not significant. Using both the the SIS and the KIVS combined may be better for predicting completed suicide than using them separately. The nonsignificant correlation between the scales indicates that they measure different components of suicide risk.

Magnifying endoscopy for the diagnosis of specialized intestinal metaplasia in short-segment Barrett's esophagus.

PubMed

Ham, Nam Seok; Jang, Jae Young; Ryu, Sung Woo; Kim, Ji Hye; Park, Eui Ju; Lee, Woong Cheul; Shim, Kwang Yeun; Jeong, Soung Won; Kim, Hyun Gun; Lee, Tae Hee; Jeon, Sung Ran; Cho, Jun Hyung; Cho, Joo Young; Jin, So Young; Lee, Ji Sung

2013-11-07

To determine whether magnified observation of short-segment Barrett's esophagus (BE) is useful for the detection of specialized intestinal metaplasia (SIM). Thirty patients with suspected short-segment BE underwent magnifying endoscopy up to × 80. The magnified images were analyzed with respect to their pit-patterns, which were simultaneously classified into five epithelial types [I (small round), II (straight), III (long oval), IV (tubular), V (villous)] by Endo's classification. Then, a 0.5% solution of methylene blue (MB) was sprayed over columnar mucosa. The patterns of the magnified image and MB staining were analyzed. Biopsies were obtained from the regions previously observed by magnifying endoscopy and MB chromoendoscopy. Three of five patients with a type V (villous) epithelial pattern had SIM, whereas 21 patients with a non-type V epithelial patterns did not have SIM. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of pit-patterns in detecting SIM were 100%, 91.3%, 92.3%, 60% and 100%, respectively (P = 0.004). Three of the 12 patients with positive MB staining had SIM, whereas 14 patients with negative MB staining did not have SIM. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MB staining in detecting SIM were 100%, 60.9%, 65.4%, 25% and 100%, respectively (P = 0.085). The specificity and accuracy of pit-pattern evaluation were significantly superior compared with MB staining for detecting SIM by comparison with the exact McNemar's test (P = 0.0391). The magnified observation of a short-segment BE according to the mucosal pattern and its classification can be predictive of SIM.

Evaluation of a new in-clinic test system to detect feline immunodeficiency virus and feline leukemia virus infection.

PubMed

Sand, Christina; Englert, Theresa; Egberink, Herman; Lutz, Hans; Hartmann, Katrin

2010-06-01

Many in-house tests for the diagnosis of feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) infection are licensed for use in veterinary practice. A new test with unknown performance has recently appeared on the market. The aims of this study were to define the efficacy of a new in-clinic test system, the Anigen Rapid FIV Ab/FeLV Ag Test, and to compare it with the current leading in-clinic test, the SNAP Kombi Plus FeLV Antigen/FIB Antibody Test. Three-hundred serum samples from randomly selected healthy and diseased cats presented to the Clinic of Small Animal Medicine at Ludwig Maximilian University were tested using both the Anigen Rapid Test and the SNAP Kombi Plus Test. Diagnostic sensitivity, specificity, and positive and negative predictive values were calculated for both tests using Western blot as the gold standard for verification of FIV infection and PCR as the gold standard for FeLV infection. The presence of antibodies against FIV was confirmed by Western blot in 9/300 samples (prevalence 3%). FeLV DNA was detected by PCR in 15/300 samples (prevalence 5%). For FIV infection the Anigen Rapid Test had a sensitivity of 88.9%, specificity of 99.7%, positive predictive value of 88.9%, and negative predictive value of 99.7%. For FeLV infection, the Anigen Rapid Test had a sensitivity of 40.0%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 96.9%. Diagnostic accuracy was similar to that of the SNAP Kombi Plus Test. The new Anigen Rapid FIV Ab/FeLV Ag Test performed very well and can be recommended for use in veterinary practice.

Should gram stains have a role in diagnosing hip arthroplasty infections?

PubMed

Johnson, Aaron J; Zywiel, Michael G; Stroh, D Alex; Marker, David R; Mont, Michael A

2010-09-01

The utility of Gram stains in diagnosing periprosthetic infections following total hip arthroplasty has recently been questioned. Several studies report low sensitivity of the test, and its poor ability to either confirm or rule out infection in patients undergoing revision total hip arthroplasty. Despite this, many institutions including that of the senior author continue to perform Gram stains during revision total hip arthroplasty. We assessed the sensitivity, specificity, accuracy, and positive and negative predictive values of Gram stains from surgical-site samplings taken from procedures on patients with both infected and aseptic revision total hip arthroplasties. A review was performed on patients who underwent revision total hip arthroplasty between 2000 and 2007. Eighty-two Gram stains were performed on patients who had infected total hip arthroplasties and underwent revision procedures. Additionally, of the 410 revision total hip arthroplasties performed on patients who were confirmed infection-free, 120 Gram stains were performed. Patients were diagnosed as infected using multiple criteria at the time of surgery. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated from these Gram stain results. The Gram stain demonstrated a sensitivity and specificity of 9.8% and 100%, respectively. In this series, the Gram stain had a negative predictive value of 62%, a positive predictive value of 100%, and an accuracy of 63%. Gram stains obtained from surgical-site samples had poor sensitivity and poor negative predictive value. Based on these findings, as well as those of other authors, we believe that Gram stains should no longer be considered for diagnosing infections in revision total hip arthroplasty. Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Validity of Alcohol Use Disorder Identification Test-Korean Revised Version for Screening Alcohol Use Disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criteria.

PubMed

Chang, Jung Wei; Kim, Jong Sung; Jung, Jin Gyu; Kim, Sung Soo; Yoon, Seok Joon; Jang, Hak Sun

2016-11-01

The Alcohol Use Disorder Identification Test (AUDIT) has been widely used to identify alcohol use disorder (AUD). This study evaluated the validity of the AUDIT-Korean revised version (AUDIT-KR) for screening AUD according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria. This research was conducted with 443 subjects who visited the Chungnam National University Hospital for a comprehensive medical examination. All subjects completed the demographic questionnaire and AUDIT-KR without assistance. Subjects were divided into two groups according to DSM-5 criteria: an AUD group, which included patients that fit the criteria for AUD (120 males and 21 females), and a non-AUD group, which included 146 males and 156 females that did not meet AUD criteria. The appropriate cut-off values, sensitivity, specificity, and positive and negative predictive values of the AUDIT-KR were evaluated. The mean±standard deviation AUDIT-KR scores were 10.32±7.48 points in males and 3.23±4.42 points in females. The area under the receiver operating characteristic curve (95% confidence interval, CI) of the AUDIT-KR for identifying AUD was 0.884 (0.840-0.920) in males and 0.962 (0.923-0.985) in females. The optimal cut-off value of the AUDIT-KR was 10 points for males (sensitivity, 81.90%; specificity, 81.33%; positive predictive value, 77.2%; negative predictive value, 85.3%) and 5 points for females (sensitivity, 100.00%; specificity, 88.54%; positive predictive value, 52.6%; negative predictive value, 100.0%). The AUDIT-KR has high reliability and validity for identifying AUD according to DSM-5 criteria.

Specific Coping Behaviors in Relation to Adolescent Depression and Suicidal Ideation

PubMed Central

Horwitz, Adam G.; Hill, Ryan M.; King, Cheryl A.

2010-01-01

The coping strategies used by adolescents to deal with stress may have implications for the development of depression and suicidal ideation. This study examined coping categories and specific coping behaviors used by adolescents to assess the relation of coping to depression and suicidal ideation. In hierarchical regression models, the specific coping behaviors of behavioral disengagement and self-blame were predictive of higher levels of depression; depression and using emotional support were predictive of suicidal ideation. Results suggest that specific behaviors within the broad coping categories of emotion-focused coping (e.g., self-blame) and avoidant coping (e.g., behavioral disengagement) account for these categories’ associations with depression and suicidal ideation. Specific problem-focused coping strategies did not independently predict lower levels of depression or suicidal ideation. It may be beneficial for interventions to focus on eliminating maladaptive coping behaviors in addition to introducing or enhancing positive coping behaviors. PMID:21074841

[Validation of the portuguese version of the Mini-Social Phobia Inventory (Mini-SPIN)].

PubMed

D'El Rey, Gustavo José Fonseca; Matos, Cláudia Wilmor

2009-01-01

Social phobia (also known as social anxiety disorder) is a severe mental disorder that brings distress and disability. The aim of this study was validate to the Portuguese language the Mini-Social Phobia Inventory (Mini-SPIN) in a populational sample. We performed a discriminative validity study of the Mini-SPIN in a sample of 644 subjects (Mini-SPIN positive group: n = 218 and control/negative group: n = 426) of a study of anxiety disorders' prevalence in the city of Santo André-SP. The Portuguese version of the Mini-SPIN (with score of 6 points, suggested in the original English version) demonstrated a sensitivity of 95.0%, specificity of 80.3%, positive predictive value of 52.8%, negative predictive value of 98.6% and incorrect classification rate of 16.9%. With score of 7 points, was observed an increase in the specificity and positive predictive value (88.6% and 62.7%), while the sensitivity and negative predictive value (84.8% and 96.2%) remained high. The Portuguese version of the Mini-SPIN showed satisfactory psychometric qualities in terms of discriminative validity. In this study, the cut-off of 7, was considered to be the most suitable to screening of the generalized social phobia.

Using Emotion as Information in Future-Oriented Cognition: Individual Differences in the Context of State Negative Affect

PubMed Central

Marroquín, Brett; Boyle, Chloe C.; Nolen-Hoeksema, Susan; Stanton, Annette L.

2016-01-01

Predictions about the future are susceptible to mood-congruent influences of emotional state. However, recent work suggests individuals also differ in the degree to which they incorporate emotion into cognition. This study examined the role of such individual differences in the context of state negative emotion. We examined whether trait tendencies to use negative or positive emotion as information affect individuals' predictions of what will happen in the future (likelihood estimation) and how events will feel (affective forecasting), and whether trait influences depend on emotional state. Participants (N=119) reported on tendencies to use emotion as information (“following feelings”), underwent an emotion induction (negative versus neutral), and made likelihood estimates and affective forecasts for future events. Views of the future were predicted by both emotional state and individual differences in following feelings. Whereas following negative feelings affected most future-oriented cognition across emotional states, following positive feelings specifically buffered individuals' views of the future in the negative emotion condition, and specifically for positive future events, a category of future-event prediction especially important in psychological health. Individual differences may confer predisposition toward optimistic or pessimistic expectations of the future in the context of acute negative emotion, with implications for adaptive and maladaptive functioning. PMID:27041783

Adaptability and Prediction of Anticipatory Muscular Activity Parameters to Different Movements in the Sitting Position.

PubMed

Chikh, Soufien; Watelain, Eric; Faupin, Arnaud; Pinti, Antonio; Jarraya, Mohamed; Garnier, Cyril

2016-08-01

Voluntary movement often causes postural perturbation that requires an anticipatory postural adjustment to minimize perturbation and increase the efficiency and coordination during execution. This systematic review focuses specifically on the relationship between the parameters of anticipatory muscular activities and movement finality in sitting position among adults, to study the adaptability and predictability of anticipatory muscular activities parameters to different movements and conditions in sitting position in adults. A systematic literature search was performed using PubMed, Science Direct, Web of Science, Springer-Link, Engineering Village, and EbscoHost. Inclusion and exclusion criteria were applied to retain the most rigorous and specific studies, yielding 76 articles, Seventeen articles were excluded at first reading, and after the application of inclusion and exclusion criteria, 23 were retained. In a sitting position, central nervous system activity precedes movement by diverse anticipatory muscular activities and shows the ability to adapt anticipatory muscular activity parameters to the movement direction, postural stability, or charge weight. In addition, these parameters could be adapted to the speed of execution, as found for the standing position. Parameters of anticipatory muscular activities (duration, order, and amplitude of muscle contractions constituting the anticipatory muscular activity) could be used as a predictive indicator of forthcoming movement. In addition, this systematic review may improve methodology in empirical studies and assistive technology for people with disabilities. © The Author(s) 2016.

The Stroke Assessment of Fall Risk (SAFR): predictive validity in inpatient stroke rehabilitation.

PubMed

Breisinger, Terry P; Skidmore, Elizabeth R; Niyonkuru, Christian; Terhorst, Lauren; Campbell, Grace B

2014-12-01

To evaluate relative accuracy of a newly developed Stroke Assessment of Fall Risk (SAFR) for classifying fallers and non-fallers, compared with a health system fall risk screening tool, the Fall Harm Risk Screen. Prospective quality improvement study conducted at an inpatient stroke rehabilitation unit at a large urban university hospital. Patients admitted for inpatient stroke rehabilitation (N = 419) with imaging or clinical evidence of ischemic or hemorrhagic stroke, between 1 August 2009 and 31 July 2010. Not applicable. Sensitivity, specificity, and area under the curve for Receiver Operating Characteristic Curves of both scales' classifications, based on fall risk score completed upon admission to inpatient stroke rehabilitation. A total of 68 (16%) participants fell at least once. The SAFR was significantly more accurate than the Fall Harm Risk Screen (p < 0.001), with area under the curve of 0.73, positive predictive value of 0.29, and negative predictive value of 0.94. For the Fall Harm Risk Screen, area under the curve was 0.56, positive predictive value was 0.19, and negative predictive value was 0.86. Sensitivity and specificity of the SAFR (0.78 and 0.63, respectively) was higher than the Fall Harm Risk Screen (0.57 and 0.48, respectively). An evidence-derived, population-specific fall risk assessment may more accurately predict fallers than a general fall risk screen for stroke rehabilitation patients. While the SAFR improves upon the accuracy of a general assessment tool, additional refinement may be warranted. © The Author(s) 2014.

Multi-Stage Target Tracking with Drift Correction and Position Prediction

NASA Astrophysics Data System (ADS)

Chen, Xin; Ren, Keyan; Hou, Yibin

2018-04-01

Most existing tracking methods are hard to combine accuracy and performance, and do not consider the shift between clarity and blur that often occurs. In this paper, we propound a multi-stage tracking framework with two particular modules: position prediction and corrective measure. We conduct tracking based on correlation filter with a corrective measure module to increase both performance and accuracy. Specifically, a convolutional network is used for solving the blur problem in realistic scene, training methodology that training dataset with blur images generated by the three blur algorithms. Then, we propose a position prediction module to reduce the computation cost and make tracker more capable of fast motion. Experimental result shows that our tracking method is more robust compared to others and more accurate on the benchmark sequences.

Insensitivity of the "Romberg test of standing balance on firm and compliant support surfaces" to the results of caloric and VEMP tests.

PubMed

Jacobson, Gary P; McCaslin, Devin L; Piker, Erin G; Gruenwald, Jill; Grantham, Sarah; Tegel, Lauren

2011-01-01

The objective of this study was to assess the sensitivity, specificity, and positive and negative predictive value of the Romberg Test of Standing Balance on Firm and Compliant Support Surfaces (RTSBFCSS) for the identification of patients with vestibular system impairments affecting the horizontal semicircular canal, saccule, and/or inferior and superior vestibular nerves. The RTSBFCSS was developed for the National Health and Nutrition Examination Survey (NHANES) and was used recently to estimate the numbers of individuals aged 40 yr or older with vestibular system impairments among the general population of the United States. A retrospective analysis of the medical records of 103 consecutive patients aged 40 yr or older (mean age 59 ± 12 yr, 71 females) who had undergone vestibular assessment at the Balance Disorders Clinic at the Vanderbilt University School of Medicine. Patients with complete electro- or videonystagmography testing, cervical vestibular evoked myogenic potential (cVEMP) testing, and the RTSBFCSS screening test were included in the analysis. A series of 2 × 2 tables were created that represented the number of "true positives," "true negatives," "false positives," and "false negatives" of the RTSBFCSS under conditions where the caloric test was abnormal and then separately where the cVEMP test was abnormal. The data were analyzed in a manner such that sensitivity, specificity, and both positive and negative predictive value of the RTSBFCSS could be calculated. When the caloric test was used as the criterion standard and the subject selection criteria in the NHANES study were used (i.e., subjects who were able to maintain postural stability for trials 1-3 of the RTSBFCSS; N = 45), the sensitivity and specificity of the RTSBFCSS to impairment of the horizontal semicircular canal or superior vestibular nerve were 55% and 64%, respectively, yielding positive and negative predictive values of 55% and 64%, respectively. When all patients aged 40 yr or older were evaluated (N = 103), the sensitivity and specificity were 61% and 58%, respectively, yielding positive and negative predictive values of 39% and 78%, respectively. Using the cVEMP test as the criterion standard for the detection of impairment affecting the saccule and/or inferior vestibular nerve did not improve the performance criteria of the NHANES screening measure. The RTSBFCSS should not be used as a screening measure for vestibular impairment.

Early prediction of blonanserin response in Japanese patients with schizophrenia.

PubMed

Kishi, Taro; Matsuda, Yuki; Fujita, Kiyoshi; Iwata, Nakao

2014-01-01

Blonanserin is a second-generation antipsychotic used for the treatment of schizophrenia in Japan and Korea. The present study aimed to examine early prediction of blonanserin in patients with schizophrenia. An 8-week, prospective, single-arm, flexible-dose clinical trial of blonanserin in patients with schizophrenia was conducted under real-world conditions. The inclusion criteria were antipsychotic naïve, and first-episode schizophrenia patients or schizophrenia patients with no consumption of any antipsychotic medication for more than 4 weeks before enrollment in this study. The positive predictive value, negative predictive value, sensitivity, specificity, and predictive power were calculated for the response status at week 4 to predict the subsequent response at week 8. Thirty-seven patients were recruited (56.8% of them had first-episode schizophrenia), and 28 (75.7%) completed the trial. At week 8, blonanserin was associated with a significant improvement in the Positive and Negative Syndrome Scale (PANSS) total score (P<0.0001) and in positive (P<0.0001), negative (P<0.0001), and general subscale scores (P<0.0001). In terms of percentage improvement of PANSS total scores from baseline to week 8, 64.9% of patients showed a ≥20% reduction in the PANSS total score and 48.6% showed a ≥30% reduction. However, 8.1% of patients experienced at least one adverse event. Using the 20% reduction in the PANSS total score at week 4 as a definition of an early response, the negative predictive values for later responses (ie, reductions of ≥30 and ≥40 in the PANSS total scores) were 88.9% and 94.1%, respectively. The specificities were 80.0% and 51.6%, respectively. Our results suggest that the blonanserin response at week 4 could predict the later response at week 8.

Early prediction of blonanserin response in Japanese patients with schizophrenia

PubMed Central

Kishi, Taro; Matsuda, Yuki; Fujita, Kiyoshi; Iwata, Nakao

2014-01-01

Background Blonanserin is a second-generation antipsychotic used for the treatment of schizophrenia in Japan and Korea. The present study aimed to examine early prediction of blonanserin in patients with schizophrenia. Methods An 8-week, prospective, single-arm, flexible-dose clinical trial of blonanserin in patients with schizophrenia was conducted under real-world conditions. The inclusion criteria were antipsychotic naïve, and first-episode schizophrenia patients or schizophrenia patients with no consumption of any antipsychotic medication for more than 4 weeks before enrollment in this study. The positive predictive value, negative predictive value, sensitivity, specificity, and predictive power were calculated for the response status at week 4 to predict the subsequent response at week 8. Results Thirty-seven patients were recruited (56.8% of them had first-episode schizophrenia), and 28 (75.7%) completed the trial. At week 8, blonanserin was associated with a significant improvement in the Positive and Negative Syndrome Scale (PANSS) total score (P<0.0001) and in positive (P<0.0001), negative (P<0.0001), and general subscale scores (P<0.0001). In terms of percentage improvement of PANSS total scores from baseline to week 8, 64.9% of patients showed a ≥20% reduction in the PANSS total score and 48.6% showed a ≥30% reduction. However, 8.1% of patients experienced at least one adverse event. Using the 20% reduction in the PANSS total score at week 4 as a definition of an early response, the negative predictive values for later responses (ie, reductions of ≥30 and ≥40 in the PANSS total scores) were 88.9% and 94.1%, respectively. The specificities were 80.0% and 51.6%, respectively. Conclusion Our results suggest that the blonanserin response at week 4 could predict the later response at week 8. PMID:25285009

Electrochemiluminescence Assays for Insulin and Glutamic Acid Decarboxylase Autoantibodies Improve Prediction of Type 1 Diabetes Risk

PubMed Central

Miao, Dongmei; Steck, Andrea K.; Zhang, Li; Guyer, K. Michelle; Jiang, Ling; Armstrong, Taylor; Muller, Sarah M.; Krischer, Jeffrey; Rewers, Marian

2015-01-01

Abstract We recently developed new electrochemiluminescence (ECL) insulin autoantibody (IAA) and glutamic acid decarboxylase 65 autoantibody (GADA) assays that discriminate high-affinity, high-risk diabetes-specific autoantibodies from low-affinity, low-risk islet autoantibodies (iAbs) detected by radioassay (RAD). Here, we report a further validation of the ECL-IAA and -GADA assays in 3,484 TrialNet study participants. The ECL assay and RAD were congruent in those with prediabetes and in subjects with multiple autoantibodies, but only 24% (P<0.0001) of single RAD-IAA-positive and 46% (P<0.0001) of single RAD-GADA-positive were confirmed by the ECL-IAA and -GADA assays, respectively. During a follow-up (mean, 2.4 years), 51% of RAD-IAA-positive and 63% of RAD-GADA-positive subjects not confirmed by ECL became iAb negative, compared with only 17% of RAD-IAA-positive (P<0.0001) and 15% of RAD-GADA-positive (P<0.0001) subjects confirmed by ECL assays. Among subjects with multiple iAbs, diabetes-free survival was significantly shorter if IAA or GADA was positive by ECL and negative by RAD than if IAA or GADA was negative by ECL and positive by RAD (P<0.019 and P<0.0001, respectively). Both positive and negative predictive values in terms of progression to type 1 diabetes mellitus were superior for ECL-IAA and ECL-GADA, compared with RADs. The prevalence of the high-risk human leukocyte antigen-DR3/4, DQB1*0302 genotype was significantly higher in subjects with RAD-IAA or RAD-GADA confirmed by ECL. In conclusion, both ECL-IAA and -GADA are more disease-specific and better able to predict the risk of progression to type 1 diabetes mellitus than the current standard RADs. PMID:25562486

Electrochemiluminescence assays for insulin and glutamic acid decarboxylase autoantibodies improve prediction of type 1 diabetes risk.

PubMed

Miao, Dongmei; Steck, Andrea K; Zhang, Li; Guyer, K Michelle; Jiang, Ling; Armstrong, Taylor; Muller, Sarah M; Krischer, Jeffrey; Rewers, Marian; Yu, Liping

2015-02-01

We recently developed new electrochemiluminescence (ECL) insulin autoantibody (IAA) and glutamic acid decarboxylase 65 autoantibody (GADA) assays that discriminate high-affinity, high-risk diabetes-specific autoantibodies from low-affinity, low-risk islet autoantibodies (iAbs) detected by radioassay (RAD). Here, we report a further validation of the ECL-IAA and -GADA assays in 3,484 TrialNet study participants. The ECL assay and RAD were congruent in those with prediabetes and in subjects with multiple autoantibodies, but only 24% (P<0.0001) of single RAD-IAA-positive and 46% (P<0.0001) of single RAD-GADA-positive were confirmed by the ECL-IAA and -GADA assays, respectively. During a follow-up (mean, 2.4 years), 51% of RAD-IAA-positive and 63% of RAD-GADA-positive subjects not confirmed by ECL became iAb negative, compared with only 17% of RAD-IAA-positive (P<0.0001) and 15% of RAD-GADA-positive (P<0.0001) subjects confirmed by ECL assays. Among subjects with multiple iAbs, diabetes-free survival was significantly shorter if IAA or GADA was positive by ECL and negative by RAD than if IAA or GADA was negative by ECL and positive by RAD (P<0.019 and P<0.0001, respectively). Both positive and negative predictive values in terms of progression to type 1 diabetes mellitus were superior for ECL-IAA and ECL-GADA, compared with RADs. The prevalence of the high-risk human leukocyte antigen-DR3/4, DQB1*0302 genotype was significantly higher in subjects with RAD-IAA or RAD-GADA confirmed by ECL. In conclusion, both ECL-IAA and -GADA are more disease-specific and better able to predict the risk of progression to type 1 diabetes mellitus than the current standard RADs.

Prostate cancer prediction using the random forest algorithm that takes into account transrectal ultrasound findings, age, and serum levels of prostate-specific antigen.

PubMed

Xiao, Li-Hong; Chen, Pei-Ran; Gou, Zhong-Ping; Li, Yong-Zhong; Li, Mei; Xiang, Liang-Cheng; Feng, Ping

2017-01-01

The aim of this study is to evaluate the ability of the random forest algorithm that combines data on transrectal ultrasound findings, age, and serum levels of prostate-specific antigen to predict prostate carcinoma. Clinico-demographic data were analyzed for 941 patients with prostate diseases treated at our hospital, including age, serum prostate-specific antigen levels, transrectal ultrasound findings, and pathology diagnosis based on ultrasound-guided needle biopsy of the prostate. These data were compared between patients with and without prostate cancer using the Chi-square test, and then entered into the random forest model to predict diagnosis. Patients with and without prostate cancer differed significantly in age and serum prostate-specific antigen levels (P < 0.001), as well as in all transrectal ultrasound characteristics (P < 0.05) except uneven echo (P = 0.609). The random forest model based on age, prostate-specific antigen and ultrasound predicted prostate cancer with an accuracy of 83.10%, sensitivity of 65.64%, and specificity of 93.83%. Positive predictive value was 86.72%, and negative predictive value was 81.64%. By integrating age, prostate-specific antigen levels and transrectal ultrasound findings, the random forest algorithm shows better diagnostic performance for prostate cancer than either diagnostic indicator on its own. This algorithm may help improve diagnosis of the disease by identifying patients at high risk for biopsy.

Focused abdominal sonography for trauma (FAST) in blunt paediatric abdominal trauma.

PubMed

Faruque, Ahmad Vaqas; Qazi, Saqib Hamid; Khan, Muhammad Arif Mateen; Akhtar, Wassem; Majeed, Amina

2013-03-01

To evaluate the role of focussed abdominal sonography for trauma in blunt paediatric abdominal trauma patients, and to see if the role of computed tomography scan could be limited to only those cases in which sonography was positive. The retrospective study covered 10 years, from January 1,2000 to December 31,2009, and was conducted at the Department of Radiology and Department of Emergency Medicine, Aga Khan University Hospital, Karachi. It comprised cases of 174 children from birth to 14 years who had presented with blunt abdominal trauma and had focussed abdominal sonography for trauma done at the hospital. The findings were correlated with computed tomography scan of the abdomen and clinical follow-up. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of focussed abdominal sonography for trauma were calculated for blunt abdominal trauma. SPSS 17 was used for statistical analysis. Of the total 174 cases, 31 (17.81%) were later confirmed by abdominal scan. Of these 31 children, sonography had been positive in 29 (93.54%) children. In 21 (67.74%) of the 31 children, sonograpy had been true positive; 8 (25%) (8/31) were false positive; and 2 (6%) (2/31) were false negative. There were 6 (19.3%) children in which sonography was positive and converted to laparotomy. There was no significant difference on account of gender (p>0.356). Focussed abdominal sonography for trauma in the study had sensitivity of 91%, specificity of 95%, positive predictive value of 73%, and negative predictive value of 73% with accuracy of 94%. All patients who had negative sonography were discharged later, and had no complication on clinical follow-up. Focussed abdominal sonography for trauma is a fairly reliable mode to assess blunt abdominal trauma in children. It is a useful tool to pick high-grade solid and hollow viscous injury. The results suggest that the role of computed tomography scan can be limited to those cases in which focussed sonography is positive.

Validation of the harmless acute pancreatitis score in predicting nonsevere course of acute pancreatitis.

PubMed

Oskarsson, V; Mehrabi, M; Orsini, N; Hammarqvist, F; Segersvärd, R; Andrén-Sandberg, A; Sadr Azodi, O

2011-01-01

The Harmless Acute Pancreatitis Score (HAPS) is a scoring algorithm to identify patients with nonsevere acute pancreatitis. The aim of this study was to evaluate the reproducibility of HAPS outside its original study setting. Baseline information of all hospitalized patients with acute pancreatitis at Karolinska University Hospital, Stockholm, Sweden, between 2004 and 2009 was collected. The parameters constituting HAPS were signs of peritonitis, hematocrit and serum creatinine levels. Since hematocrit was not available in all patients, complete sample analysis was performed by replacing hematocrit with hemoglobin (strongly correlated with hematocrit; r = 0.86). In total, 531 patients with a first-time or a recurrent attack of acute pancreatitis were included. Among 353 patients with complete information on parameters constituting HAPS, 79 patients were predicted to have a nonsevere course, of whom 1 patient developed severe acute pancreatitis. The specificity of HAPS in predicting a nonsevere course of acute pancreatitis was 96.3% (95% CI: 81.0-99.9) with a corresponding positive predictive value of 98.7% (95% CI: 93.1-100). Complete sample analysis replacing hematocrit with hemoglobin level predicted a nonsevere course in 182 patients, of whom 2 patients had severe acute pancreatitis (94.3% specificity and 98.9% positive predictive value). HAPS is a highly specific scoring algorithm that predicts a nonsevere course of acute pancreatitis. Therefore, HAPS might be an additional tool in the clinical assessment of acute pancreatitis where early screening is important to treat the patients at an optimal level of care. Copyright © 2011 S. Karger AG, Basel.

Comparison of serum specific IgE with skin prick test in the diagnosis of allergy in Malaysia.

PubMed

Asha'ari, Z A; Suhaimi, Y; Yusof, R A; Rushdan, I; Maraina, C H C

2011-08-01

We compared a newer serum specific IgE (SSIgE) test with skin prick testing (SPT) in the diagnosis of allergy in Malaysia. Ninety newly diagnosed allergic patients were enrolled for both tests. Using SPT as a clinical gold standard, the sensitivity, specificity, positive, and negative predictive values (PPV, NPV) were calculated for SSIgE for each of the common allergens tested. The highest positive results for both SPT and SSIgE were for house dust mite and cat. Compared to SPT, SSIgE showed better sensitivity but poorer specificity, low PPV and good NPV in all the allergens tested. Significant positive correlation was seen between the diameter of wheal and flare of SPT and the SSIgE results.

Positive Skin Test or Specific IgE to Penicillin Does Not Reliably Predict Penicillin Allergy.

PubMed

Tannert, Line Kring; Mortz, Charlotte Gotthard; Skov, Per Stahl; Bindslev-Jensen, Carsten

According to guidelines, patients are diagnosed with penicillin allergy if skin test (ST) result or specific IgE (s-IgE) to penicillin is positive. However, the true sensitivity and specificity of these tests are presently not known. To investigate the clinical relevance of a positive ST result and positive s-IgE and to study the reproducibility of ST and s-IgE. A sample of convenience of 25 patients with positive penicillin ST results, antipenicillin s-IgE results, or both was challenged with their culprit penicillin. Further 19 patients were not challenged, but deemed allergic on the basis of a recent anaphylactic reaction or delayed reactions to skin testing. Another sample of convenience of 18 patients, 17 overlapping with the 25 challenged, with initial skin testing and s-IgE (median, 25; range, 3-121), months earlier (T -1 ), was repeat skin tested and had s-IgE measured (T 0 ), and then skin tested and had s-IgE measured 4 weeks later (T 1 ). Only 9 (36%) of 25 were challenge positive. There was an increased probability of being penicillin allergic if both ST result and s-IgE were positive at T 0 . Positive ST result or positive s-IgE alone did not predict penicillin allergy. Among the 18 patients repeatedly tested, 46.2% (12 of 25) of positive ST results at T -1 were reproducibly positive at T 0 . For s-IgE, 54.2% (14 of 24) positive measurements were still positive at T 0 and 7 converted to positive at T 1 . The best predictor for a clinically significant (IgE-mediated) penicillin allergy is a combination of a positive case history with simultaneous positive ST result and s-IgE or a positive challenge result. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Validity of verbal autopsy method to determine causes of death among adults in the urban setting of Ethiopia

PubMed Central

2012-01-01

Background Verbal autopsy has been widely used to estimate causes of death in settings with inadequate vital registries, but little is known about its validity. This analysis was part of Addis Ababa Mortality Surveillance Program to examine the validity of verbal autopsy for determining causes of death compared with hospital medical records among adults in the urban setting of Ethiopia. Methods This validation study consisted of comparison of verbal autopsy final diagnosis with hospital diagnosis taken as a “gold standard”. In public and private hospitals of Addis Ababa, 20,152 adult deaths (15 years and above) were recorded between 2007 and 2010. With the same period, a verbal autopsy was conducted for 4,776 adult deaths of which, 1,356 were deceased in any of Addis Ababa hospitals. Then, verbal autopsy and hospital data sets were merged using the variables; full name of the deceased, sex, address, age, place and date of death. We calculated sensitivity, specificity and positive predictive values with 95% confidence interval. Results After merging, a total of 335 adult deaths were captured. For communicable diseases, the values of sensitivity, specificity and positive predictive values of verbal autopsy diagnosis were 79%, 78% and 68% respectively. For non-communicable diseases, sensitivity of the verbal autopsy diagnoses was 69%, specificity 78% and positive predictive value 79%. Regarding injury, sensitivity of the verbal autopsy diagnoses was 70%, specificity 98% and positive predictive value 83%. Higher sensitivity was achieved for HIV/AIDS and tuberculosis, but lower specificity with relatively more false positives. Conclusion These findings may indicate the potential of verbal autopsy to provide cost-effective information to guide policy on communicable and non communicable diseases double burden among adults in Ethiopia. Thus, a well structured verbal autopsy method, followed by qualified physician reviews could be capable of providing reasonable cause specific mortality estimates in Ethiopia. However, the limited generalizability of this study due to the fact that matched verbal autopsy deaths were all in-hospital deaths in an urban center, thus results may not be generalizable to rural home deaths. Such application and refinement of existing verbal autopsy methods holds out the possibility of obtaining replicable, sustainable and internationally comparable mortality statistics of known quality. Similar validation studies need to be undertaken considering the limitation of medical records as “gold standard” since records may not be confirmed using laboratory investigations or medical technologies. The validation studies need to address child and maternal causes of death and possibly all underlying causes of death. PMID:22928712

Breast cancer mammographic diagnosis performance in a public health institution: a retrospective cohort study.

PubMed

Mello, Juliana M R B; Bittelbrunn, Fernando P; Rockenbach, Marcio A B C; May, Guilherme G; Vedolin, Leonardo M; Kruger, Marilia S; Soldatelli, Matheus D; Zwetsch, Guilherme; de Miranda, Gabriel T F; Teixeira, Saone I P; Arruda, Bruna S

2017-12-01

To evaluate the quality assurance of mammography results at a reference institution for the diagnosis and treatment of breast cancer in southern Brazil, based on the BIRADS (Breast Imaging Reporting and Data System) 5th edition recommendations for auditing purposes. Retrospective cohort and cross-sectional study with 4502 patients (9668 mammographies)) who underwent at least one or both breast mammographies throughout 2013 at a regional public hospital, linked to a federal public university. The results were followed until 31 December 2014, including true positives (TPs), true negatives (TNs), false positives (FPs), false negatives (FNs), positive predictive values (PPVs), negative predictive value (NPV), sensitivity and specificity, with a confidence interval of 95%. The study showed high quality assurance, particularly regarding sensitivity (90.22%) and specificity (92.31%). The overall positive predictive value (PPV) was 65.35%, and the negative predictive value (NPV) was 98.32%. The abnormal interpretation rate (recall rate) was 12.26%. The results are appropriate when compared to the values proposed by the BIRADS 5th edition. Additionally, the study provided self-reflection considering our radiological practice, which is essential for improvements and collaboration regarding breast cancer detection. It may stimulate better radiological practice performance and continuing education, despite possible infrastructure and facility limitations. • Accurate quality performance rates are possible despite financial and governmental limitations. • Low-income institutions should develop standardised teamwork to improve radiological practice. • Regular mammography audits may help to increase the quality of public health systems.

Comparison of three-view thoracic radiography and computed tomography for detection of pulmonary nodules in dogs with neoplasia.

PubMed

Armbrust, Laura J; Biller, David S; Bamford, Aubrey; Chun, Ruthanne; Garrett, Laura D; Sanderson, Michael W

2012-05-01

To compare the detection of pulmonary nodules by use of 3-view thoracic radiography and CT in dogs with confirmed neoplasia. Prospective case series. 33 dogs of various breeds. 3 interpreters independently evaluated 3-view thoracic radiography images. The location and size of pulmonary nodules were recorded. Computed tomographic scans of the thorax were obtained and evaluated by a single interpreter. The location, size, margin, internal architecture, and density of pulmonary nodules were recorded. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for thoracic radiography (with CT as the gold standard). 21 of 33 (64%) dogs had pulmonary nodules or masses detected on CT. Of the dogs that had positive CT findings, 17 of 21 (81%) had pulmonary nodules or masses detected on radiographs by at least 1 interpreter. Sensitivity of radiography ranged from 71% to 95%, and specificity ranged from 67% to 92%. Radiography had a positive predictive value of 83% to 94% and a negative predictive value of 65% to 89%. The 4 dogs that were negative for nodules on thoracic radiography but positive on CT were all large-breed to giant-breed dogs with osteosarcoma. CT was more sensitive than radiography for detection of pulmonary nodules. This was particularly evident in large-breed to giant-breed dogs. Thoracic CT is recommended in large-breed to giant-breed dogs with osteosarcoma if the detection of pulmonary nodules will change treatment.

Reliability of fluorescein dye disappearance test in assessment of adults with nasolacrimal duct obstruction.

PubMed

Kashkouli, Mohsen Bahmani; Mirzajani, Hoora; Jamshidian-Tehrani, Mansooreh; Pakdel, Farzad; Nojomi, Marzieh; Aghaei, Gholam-Hossein

2013-01-01

To evaluate the role of fluorescein dye disappearance test (FDDT) in assessment of adults with primary acquired nasolacrimal duct obstruction (PANDO) and its correlation with age and severity of epiphora. In a prospective, cross-sectional comparative study, FDDT at 2 (2-FDDT), 5 (5-FDDT), and 10 (10-FDDT) minutes were performed in 58 eyes of 58 patients with PANDO (case) and 58 eyes of 58 subjects without epiphora (control) between 2008 and 2010. Exclusion criteria were any disease, trauma, or medications that might have an effect on tear drainage system. Patients with functional or incomplete obstruction and upper lacrimal drainage system obstruction were excluded in the case group. FDDT and severity of epiphora were graded. Case and control groups were matched. 2-FDDT showed a sensitivity of 82.8%, specificity of 91.4%, positive predictive value of 90.6%, and negative predictive value of 84.1%. Sensitivity and negative predictive value decreased to 71.1% and 78.6% in 5-FDDT. 5-FDDT specificity and positive predictive value, however, increased to 94.8% and 93.5%, respectively. There was no statistically significant correlation between severity of epiphora and age with FDDT. FDDT is a simple, reliable, and highly specific test in assessment of adults with PANDO.

Osteoblastic lesion screening with an advanced post-processing package enabling in-plane rib reading in CT-images.

PubMed

Seuss, Hannes; Dankerl, Peter; Cavallaro, Alexander; Uder, Michael; Hammon, Matthias

2016-05-20

To evaluate screening and diagnostic accuracy for the detection of osteoblastic rib lesions using an advanced post-processing package enabling in-plane rib reading in CT-images. We retrospectively assessed the CT-data of 60 consecutive prostate cancer patients by applying dedicated software enabling in-plane rib reading. Reading the conventional multiplanar reconstructions was considered to be the reference standard. To simulate clinical practice, the reader was given 10 s to screen for sclerotic rib lesions in each patient applying both approaches. Afterwards, every rib was evaluated individually with both approaches without a time limit. Sensitivities, specificities, positive/negative predictive values and the time needed for detection were calculated depending on the lesion's size (largest diameter < 5 mm, 5-10 mm, > 10 mm). In 53 of 60 patients, all ribs were properly displayed in plane, in five patients ribs were partially displayed correctly, and in two patients none of the ribs were displayed correctly. During the 10-s screening approach all patients with sclerotic rib lesions were correctly identified reading the in-plane images (including the patients without a correct rib segmentation), whereas 14 of 23 patients were correctly identified reading conventional multiplanar images. Overall screening sensitivity, specificity, and positive/negative predictive values were 100/27.0/46.0/100 %, respectively, for in-plane reading and 60.9/100/100/80.4 %, respectively, for multiplanar reading. Overall diagnostic (no time limit) sensitivity, specificity, and positive/negative predictive values of in-plane reading were 97.8/92.8/74.6/99.5 %, respectively. False positive results predominantly occurred for lesions <5 mm in size. In-plane reading of the ribs allows reliable detection of osteoblastic lesions for screening purposes. The limited specificity results from false positives predominantly occurring for small lesions.

[Usefulness of magnetic resonance imaging in the evaluation of patellar malalignment].

PubMed

Figueroa, D; Novoa, F; Meleán, P; Calvo, R; Vaisman, A; Figueroa, F; Delgado, G

2014-01-01

The aim of this study is to evaluate the usefulness of Magnetic Resonance Imaging (MRI) at 20° of knee flexion in patients with patellofemoral pain syndrome (PFPS) caused by suspected patellofemoral malalignment (PFM). Fifty MRIs were performed on 25 patients with PFPS secondary to suspected PFM based on clinical examination, and on 25 patients without PFPS (control group). Measurements were made of tibial tuberosity-trochlear groove distance (TTTG) and modified Laurin, Merchant and trochlear angles. The results were analyzed with ANOVA and Fischer tests. Pearson correlation coefficients were used to analyze differences between PFPS and control cases. Specificity, sensitivity, positive predictive value and negative predictive value for knee pain were documented. Significant differences were observed between PFPS and control groups in TTTG (11.79 mm vs. 9.35 mm; P=.002), Laurin angle (12.17° vs. 15.56°; P=.05), and trochlear angle (139° vs. 130.02°; P=.049). No differences were found between groups as regards the Merchant angle (P=.5). TTTG was 70% predictive of PFPS; however, it was only 53.33% specific, with a sensitivity of 51.61% for PFPS. Laurin angle was 77.78% predictive of PFPS, with a specificity of 92% and a sensitivity of 28%. Trochlear angle was 85.71% predictive of PFPS, with a specificity of 96% and a sensitivity of 24%. MRI can confirm clinically suspected PFPS secondary to malalignment. MRI determination of TTTG, patellar tilt, and trochlear angle correlates positively with clinical diagnosis of PFPS, suggesting that PFPS is caused by subtle malalignment. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

High-definition endoscopy with digital chromoendoscopy for histologic prediction of distal colorectal polyps.

PubMed

Rath, Timo; Tontini, Gian E; Nägel, Andreas; Vieth, Michael; Zopf, Steffen; Günther, Claudia; Hoffman, Arthur; Neurath, Markus F; Neumann, Helmut

2015-10-22

Distal diminutive colorectal polyps are common and accurate endoscopic prediction of hyperplastic or adenomatous polyp histology could reduce procedural time, costs and potential risks associated with the resection. Within this study we assessed whether digital chromoendoscopy can accurately predict the histology of distal diminutive colorectal polyps according to the ASGE PIVI statement. In this prospective cohort study, 224 consecutive patients undergoing screening or surveillance colonoscopy were included. Real time histology of 121 diminutive distal colorectal polyps was evaluated using high-definition endoscopy with digital chromoendoscopy and the accuracy of predicting histology with digital chromoendoscopy was assessed. The overall accuracy of digital chromoendoscopy for prediction of adenomatous polyp histology was 90.1 %. Sensitivity, specificity, positive and negative predictive values were 93.3, 88.7, 88.7, and 93.2 %, respectively. In high-confidence predictions, the accuracy increased to 96.3 % while sensitivity, specificity, positive and negative predictive values were calculated as 98.1, 94.4, 94.5, and 98.1 %, respectively. Surveillance intervals with digital chromoendoscopy were correctly predicted with >90 % accuracy. High-definition endoscopy in combination with digital chromoendoscopy allowed real-time in vivo prediction of distal colorectal polyp histology and is accurate enough to leave distal colorectal polyps in place without resection or to resect and discard them without pathologic assessment. This approach has the potential to reduce costs and risks associated with the redundant removal of diminutive colorectal polyps. ClinicalTrials NCT02217449.

Predicting drug-induced liver injury in human with Naïve Bayes classifier approach.

PubMed

Zhang, Hui; Ding, Lan; Zou, Yi; Hu, Shui-Qing; Huang, Hai-Guo; Kong, Wei-Bao; Zhang, Ji

2016-10-01

Drug-induced liver injury (DILI) is one of the major safety concerns in drug development. Although various toxicological studies assessing DILI risk have been developed, these methods were not sufficient in predicting DILI in humans. Thus, developing new tools and approaches to better predict DILI risk in humans has become an important and urgent task. In this study, we aimed to develop a computational model for assessment of the DILI risk with using a larger scale human dataset and Naïve Bayes classifier. The established Naïve Bayes prediction model was evaluated by 5-fold cross validation and an external test set. For the training set, the overall prediction accuracy of the 5-fold cross validation was 94.0 %. The sensitivity, specificity, positive predictive value and negative predictive value were 97.1, 89.2, 93.5 and 95.1 %, respectively. The test set with the concordance of 72.6 %, sensitivity of 72.5 %, specificity of 72.7 %, positive predictive value of 80.4 %, negative predictive value of 63.2 %. Furthermore, some important molecular descriptors related to DILI risk and some toxic/non-toxic fragments were identified. Thus, we hope the prediction model established here would be employed for the assessment of human DILI risk, and the obtained molecular descriptors and substructures should be taken into consideration in the design of new candidate compounds to help medicinal chemists rationally select the chemicals with the best prospects to be effective and safe.

Accuracy of Self-Reported Cervical and Breast Cancer Screening by Women with Intellectual Disability

ERIC Educational Resources Information Center

Son, Esther; Parish, Susan L.; Swaine, Jamie G.; Luken, Karen

2013-01-01

This study examines the accuracy of self-report of cervical and breast cancer screening by women with intellectual disability ("n" ?=? 155). Data from face-to-face interviews and medical records were analyzed. Total agreement, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Total…

"I'll Remember This!" Effects of Emotionality on Memory Predictions versus Memory Performance

ERIC Educational Resources Information Center

Zimmerman, Carissa A.; Kelley, Colleen M.

2010-01-01

Emotionality is a key component of subjective experience that influences memory. We tested how the emotionality of words affects memory monitoring, specifically, judgments of learning, in both cued recall and free recall paradigms. In both tasks, people predicted that positive and negative emotional words would be recalled better than neutral…

Psychiatric Diagnoses in Historic and Contemporary Military Cohorts: Combat Deployment and the Healthy Warrior Effect

DTIC Science & Technology

2008-04-23

In general, the positive predictive value of screening questionnaires is quite poor when disease prevalence is modest/rare, as in the ex- ample of...of sensitivity, specificity, likelihood ratios and predictive values with disease prevalence . Stat Med 1997;16:981–91. 26. Wolfe J, Erickson DJ

Exposure-based screening for Nipah virus encephalitis, Bangladesh.

PubMed

Sazzad, Hossain M S; Luby, Stephen P; Ströher, Ute; Daszak, Peter; Sultana, Sharmin; Afroj, Sayma; Rahman, Mahmudur; Gurley, Emily S

2015-02-01

We measured the performance of exposure screening questions to identify Nipah virus encephalitis in hospitalized encephalitis patients during the 2012-13 Nipah virus season in Bangladesh. The sensitivity (93%), specificity (82%), positive predictive value (37%), and negative predictive value (99%) results suggested that screening questions could more quickly identify persons with Nipah virus encephalitis.

The Utility of the Prototype/Willingness Model in Predicting Alcohol Use among North American Indigenous Adolescents

ERIC Educational Resources Information Center

Armenta, Brian E.; Hautala, Dane S.; Whitbeck, Les B.

2015-01-01

In the present study, we considered the utility of the prototype/willingness model in predicting alcohol use among North-American Indigenous adolescents. Specifically, using longitudinal data, we examined the associations among subjective drinking norms, positive drinker prototypes, drinking expectations (as a proxy of drinking willingness), and…

Diagnostic accuracy of tuberculous lymphadenitis fine needle aspiration biopsy confirmed by PCR as gold standard

NASA Astrophysics Data System (ADS)

DSuryadi; Delyuzar; Soekimin

2018-03-01

Indonesia is the second country with the TB (tuberculosis) burden in the world. Improvement in controlling TB and reducing the complications can accelerate early diagnosis and correct treatment. PCR test is a gold standard. However, it is quite expensive for routine diagnosis. Therefore, an accurate and cheaper diagnostic method such as fine needle aspiration biopsy is needed. The study aimsto determine the accuracy of fine needle aspiration biopsy cytology in the diagnosis of tuberculous lymphadenitis. A cross-sectional analytic study was conducted to the samples from patients suspected with tuberculous lymphadenitis. The fine needle aspiration biopsy (FNAB)test was performed and confirmed by PCR test.There is a comparison to the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of both methods. Sensitivity (92.50%), specificity (96.49%), accuracy (94.85%), positive predictive value (94.87%) and negative predictive value (94.83%) were in FNAB test compared to gold standard. We concluded that fine needle aspiration biopsy is a recommendation for a cheaper and accurate diagnostic test for tuberculous lymphadenitis diagnosis.

CT for all or selective approach? Who really needs a cervical spine CT after blunt trauma.

PubMed

Duane, Therèse M; Young, Andrew; Mayglothling, Julie; Wilson, Sean P; Weber, William F; Wolfe, Luke G; Ivatury, Rao R

2013-04-01

Computed tomography (CT) is the standard to screen blunt trauma patients for cervical spine (c-spine) fractures, yet there remains a reluctance to scan all trauma team activations because of radiation exposure and cost. The purpose of this study was to identify predictors of positive CT in an effort to decrease future CT use without compromising patient care. We performed a prospective study in which we documented 18 combined NEXUS and Canadian c-spine criteria on 5,182 patients before CT comparing those with and without fractures to identify predictors of injury. Clinical examination was considered positive if any of the 18 criteria were positive. There were 324 patients with a fracture, for an incidence rate of 6.25%. Fracture patients were older (43.89 ± 18.83 years vs. 38.42 ± 17.45 years, p <; 0.0001), with a lower GCS (Glasgow Coma Scale) score (13.49 ± 3.49 vs. 14.32 ± 2.34, p < 0.0001), than nonfracture patients. Clinical examination had a 100% (324 of 324) sensitivity, 0.62% (30 of 4,858) specificity, 6.29% (324 of 5,152) positive predictive value, and 100% (30 of 30) negative predictive value. A total of 77.8% (14 of 18) criteria were significantly associated with fracture by univariate analysis, seven of which were independent predictors of fracture by logistic regression (midline tenderness, GCS score < 15, age ≥65 years, paresthesias, rollover motor vehicle collision, ejected, never in sitting position in emergency department). Evaluation of these seven factors demonstrated a sensitivity of 99.07% (321 of 324), positive predictive value of 6.95% (321 of 4,617), specificity of 11.57% (562 of 4,858), and negative predictive value of 99.47% (562 of 565). Although sensitive, the standard clinical criteria used to determine patients who need radiographs lack specificity. Based on these results, more narrow criteria should be validated in an effort to limit the number of c-spine CTs while not compromising patient care. Prognostic study, level II; diagnostic study, level II.

Iodine-123 metaiodobenzylguanidine scintigraphy and iodine-123 ioflupane single photon emission computed tomography in Lewy body diseases: complementary or alternative techniques?

PubMed

Treglia, Giorgio; Cason, Ernesto; Cortelli, Pietro; Gabellini, Anna; Liguori, Rocco; Bagnato, Antonio; Giordano, Alessandro; Fagioli, Giorgio

2014-01-01

To compare myocardial sympathetic imaging using (123)I-Metaiodobenzylguanidine (MIBG) scintigraphy and striatal dopaminergic imaging using (123)I-Ioflupane (FP-CIT) single photon emission computed tomography (SPECT) in patients with suspected Lewy body diseases (LBD). Ninety-nine patients who performed both methods within 2 months for differential diagnosis between Parkinson's disease (PD) and other parkinsonism (n = 68) or between dementia with Lewy bodies (DLB) and other dementia (n = 31) were enrolled. Sensitivity, specificity, accuracy, positive and negative predictive values of both methods were calculated. For (123) I-MIBG scintigraphy, the overall sensitivity, specificity, accuracy, positive and negative predictive values in LBD were 83%, 79%, 82%, 86%, and 76%, respectively. For (123)I-FP-CIT SPECT, the overall sensitivity, specificity, accuracy, positive and negative predictive values in LBD were 93%, 41%, 73%, 71%, and 80%, respectively. There was a statistically significant difference between these two methods in patients without LBD, but not in patients with LBD. LBD usually present both myocardial sympathetic and striatal dopaminergic impairments. (123)I-FP-CIT SPECT presents high sensitivity in the diagnosis of LBD; (123)I-MIBG scintigraphy may have a complementary role in differential diagnosis between PD and other parkinsonism. These scintigraphic methods showed similar diagnostic accuracy in differential diagnosis between DLB and other dementia. Copyright © 2012 by the American Society of Neuroimaging.

ADEPT, a dynamic next generation sequencing data error-detection program with trimming

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

Feng, Shihai; Lo, Chien-Chi; Li, Po-E

Illumina is the most widely used next generation sequencing technology and produces millions of short reads that contain errors. These sequencing errors constitute a major problem in applications such as de novo genome assembly, metagenomics analysis and single nucleotide polymorphism discovery. In this study, we present ADEPT, a dynamic error detection method, based on the quality scores of each nucleotide and its neighboring nucleotides, together with their positions within the read and compares this to the position-specific quality score distribution of all bases within the sequencing run. This method greatly improves upon other available methods in terms of the truemore » positive rate of error discovery without affecting the false positive rate, particularly within the middle of reads. We conclude that ADEPT is the only tool to date that dynamically assesses errors within reads by comparing position-specific and neighboring base quality scores with the distribution of quality scores for the dataset being analyzed. The result is a method that is less prone to position-dependent under-prediction, which is one of the most prominent issues in error prediction. The outcome is that ADEPT improves upon prior efforts in identifying true errors, primarily within the middle of reads, while reducing the false positive rate.« less

ADEPT, a dynamic next generation sequencing data error-detection program with trimming

DOE PAGES

Feng, Shihai; Lo, Chien-Chi; Li, Po-E; ...

2016-02-29

Illumina is the most widely used next generation sequencing technology and produces millions of short reads that contain errors. These sequencing errors constitute a major problem in applications such as de novo genome assembly, metagenomics analysis and single nucleotide polymorphism discovery. In this study, we present ADEPT, a dynamic error detection method, based on the quality scores of each nucleotide and its neighboring nucleotides, together with their positions within the read and compares this to the position-specific quality score distribution of all bases within the sequencing run. This method greatly improves upon other available methods in terms of the truemore » positive rate of error discovery without affecting the false positive rate, particularly within the middle of reads. We conclude that ADEPT is the only tool to date that dynamically assesses errors within reads by comparing position-specific and neighboring base quality scores with the distribution of quality scores for the dataset being analyzed. The result is a method that is less prone to position-dependent under-prediction, which is one of the most prominent issues in error prediction. The outcome is that ADEPT improves upon prior efforts in identifying true errors, primarily within the middle of reads, while reducing the false positive rate.« less

Use of Direct LAMP Screening of Broiler Fecal Samples for Campylobacter jejuni and Campylobacter coli in the Positive Flock Identification Strategy.

PubMed

Sabike, Islam I; Uemura, Ryoko; Kirino, Yumi; Mekata, Hirohisa; Sekiguchi, Satoshi; Okabayashi, Tamaki; Goto, Yoshitaka; Yamazaki, Wataru

2016-01-01

Rapid identification of Campylobacter -positive flocks before slaughter, following freezing and heat treatment for the Campylobacter -positive carcasses at the slaughterhouses is an effective control strategy against foodborne campylobacteriosis. We evaluated a loop-mediated isothermal amplification (LAMP) assay for the direct screening of naturally contaminated chicken cloacal swabs for C. jejuni / C. coli to compare this assay with conventional quantitative culture methods. In a comparison study of 165 broilers, the LAMP assay showed 82.8% (48/58 by conventional culture) sensitivity, 100% (107/107) specificity, 100% (48/48) positive predictive value (PPV), and 91.5% (107/117) negative predictive value (NPV). In a comparison of 55 flocks, LAMP showed 90.5% (19/21) sensitivity, 100% (34/34) specificity, 100% (19/19) PPV, and 94.4% (34/36) NPV. In the cumulative total of 28 farm-level comparisons, LAMP showed 100% (12/12) sensitivity, 100% (16/16) specificity, 100% (12/12) PPV, and 100% (16/16) NPV. The LAMP assay required less than 90 min from the arrival of the fecal samples to final results in the laboratory. This suggests that the LAMP assay will facilitate the identification of C. jejuni / C. coli -positive broiler flocks at the farm level or in slaughterhouses before slaughtering, which would make it an effective tool in preventing the spread of Campylobacter contamination.

Analysis of the utility of stone gram stain in urolithiasis treated with percutaneous nephrolithotomy.

PubMed

Cockerill, Patrick A; Rivera, Marcelino E; Krambeck, Amy E

2014-06-01

To define the sensitivity and specificity of stone gram stain for infected urolithiasis treated with percutaneous nephrolithotomy (PCNL). PCNL procedures performed at our institution were analyzed between January 2009 and May 2013. Stone fragments were sent in a sterile fashion for aerobic and fungal cultures. A gram stain and fungal smear were performed on the stones and reported within 24 hours of collection. A total of 228 patients underwent 248 PCNLs. Of the 248 stones, 81 (33%) had a positive stone culture. Stone gram stain was positive in 31 cases and negative in 50. There were 167 negative stone cultures, and in these cases, gram stain was positive in 5 and negative in 162. The calculated sensitivity and specificity of stone gram stain were 38% and 97%. The positive and negative predictive values were 86% and 76%, respectively. In the subset of 16 patients with positive stone fungal cultures, fungal smear was performed in 12 and was positive in 4, giving fungal smear a sensitivity of 33%. The results of this study suggest that stone gram stain cannot be relied on to detect a positive stone culture and may fail to detect up to 62% of infected stones. However, when positive, gram stain accurately predicts a positive stone culture in 86% of cases. Copyright © 2014 Elsevier Inc. All rights reserved.

Social Structure Shapes Cultural Stereotypes and Emotions: A Causal Test of the Stereotype Content Model

PubMed Central

Caprariello, Peter A.; Cuddy, Amy J. C.; Fiske, Susan T.

2013-01-01

The stereotype content model (SCM) posits that social structure predicts specific cultural stereotypes and associated emotional prejudices. No prior evidence at a societal level has manipulated both structural predictors and measured both stereotypes and prejudices. In the present study, participants (n = 120) responded to an immigration scenario depicting a high- or low-status group, competitive or not competitive, and rated their likely stereotype (on warmth and competence) and elicited emotional prejudices (admiration, contempt, envy, and pity). Seven of eight specific predictions are fully confirmed, supporting the SCM's predicted causality for social structural effects on cultural stereotypes and emotional prejudices. PMID:24285928

Nomograms to predict the pathological stage of clinically localized prostate cancer in Korean men: comparison with western predictive tools using decision curve analysis.

PubMed

Jeong, Chang Wook; Jeong, Seong Jin; Hong, Sung Kyu; Lee, Seung Bae; Ku, Ja Hyeon; Byun, Seok-Soo; Jeong, Hyeon; Kwak, Cheol; Kim, Hyeon Hoe; Lee, Eunsik; Lee, Sang Eun

2012-09-01

To develop and evaluate nomograms to predict the pathological stage of clinically localized prostate cancer after radical prostatectomy in Korean men. We reviewed the medical records of 2041 patients who had clinical stages T1c-T3a prostate cancer and were treated solely with radical prostatectomy at two hospitals. Logistic regressions were carried out to predict organ-confined disease, extraprostatic extension, seminal vesicle invasion, and lymph node metastasis using preoperative variables and resulting nomograms. Internal validations were assessed using the area under the receiver operating characteristic curve and calibration plot, and then external validations were carried out on 129 patients from another hospital. Head-to-head comparisons with 2007 Partin tables and Cancer of the Prostate Risk Assessment score were carried out using the area under the curve and decision curve analysis. The significant predictors for organ-confined disease and extraprostatic extension were clinical stage, prostate-specific antigen, Gleason score and a percent positive core of biopsy. Significant predictors for seminal vesicle invasion were prostate-specific antigen, Gleason score and percent positive core, and those for lymph node metastasis were prostate-specific antigen and percent positive core. The area under the curve of established nomograms for organ-confined disease, extraprostatic extension, seminal vesicle invasion and lymph node metastasis were 0.809, 0.804, 0.889 and 0.838, respectively. The nomograms were well calibrated and externally validated. These nomograms showed significantly higher accuracies and net benefits than two Western tools in Korean men. This is the first study to have developed and fully validated nomograms to predict the pathological stage of prostate cancer in an Asian population. These nomograms might be more accurate and useful for Korean men than other predictive models developed using Western populations. © 2012 The Japanese Urological Association.

Assessment of algorithms to identify patients with thrombophilia following venous thromboembolism.

PubMed

Delate, Thomas; Hsiao, Wendy; Kim, Benjamin; Witt, Daniel M; Meyer, Melissa R; Go, Alan S; Fang, Margaret C

2016-01-01

Routine testing for thrombophilia following venous thromboembolism (VTE) is controversial. The use of large datasets to study the clinical impact of thrombophilia testing on patterns of care and patient outcomes may enable more efficient analysis of this practice in a wide range of settings. We set out to examine how accurately algorithms using International Classification of Diseases 9th Revision (ICD-9) codes and/or pharmacy data reflect laboratory-confirmed thrombophilia diagnoses. A random sample of adult Kaiser Permanente Colorado patients diagnosed with unprovoked VTE between 1/2004 and 12/2010 underwent medical record abstraction of thrombophilia test results. Algorithms using "ICD-9" (positive if a thrombophilia ICD-9 code was present), "Extended anticoagulation (AC)" (positive if AC therapy duration was >6 months), and "ICD-9 & Extended AC" (positive for both) criteria to identify possible thrombophilia cases were tested. Using positive thrombophilia laboratory results as the gold standard, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value of each algorithm were calculated, along with 95% confidence intervals (CIs). In our cohort of 636 patients, sensitivities were low (<50%) for each algorithm. "ICD-9" yielded the highest PPV (41.5%, 95% CI 26.3-57.9%) and a high specificity (95.9%, 95% CI 94.0-97.4%). "Extended AC" had the highest sensitivity but lowest specificity, and "ICD-9 & Extended AC" had the highest specificity but lowest sensitivity. ICD-9 codes for thrombophilia are highly specific for laboratory-confirmed cases, but all algorithms had low sensitivities. Further development of methods to identify thrombophilia patients in large datasets is warranted. Copyright © 2015 Elsevier Ltd. All rights reserved.

Review-of-systems questionnaire as a predictive tool for psychogenic nonepileptic seizures.

PubMed

Robles, Liliana; Chiang, Sharon; Haneef, Zulfi

2015-04-01

Patients with refractory epilepsy undergo video-electroencephalography for seizure characterization, among whom approximately 10-30% will be discharged with the diagnosis of psychogenic nonepileptic seizures (PNESs). Clinical PNES predictors have been described but in general are not sensitive or specific. We evaluated whether multiple complaints in a routine review-of-system (ROS) questionnaire could serve as a sensitive and specific marker of PNESs. We performed a retrospective analysis of a standardized ROS questionnaire completed by patients with definite PNESs and epileptic seizures (ESs) diagnosed in our adult epilepsy monitoring unit. A multivariate analysis of covariance (MANCOVA) was used to determine whether groups with PNES and ES differed with respect to the percentage of complaints in the ROS questionnaire. Tenfold cross-validation was used to evaluate the predictive error of a logistic regression classifier for PNES status based on the percentage of positive complaints in the ROS questionnaire. A total of 44 patients were included for analysis. Patients with PNESs had a significantly higher number of complaints in the ROS questionnaire compared to patients with epilepsy. A threshold of 17% positive complaints achieved a 78% specificity and 85% sensitivity for discriminating between PNESs and ESs. We conclude that the routine ROS questionnaire may be a sensitive and specific predictive tool for discriminating between PNESs and ESs. Published by Elsevier Inc.

Accurate prediction of bacterial type IV secreted effectors using amino acid composition and PSSM profiles.

PubMed

Zou, Lingyun; Nan, Chonghan; Hu, Fuquan

2013-12-15

Various human pathogens secret effector proteins into hosts cells via the type IV secretion system (T4SS). These proteins play important roles in the interaction between bacteria and hosts. Computational methods for T4SS effector prediction have been developed for screening experimental targets in several isolated bacterial species; however, widely applicable prediction approaches are still unavailable In this work, four types of distinctive features, namely, amino acid composition, dipeptide composition, .position-specific scoring matrix composition and auto covariance transformation of position-specific scoring matrix, were calculated from primary sequences. A classifier, T4EffPred, was developed using the support vector machine with these features and their different combinations for effector prediction. Various theoretical tests were performed in a newly established dataset, and the results were measured with four indexes. We demonstrated that T4EffPred can discriminate IVA and IVB effectors in benchmark datasets with positive rates of 76.7% and 89.7%, respectively. The overall accuracy of 95.9% shows that the present method is accurate for distinguishing the T4SS effector in unidentified sequences. A classifier ensemble was designed to synthesize all single classifiers. Notable performance improvement was observed using this ensemble system in benchmark tests. To demonstrate the model's application, a genome-scale prediction of effectors was performed in Bartonella henselae, an important zoonotic pathogen. A number of putative candidates were distinguished. A web server implementing the prediction method and the source code are both available at http://bioinfo.tmmu.edu.cn/T4EffPred.

Role of specimen US for predicting resection margin status in breast conserving therapy.

PubMed

Moschetta, M; Telegrafo, M; Introna, T; Coi, L; Rella, L; Ranieri, V; Cirili, A; Stabile Ianora, A A; Angelelli, G

2015-01-01

To assess the diagnostic accuracy of specimen ultrasound (US) for predicting resection margin status in women undergoing breast conserving therapy for US-detected cancer, having the histological findings as the reference standard. A total of 132 consecutive patients (age range, 34-87 years; mean, 51 years) underwent breast-conserving surgery for US-detected invasive breast cancer. All surgical specimens underwent US examination. The presence of lesion within the specimen and its distance from the specimen margins were assessed considering a threshold distance between the lesion and specimen margins of 10 mm. US findings were then compared with the pathological ones and specimen US. Sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative predictive values (NPV) for predicting histological margin status were evaluated, having the histological findings as the reference standard. The histological examination detected invasive ductal carcinoma in 96/132 (73%) cases, invasive lobular carcinoma in 32/132 (24%), mucinous carcinoma in 4/132 (3%). The pathological margin analysis revealed 96/132 (73%) negative margins and 36 (27%) close/positive margins. US examination detected all 132 breast lesions within the surgical specimens. 110 (83%) negative margins and 22 (17%) positive margins were found on US. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 44%, 94%, 80%, 73% and 82%, respectively, were found for specimen US. Specimen US represents a time and cost saving imaging tool for evaluating the presence of US detected-breast lesion within surgical specimen and for predicting the histological margin status.

Predicting the reactivity of proteins from their sequence alone: Kazal family of protein inhibitors of serine proteinases

PubMed Central

Lu, Stephen M.; Lu, Wuyuan; Qasim, M. A.; Anderson, Stephen; Apostol, Izydor; Ardelt, Wojciech; Bigler, Theresa; Chiang, Yi Wen; Cook, James; James, Michael N. G.; Kato, Ikunoshin; Kelly, Clyde; Kohr, William; Komiyama, Tomoko; Lin, Tiao-Yin; Ogawa, Michio; Otlewski, Jacek; Park, Soon-Jae; Qasim, Sabiha; Ranjbar, Michael; Tashiro, Misao; Warne, Nicholas; Whatley, Harry; Wieczorek, Anna; Wieczorek, Maciej; Wilusz, Tadeusz; Wynn, Richard; Zhang, Wenlei; Laskowski, Michael

2001-01-01

An additivity-based sequence to reactivity algorithm for the interaction of members of the Kazal family of protein inhibitors with six selected serine proteinases is described. Ten consensus variable contact positions in the inhibitor were identified, and the 19 possible variants at each of these positions were expressed. The free energies of interaction of these variants and the wild type were measured. For an additive system, this data set allows for the calculation of all possible sequences, subject to some restrictions. The algorithm was extensively tested. It is exceptionally fast so that all possible sequences can be predicted. The strongest, the most specific possible, and the least specific inhibitors were designed, and an evolutionary problem was solved. PMID:11171964

Fatty liver index and hepatic steatosis index for prediction of non-alcoholic fatty liver disease in type 1 diabetes.

PubMed

Sviklāne, Laura; Olmane, Evija; Dzērve, Zane; Kupčs, Kārlis; Pīrāgs, Valdis; Sokolovska, Jeļizaveta

2018-01-01

Little is known about the diagnostic value of hepatic steatosis index (HSI) and fatty liver index (FLI), as well as their link to metabolic syndrome in type 1 diabetes mellitus. We have screened the effectiveness of FLI and HSI in an observational pilot study of 40 patients with type 1 diabetes. FLI and HSI were calculated for 201 patients with type 1 diabetes. Forty patients with FLI/HSI values corresponding to different risk of liver steatosis were invited for liver magnetic resonance study. In-phase/opposed-phase technique of magnetic resonance was used. Accuracy of indices was assessed from the area under the receiver operating characteristic curve. Twelve (30.0%) patients had liver steatosis. For FLI, sensitivity was 90%; specificity, 74%; positive likelihood ratio, 3.46; negative likelihood ratio, 0.14; positive predictive value, 0.64; and negative predictive value, 0.93. For HSI, sensitivity was 86%; specificity, 66%; positive likelihood ratio, 1.95; negative likelihood ratio, 0.21; positive predictive value, 0.50; and negative predictive value, 0.92. Area under the receiver operating characteristic curve for FLI was 0.86 (95% confidence interval [0.72; 0.99]); for HSI 0.75 [0.58; 0.91]. Liver fat correlated with liver enzymes, waist circumference, triglycerides, and C-reactive protein. FLI correlated with C-reactive protein, liver enzymes, and blood pressure. HSI correlated with waist circumference and C-reactive protein. FLI ≥ 60 and HSI ≥ 36 were significantly associated with metabolic syndrome and nephropathy. The tested indices, especially FLI, can serve as surrogate markers for liver fat content and metabolic syndrome in type 1 diabetes. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Prediction of uncomplicated pregnancies in obese women: a prospective multicentre study.

PubMed

Vieira, Matias C; White, Sara L; Patel, Nashita; Seed, Paul T; Briley, Annette L; Sandall, Jane; Welsh, Paul; Sattar, Naveed; Nelson, Scott M; Lawlor, Debbie A; Poston, Lucilla; Pasupathy, Dharmintra

2017-11-03

All obese pregnant women are considered at equal high risk with respect to complications in pregnancy and birth, and are commonly managed through resource-intensive care pathways. However, the identification of maternal characteristics associated with normal pregnancy outcomes could assist in the management of these pregnancies. The present study aims to identify the factors associated with uncomplicated pregnancy and birth in obese women, and to assess their predictive performance. Data form obese women (BMI ≥ 30 kg/m 2 ) with singleton pregnancies included in the UPBEAT trial were used in this analysis. Multivariable logistic regression was used to identify sociodemographic, clinical and biochemical factors at 15 +0 to 18 +6 weeks' gestation associated with uncomplicated pregnancy and birth, defined as delivery of a term live-born infant without antenatal or labour complications. Predictive performance was assessed using area under the receiver operating characteristic curve (AUROC). Internal validation and calibration were also performed. Women were divided into fifths of risk and pregnancy outcomes were compared between groups. Sensitivity, specificity, and positive and negative predictive values were calculated using the upper fifth as the positive screening group. Amongst 1409 participants (BMI 36.4, SD 4.8 kg/m 2 ), the prevalence of uncomplicated pregnancy and birth was 36% (505/1409). Multiparity and increased plasma adiponectin, maternal age, systolic blood pressure and HbA1c were independently associated with uncomplicated pregnancy and birth. These factors achieved an AUROC of 0.72 (0.68-0.76) and the model was well calibrated. Prevalence of gestational diabetes, preeclampsia and other hypertensive disorders, preterm birth, and postpartum haemorrhage decreased whereas spontaneous vaginal delivery increased across the fifths of increasing predicted risk of uncomplicated pregnancy and birth. Sensitivity, specificity, and positive and negative predictive values were 38%, 89%, 63% and 74%, respectively. A simpler model including clinical factors only (no biomarkers) achieved an AUROC of 0.68 (0.65-0.71), with sensitivity, specificity, and positive and negative predictive values of 31%, 86%, 56% and 69%, respectively. Clinical factors and biomarkers can be used to help stratify pregnancy and delivery risk amongst obese pregnant women. Further studies are needed to explore alternative pathways of care for obese women demonstrating different risk profiles for uncomplicated pregnancy and birth.

SELDI-TOF-MS proteomic profiling of serum, urine, and amniotic fluid in neural tube defects.

PubMed

Liu, Zhenjiang; Yuan, Zhengwei; Zhao, Qun

2014-01-01

Neural tube defects (NTDs) are common birth defects, whose specific biomarkers are needed. The purpose of this pilot study is to determine whether protein profiling in NTD-mothers differ from normal controls using SELDI-TOF-MS. ProteinChip Biomarker System was used to evaluate 82 maternal serum samples, 78 urine samples and 76 amniotic fluid samples. The validity of classification tree was then challenged with a blind test set including another 20 NTD-mothers and 18 controls in serum samples, and another 19 NTD-mothers and 17 controls in urine samples, and another 20 NTD-mothers and 17 controls in amniotic fluid samples. Eight proteins detected in serum samples were up-regulated and four proteins were down-regulated in the NTD group. Four proteins detected in urine samples were up-regulated and one protein was down-regulated in the NTD group. Six proteins detected in amniotic fluid samples were up-regulated and one protein was down-regulated in the NTD group. The classification tree for serum samples separated NTDs from healthy individuals, achieving a sensitivity of 91% and a specificity of 97% in the training set, and achieving a sensitivity of 90% and a specificity of 97% and a positive predictive value of 95% in the test set. The classification tree for urine samples separated NTDs from controls, achieving a sensitivity of 95% and a specificity of 94% in the training set, and achieving a sensitivity of 89% and a specificity of 82% and a positive predictive value of 85% in the test set. The classification tree for amniotic fluid samples separated NTDs from controls, achieving a sensitivity of 93% and a specificity of 89% in the training set, and achieving a sensitivity of 90% and a specificity of 88% and a positive predictive value of 90% in the test set. These suggest that SELDI-TOF-MS is an additional method for NTDs pregnancies detection.

Evaluation of the Predictive Validity of Thermography in Identifying Extravasation With Intravenous Chemotherapy Infusions.

PubMed

Matsui, Yuko; Murayama, Ryoko; Tanabe, Hidenori; Oe, Makoto; Motoo, Yoshiharu; Wagatsuma, Takanori; Michibuchi, Michiko; Kinoshita, Sachiko; Sakai, Keiko; Konya, Chizuko; Sugama, Junko; Sanada, Hiromi

Early detection of extravasation is important, but conventional methods of detection lack objectivity and reliability. This study evaluated the predictive validity of thermography for identifying extravasation during intravenous antineoplastic therapy. Of 257 patients who received chemotherapy through peripheral veins, extravasation was identified in 26. Thermography was performed every 15 to 30 minutes during the infusions. Sensitivity, specificity, positive predictive value, and negative predictive value using thermography were 84.6%, 94.8%, 64.7%, and 98.2%, respectively. This study showed that thermography offers an accurate prediction of extravasation.

The assessment of serum-mediated phagocytosis of necrotic material by polymorphonuclear leukocytes to diagnose and predict the clinical features of systemic lupus erythematosus: an observational longitudinal study.

PubMed

Compagno, Michele; Gullstrand, Birgitta; Jacobsen, Søren; Eilertsen, Gro Ø; Nilsson, Jan Åke; Lood, Christian; Jönsen, Andreas; Truedsson, Lennart; Sturfelt, Gunnar; Bengtsson, Anders A

2016-02-10

Serum-mediated phagocytosis of antibody- and complement-opsonized necrotic cell material (NCM) by polymorphonuclear leukocytes can be quantified by using a flow cytometry-based assay. The phagocytosis of necrotic cell material (PNC) assay parallels the well-known lupus erythematosus cell test. In this study, we aimed to investigate the diagnostic accuracy of the assay and the relationship with clinical manifestations and disease activity in systemic lupus erythematosus (SLE). The diagnostic accuracy for SLE diagnosis of the PNC assay was studied by cross-sectional assessment of blood samples from 148 healthy control subjects and a multicenter rheumatic group (MRG) of 529 patients with different rheumatic symptoms. A cohort of 69 patients with an established SLE diagnosis (SLE cohort) underwent longitudinal clinical and laboratory follow-up for analysis of the temporal relationships between PNC positivity and specific clinical manifestations. In 35 of 529 MRG patients, 13 of whom had SLE, the PNC assay result was positive. Combined positivity of the PNC assay and anti-double-stranded DNA antibodies increased specificity and positive predictive value for SLE diagnosis to 0.99 and 0.67, respectively. In the longitudinal study, 42 of 69 SLE cohort patients had positive results in the PNC assay at least once. PNC assay positivity was associated with current hematological manifestations and could predict mucocutaneous manifestations. When combined with hypocomplementemia, PNC positivity preceded increased Systemic Lupus Erythematosus Disease Activity Index 2000 score, glomerulonephritis, and alopecia. Serum-mediated PNC by polymorphonuclear leukocytes is commonly but not exclusively seen in patients with SLE. The PNC assay may be used in follow-up of patients with SLE and, especially in combination with other routinely assessed laboratory tests, may help to predict flares and different clinical manifestations, including glomerulonephritis. Our results encourage further development of the PNC assay as a complementary laboratory tool in management of patients with SLE.

Self-efficacy and dietary fat reduction behaviors in obese African-American and white mothers.

PubMed

Chang, Mei-Wei; Brown, Roger L; Baumann, Linda J; Nitzke, Susan A

2008-05-01

This study examined the influence of weight management and education on five types of fat reduction behaviors mediated through three task-specific domains of self-efficacy among young, low-income obese African-American and white mothers. It also investigated interaction of race with the relationships between weight management, education, self-efficacy, and fat reduction behaviors. A sample of obese African-American and white mothers was recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Wisconsin. Participants reported their weight management status, education, self-efficacy for eating low-fat food, and fat reduction behaviors. For both racial groups, weight management status predicted low-fat food substitution and meat modification behaviors; education predicted meat modification behavior. Three task-specific domains of self-efficacy (negative mood, positive mood, and food availability) predicted different types of fat reduction behaviors and differed by race. Weight management influenced behaviors of low-fat food substitution, meat modification, and fried-food avoidance, mediated partially through self-efficacies of negative mood (African Americans), positive mood (African Americans, whites), and food availability (African Americans). Race affected the relationships between weight management, education, three task-specific domains of self-efficacy, and five types of fat reduction behaviors. Self-efficacies operated differentially for African Americans and whites. Thus, strategies to address specific fat reduction behaviors have the potential to be more effective when tailored to specific individual characteristics such as racial background, history of weight management strategies and task-specific domains of self-efficacy.

Computed tomography detection of extracapsular spread of squamous cell carcinoma of the head and neck in metastatic cervical lymph nodes.

PubMed

Carlton, Joshua A; Maxwell, Adam W; Bauer, Lyndsey B; McElroy, Sara M; Layfield, Lester J; Ahsan, Humera; Agarwal, Ajay

2017-06-01

Background and purpose In patients with squamous cell carcinoma of the head and neck (HNSCC), extracapsular spread (ECS) of metastases in cervical lymph nodes affects prognosis and therapy. We assessed the accuracy of intravenous contrast-enhanced computed tomography (CT) and the utility of imaging criteria for preoperative detection of ECS in metastatic cervical lymph nodes in patients with HNSCC. Materials and methods Preoperative intravenous contrast-enhanced neck CT images of 93 patients with histopathological HNSCC metastatic nodes were retrospectively assessed by two neuroradiologists for ECS status and ECS imaging criteria. Radiological assessments were compared with histopathological assessments of neck dissection specimens, and interobserver agreement of ECS status and ECS imaging criteria were measured. Results Sensitivity, specificity, positive predictive value, and accuracy for overall ECS assessment were 57%, 81%, 82% and 67% for observer 1, and 66%, 76%, 80% and 70% for observer 2, respectively. Correlating three or more ECS imaging criteria with histopathological ECS increased specificity and positive predictive value, but decreased sensitivity and accuracy. Interobserver agreement for overall ECS assessment demonstrated a kappa of 0.59. Central necrosis had the highest kappa of 0.74. Conclusion CT has moderate specificity for ECS assessment in HNSCC metastatic cervical nodes. Identifying three or more ECS imaging criteria raises specificity and positive predictive value, therefore preoperative identification of multiple criteria may be clinically useful. Interobserver agreement is moderate for overall ECS assessment, substantial for central necrosis. Other ECS CT criteria had moderate agreement at best and therefore should not be used individually as criteria for detecting ECS by CT.

The accuracy of HIV rapid testing in integrated bio-behavioral surveys of men who have sex with men across 5 Provinces in South Africa

PubMed Central

Kufa, Tendesayi; Lane, Tim; Manyuchi, Albert; Singh, Beverley; Isdahl, Zachary; Osmand, Thomas; Grasso, Mike; Struthers, Helen; McIntyre, James; Chipeta, Zawadi; Puren, Adrian

2017-01-01

Abstract We describe the accuracy of serial rapid HIV testing among men who have sex with men (MSM) in South Africa and discuss the implications for HIV testing and prevention. This was a cross-sectional survey conducted at five stand-alone facilities from five provinces. Demographic, behavioral, and clinical data were collected. Dried blood spots were obtained for HIV-related testing. Participants were offered rapid HIV testing using 2 rapid diagnostic tests (RDTs) in series. In the laboratory, reference HIV testing was conducted using a third-generation enzyme immunoassay (EIA) and a fourth-generation EIA as confirmatory. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false-positive, and false-negative rates were determined. Between August 2015 and July 2016, 2503 participants were enrolled. Of these, 2343 were tested by RDT on site with a further 2137 (91.2%) having definitive results on both RDT and EIA. Sensitivity, specificity, positive predictive value, negative predictive value, false-positive rates, and false-negative rates were 92.6% [95% confidence interval (95% CI) 89.6–94.8], 99.4% (95% CI 98.9–99.7), 97.4% (95% CI 95.2–98.6), 98.3% (95% CI 97.6–98.8), 0.6% (95% CI 0.3–1.1), and 7.4% (95% CI 5.2–10.4), respectively. False negatives were similar to true positives with respect to virological profiles. Overall accuracy of the RDT algorithm was high, but sensitivity was lower than expected. Post-HIV test counseling should include discussions of possible false-negative results and the need for retesting among HIV negatives. PMID:28700474

"Eyeball test" of thermographic patterns for predicting a successful lateral infraclavicular block.

PubMed

Andreasen, Asger M; Linnet, Karen E; Asghar, Semera; Rothe, Christian; Rosenstock, Charlotte V; Lange, Kai H W; Lundstrøm, Lars H

2017-11-01

Increased distal skin temperature can be used to predict the success of lateral infraclavicular (LIC) block. We hypothesized that an "eyeball test" of specific infrared thermographic patterns after LIC block could be used to determine block success. In this observational study, five observers trained in four distinct thermographic patterns independently evaluated thermographic images of the hands of 40 patients at baseline and at one-minute intervals for 30 min after a LIC block. Sensitivity, specificity, and predictive values of a positive and a negative test were estimated to evaluate the validity of specific thermographic patterns for predicting a successful block. Sensory and motor block of the musculocutaneous, radial, ulnar, and median nerves defined block success. Fleiss' kappa statistics of multiple interobserver agreements were used to evaluate reliability. As a diagnostic test, the defined specific thermographic patterns of the hand predicted a successful block with increasing accuracy over the 30-min observation period. Block success was predicted with a sensitivity of 92.4% (95% confidence interval [CI], 86.8 to 96.2) and with a specificity of 84.0% (95% CI, 70.3 to 92.4) at min 30. The Fleiss' kappa for the five observers was 0.87 (95% CI, 0.77 to 0.96). We conclude that visual evaluation by an eyeball test of specific thermographic patterns of the blocked hands may be useful as a valid and reliable diagnostic test for predicting a successful LIC block.

Assessment of Myometrial Invasion in Premenopausal Grade 1 Endometrial Carcinoma: Is Magnetic Resonance Imaging a Reliable Tool in Selecting Patients for Fertility-Preserving Therapy?

PubMed

Sakane, Makoto; Hori, Masatoshi; Onishi, Hiromitsu; Tsuboyama, Takahiro; Ota, Takashi; Tatsumi, Mitsuaki; Ueda, Yutaka; Kimura, Toshihiro; Kimura, Tadashi; Tomiyama, Noriyuki

The aim of this study was to evaluate the diagnostic ability of magnetic resonance imaging (MRI) in premenopausal women with G1 endometrial carcinoma. Twenty-six patients underwent T2W, diffusion weighted, and dynamic contrast-enhanced 3-T MRI. The degree of myometrial invasion was pathologically classified into no invasion, shallow (3 mm or less), and more. Two radiologists assessed myometrial invasion on MRI. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values, AUC, and interobserver agreement were analyzed. For assessing myometrial invasion, mean accuracy, sensitivity, specificity, positive predictive values, negative predictive values, and AUC, respectively, were as follows: 63%, 42%, 85%, 79%, 47%, and 0.75. Mean interobserver agreement was fair (k = 0.36). Shallow invasions were underestimated as no invasion on MRI in all 6 cases. Magnetic resonance imaging produced false-negative result on half of patients. The misjudgments tended to happen in patients with shallow invasion.

Reagent strip testing is not sensitive for the screening of asymptomatic bacteriuria in pregnant women.

PubMed

Lumbiganon, Pisake; Chongsomchai, Chompilas; Chumworathayee, Bundit; Thinkhamrop, Jadsada

2002-08-01

The objective of the study was to assess the diagnostic performance of the reagent strip in screening for asymptomatic bacteriuria in pregnant women using urine culture as a gold standard. This study comprised 204 asymptomatic pregnant women who attended their first antenatal care at Srinagarind Hospital, Khon Kaen University from April 1, 1999 to June 30, 1999. Women with symptoms of urinary tract infection, antibiotic treatment within the previous 7 days, pregnancy-induced hypertension, bleeding per vagina and history of urinary tract diseases were excluded. Urine specimens were collected by clean catched midstream urine technique for urinalysis, reagent strip test and urine culture. Diagnostic performance of reagent strip in terms of sensitivity, specificity, positive and negative predictive value was analyzed. Urine reagent strip test had a sensitivity of 13.9 per cent, a specificity of 95.6 per cent, a positive predictive value of 46.1 per cent, a negative predictive value of 80.6 per cent in detecting asymptomatic bacteriuria in pregnant women.

External validation of a nomogram for prediction of side-specific extracapsular extension at robotic radical prostatectomy.

PubMed

Zorn, Kevin C; Gallina, Andrea; Hutterer, Georg C; Walz, Jochen; Shalhav, Arieh L; Zagaja, Gregory P; Valiquette, Luc; Gofrit, Ofer N; Orvieto, Marcelo A; Taxy, Jerome B; Karakiewicz, Pierre I

2007-11-01

Several staging tools have been developed for open radical prostatectomy (ORP) patients. However, the validity of these tools has never been formally tested in patients treated with robot-assisted laparoscopic radical prostatectomy (RALP). We tested the accuracy of an ORP-derived nomogram in predicting the rate of extracapsular extension (ECE) in a large RALP cohort. Serum prostate specific antigen (PSA) and side-specific clinical stage and biopsy Gleason sum information were used in a previously validated nomogram predicting side-specific ECE. The nomogram-derived predictions were compared with the observed rate of ECE, and the accuracy of the predictions was quantified. Each prostate lobe was analyzed independently. As complete data were available for 576 patients, the analyses targeted 1152 prostate lobes. Median age and serum PSA concentration at radical prostatectomy were 60 years and 5.4 ng/mL, respectively. The majority of side-specific clinical stages were T(1c) (993; 86.2%). Most side-specific biopsy Gleason sums were 6 (572; 49.7%). The median side-specific percentages of positive cores and of cancer were, respectively, 20.0% and 5.0%. At final pathologic review, 107 patients (18.6%) had ECE, and side-specific ECE was present in 117 patients (20.3%). The nomogram was 89% accurate in the RALP cohort v 84% in the previously reported ORP validation. The ORP side-specific ECE nomogram is highly accurate in the RALP population, suggesting that predictive and possibly prognostic tools developed in ORP patients may be equally accurate in their RALP counterparts.

Statistical analysis of surface-water-quality data in and near the coal-mining region of southwestern Indiana, 1957-80

USGS Publications Warehouse

Martin, Jeffrey D.; Crawford, Charles G.

1987-01-01

The Surface Mining Control and Reclamation Act of 1977 requires that applications for coal-mining permits contain information about the water quality of streams at and near a proposed mine. To meet this need for information, streamflow, specific conductance, pH, and concentrations of total alkalinity, sulfate, dissolved solids, suspended solids, total iron, and total manganese at 37 stations were analyzed to determine the spatial and seasonal variations in water quality and to develop equations for predicting water quality. The season of lowest median streamflow was related to the size of the drainage area. Median streamflow was least during fall at 15 of 16 stations having drainage areas greater than 1,000 square miles but was least during summer at 17 of 21 stations having drainage areas less than 1,000 square miles. In general, the season of lowest median specific conductance occurred during the season of highest streamflow except at stations on the Wabash River. Median specific conductance was least during summer at 9 of 9 stations on the Wabash River, but was least during winter or spring (the seasons of highest streamflow) at 27 of the remaining 28 stations. Linear, inverse, semilog, log-log, and hyperbolic regression models were used to investigate the functional relations between water-quality characteristics and streamflow. Of 186 relations investigated, 143 were statistically significant. Specific conductance and concentrations of total alkalinity and sulfate were negatively related to streamflow at all stations except for a positive relation between total alkalinity concentration and streamflow at Patoka River near Princeton. Concentrations of total alkalinity and sulfate were positively related to specific conductance at all stations except for a negative relation at Patoka River near Princeton and for a positive and negative relation at Patoka River at Jasper. Most of these relations are good, have small confidence intervals, and will give reliable predictions of the water-quality variables listed above. The poorest relations are typically at stations in the Patoka River watershed. Suspended-solids concentration was positively related to streamflow at all but two stations on the Patoka River. These relations are poor, have large confidence intervals, and will give less reliable predictions of suspended-solids concentration. Predictive equations for the regional relations between dissolved-solids concentration and specific conductance and between sulfate concentration and specific conductance, and the seasonal patterns of water quality, are probably valid for the coal-mining regions of Illinois and western Kentucky.

Semi-supervised prediction of SH2-peptide interactions from imbalanced high-throughput data.

PubMed

Kundu, Kousik; Costa, Fabrizio; Huber, Michael; Reth, Michael; Backofen, Rolf

2013-01-01

Src homology 2 (SH2) domains are the largest family of the peptide-recognition modules (PRMs) that bind to phosphotyrosine containing peptides. Knowledge about binding partners of SH2-domains is key for a deeper understanding of different cellular processes. Given the high binding specificity of SH2, in-silico ligand peptide prediction is of great interest. Currently however, only a few approaches have been published for the prediction of SH2-peptide interactions. Their main shortcomings range from limited coverage, to restrictive modeling assumptions (they are mainly based on position specific scoring matrices and do not take into consideration complex amino acids inter-dependencies) and high computational complexity. We propose a simple yet effective machine learning approach for a large set of known human SH2 domains. We used comprehensive data from micro-array and peptide-array experiments on 51 human SH2 domains. In order to deal with the high data imbalance problem and the high signal-to-noise ration, we casted the problem in a semi-supervised setting. We report competitive predictive performance w.r.t. state-of-the-art. Specifically we obtain 0.83 AUC ROC and 0.93 AUC PR in comparison to 0.71 AUC ROC and 0.87 AUC PR previously achieved by the position specific scoring matrices (PSSMs) based SMALI approach. Our work provides three main contributions. First, we showed that better models can be obtained when the information on the non-interacting peptides (negative examples) is also used. Second, we improve performance when considering high order correlations between the ligand positions employing regularization techniques to effectively avoid overfitting issues. Third, we developed an approach to tackle the data imbalance problem using a semi-supervised strategy. Finally, we performed a genome-wide prediction of human SH2-peptide binding, uncovering several findings of biological relevance. We make our models and genome-wide predictions, for all the 51 SH2-domains, freely available to the scientific community under the following URLs: http://www.bioinf.uni-freiburg.de/Software/SH2PepInt/SH2PepInt.tar.gz and http://www.bioinf.uni-freiburg.de/Software/SH2PepInt/Genome-wide-predictions.tar.gz, respectively.

A Feedback-Controlled Mandibular Positioner Identifies Individuals With Sleep Apnea Who Will Respond to Oral Appliance Therapy.

PubMed

Remmers, John E; Topor, Zbigniew; Grosse, Joshua; Vranjes, Nikola; Mosca, Erin V; Brant, Rollin; Bruehlmann, Sabina; Charkhandeh, Shouresh; Zareian Jahromi, Seyed Abdolali

2017-07-15

Mandibular protruding oral appliances represent a potentially important therapy for obstructive sleep apnea (OSA). However, their clinical utility is limited by a less-than-ideal efficacy rate and uncertainty regarding an efficacious mandibular position, pointing to the need for a tool to assist in delivery of the therapy. The current study assesses the ability to prospectively identify therapeutic responders and determine an efficacious mandibular position. Individuals (n = 202) with OSA participated in a blinded, 2-part investigation. A system for identifying therapeutic responders was developed in part 1 (n = 149); the predictive accuracy of this system was prospectively evaluated on a new population in part 2 (n = 53). Each participant underwent a 2-night, in-home feedback-controlled mandibular positioner (FCMP) test, followed by treatment with a custom oral appliance and an outcome study with the oral appliance in place. A machine learning classification system was trained to predict therapeutic outcome on data obtained from FCMP studies on part 1 participants. The accuracy of this trained system was then evaluated on part 2 participants by examining the agreement between prospectively predicted outcome and observed outcome. A predicted efficacious mandibular position was derived from each FCMP study. Predictive accuracy was as follows: sensitivity 85%; specificity 93%; positive predictive value 97%; and negative predictive value 72%. Of participants correctly predicted to respond to therapy, the predicted mandibular protrusive position proved efficacious in 86% of cases. An unattended, in-home FCMP test prospectively identifies individuals with OSA who will respond to oral appliance therapy and provides an efficacious mandibular position. The trial that this study reports on is registered on www.clinicaltrials.gov, ID NCT03011762, study name: Feasibility and Predictive Accuracy of an In-Home Computer Controlled Mandibular Positioner in Identifying Favourable Candidates for Oral Appliance Therapy. © 2017 American Academy of Sleep Medicine

Getting the Best Return on Your Screening Investment: An Analysis of the Suicidal Ideation Questionnaire and Reynolds Adolescent Depression Scale

ERIC Educational Resources Information Center

Gutierrez, Peter M.; Osman, Augustine

2009-01-01

Data from 64 adolescent inpatients admitted for serious suicidal ideation, 50 adolescent inpatients admitted following a suicide attempt, and 56 randomly selected high school control participants were used to evaluate the sensitivity, specificity, positive predictive value, and negative predictive value of the Suicidal Ideation Questionnaire (SIQ)…

Evaluation of a Records-Review Surveillance System Used to Determine the Prevalence of Autism Spectrum Disorders

ERIC Educational Resources Information Center

Avchen, Rachel Nonkin; Wiggins, Lisa D.; Devine, Owen; Van Naarden Braun, Kim; Rice, Catherine; Hobson, Nancy C.; Schendel, Diana; Yeargin-Allsopp, Marshalyn

2011-01-01

We conducted the first study that estimates the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a population-based autism spectrum disorders (ASD) surveillance system developed at the Centers for Disease Control and Prevention. The system employs a records-review methodology that yields ASD…

Evaluation of the utility of atopy patch testing, skin prick testing, and total and specific IgE assays in the diagnosis of cow's milk allergy.

PubMed

Keskin, Ozlem; Tuncer, Ayfer; Adalioglu, Gonul; Sekerel, Bulent E; Sackesen, Cansin; Kalayci, Omer

2005-05-01

Information on the utility of atopy patch testing (APT) in the diagnosis of food allergy is derived from studies of children with atopic dermatitis. To evaluate the usefulness of APT in the diagnosis of cow's milk allergy (CMA) and to determine interleukin 4 and interferon-gamma production by peripheral blood mononuclear cells. Thirty-seven children (median age, 11 months) with suspected CMA who had a variety of symptoms that involved many organ systems were evaluated using double-blind placebo-controlled food challenges (DBPCFCs), and the performances of milk specific IgE, skin prick testing (SPT), and APT were determined. To search for a possible relationship between the diagnostic tests and the TH1/TH2 immune response, we measured interferon-gamma and interleukin 4 levels in the supernatants of peripheral blood mononuclear cell cultures. Seventeen children with positive DBPCFC results and 6 with a history of anaphylaxis were diagnosed as having CMA. The combined use of APT and SPT had a sensitivity of 100% and a negative predictive value of 100% but a specificity of 50% and a positive predictive value of 76%. The addition of milk specific IgE assays to APT and SPT did not improve these values. Pattern of cytokine secretion was not associated with APT positivity or a specific response to DBPCFC. Atopy patch testing may be a useful adjunct to SPT in excluding CMA in children who have allergic manifestations other than atopic dermatitis. However, DBPCFCs are still necessary in the presence of positive test results.

Predictive genetic testing for the identification of high-risk groups: a simulation study on the impact of predictive ability

PubMed Central

2011-01-01

Background Genetic risk models could potentially be useful in identifying high-risk groups for the prevention of complex diseases. We investigated the performance of this risk stratification strategy by examining epidemiological parameters that impact the predictive ability of risk models. Methods We assessed sensitivity, specificity, and positive and negative predictive value for all possible risk thresholds that can define high-risk groups and investigated how these measures depend on the frequency of disease in the population, the frequency of the high-risk group, and the discriminative accuracy of the risk model, as assessed by the area under the receiver-operating characteristic curve (AUC). In a simulation study, we modeled genetic risk scores of 50 genes with equal odds ratios and genotype frequencies, and varied the odds ratios and the disease frequency across scenarios. We also performed a simulation of age-related macular degeneration risk prediction based on published odds ratios and frequencies for six genetic risk variants. Results We show that when the frequency of the high-risk group was lower than the disease frequency, positive predictive value increased with the AUC but sensitivity remained low. When the frequency of the high-risk group was higher than the disease frequency, sensitivity was high but positive predictive value remained low. When both frequencies were equal, both positive predictive value and sensitivity increased with increasing AUC, but higher AUC was needed to maximize both measures. Conclusions The performance of risk stratification is strongly determined by the frequency of the high-risk group relative to the frequency of disease in the population. The identification of high-risk groups with appreciable combinations of sensitivity and positive predictive value requires higher AUC. PMID:21797996

Hub qualitative blood culture is useful for diagnosis of catheter-related infections in critically ill patients.

PubMed

Tanguy, Michèle; Seguin, Philippe; Laviolle, Bruno; Desbordes, Laurent; Mallédant, Yannick

2005-05-01

To assess clinical safety and accuracy of qualitative blood culture drawn through the hub for ruling out catheter-related infection (CRI). Prospective observational study in a surgical intensive care unit. All patients with sepsis of unknown origin and possibly due to a CRI. Blood culture drawn through a central venous catheter (CVC) just before the catheter was cultured. In 126 patients we investigated 135 cases of sepsis of unknown origin. Using a clinical and bacteriological approach as the reference, the performance of the CVC blood culture was evaluated by the calculation of sensitivity, specificity, and positive and negative predictive values. When CVC blood culture was positive, the time to positivity was considered. Using standard definitions, seven CRIs were diagnosed. CVC blood culture identified five CRIs including the three episodes of catheter-related bacteremia. The method missed two coagulase-negative staphylococcus CRIs without bacteremia. Thirteen false-positive results occurred, including seven bacteremias from a distant source. The CVC blood culture had a sensitivity of 71% (CI 30-95%), specificity of 90% (CI 83-94%), negative predictive value of 98% (CI 93-100%), and positive predictive value of 28% (CI 11-54%). In cases of catheter-related bacteremia the time to positivity of CVC blood culture was 24 h or less. Negative CVC blood culture at 24 h seems useful for management of CVC in selected critically ill surgical patients developing a clinical sepsis. The subsequent risk of catheter-related bacteremia cannot be excluded advocating for an uninterrupted clinical and bacteriological survey.

Method for Predicting the Energy Characteristics of Li-Ion Cells Designed for High Specific Energy

NASA Technical Reports Server (NTRS)

Bennett, William, R.

2012-01-01

Novel electrode materials with increased specific capacity and voltage performance are critical to the NASA goals for developing Li-ion batteries with increased specific energy and energy density. Although performance metrics of the individual electrodes are critically important, a fundamental understanding of the interactions of electrodes in a full cell is essential to achieving the desired performance, and for establishing meaningful goals for electrode performance in the first place. This paper presents design considerations for matching positive and negative electrodes in a viable design. Methods for predicting cell-level performance, based on laboratory data for individual electrodes, are presented and discussed.

Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients.

PubMed

Bae, Ji-Hoon; Paik, Nak Hwan; Park, Gyu-Won; Yoon, Jung-Ro; Chae, Dong-Ju; Kwon, Jae Ho; Kim, Jong In; Nha, Kyung-Wook

2013-03-01

The purpose of this study was to determine the accuracy, sensitivity, specificity, and predictive values of a single event of painful popping in the presence of a posterior root tear of the medial meniscus in middle-aged to older Asian patients. We conducted a retrospective review of medical records of 936 patients who underwent arthroscopic surgeries for an isolated medial meniscus tear between January 2000 and December 2010. There were 332 men and 604 women with a mean age of 41 years (range, 25 to 66 years). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of a painful popping sensation for a posterior root tear of the medial meniscus were calculated. Arthroscopy confirmed the presence of posterior root tears of the medial menisci in 237 of 936 patients (25.3%). A single event of a painful popping sensation was present in 86 of these 936 patients (9.1%). Of these 86 patients with a painful popping sensation, 83 (96.5%) were categorized as having an isolated posterior root tear of the medial meniscus. The positive predictive value of a painful popping sensation in identifying a posterior root tear of the medial meniscus was 96.5%, the negative predictive value was 81.8%, the sensitivity was 35.0%, the specificity was 99.5%, and the diagnostic accuracy was 77.9%. A single event of painful popping can be a highly predictive clinical sign of a posterior root tear of the medial meniscus in the middle-aged to older Asian population. However, it has low sensitivity for the detection of a posterior root tear of the medial meniscus. Level IV, therapeutic case series. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Accuracy of blood culture for early diagnosis of mediastinitis in febrile patients after cardiac surgery.

PubMed

San Juan, R; Aguado, J M; López, M J; Lumbreras, C; Enriquez, F; Sanz, F; Chaves, F; López-Medrano, F; Lizasoain, M; Rufilanchas, J J

2005-03-01

Postsurgical mediastinitis (PSM) remains a major cause of morbidity and mortality in patients undergoing cardiac surgery procedures. Although prompt diagnosis is crucial in these patients, neither clinical data nor imaging techniques have shown enough sensitivity or specificity for early diagnosis of PSM. The aim of the present study was to assess the validity of blood cultures as a diagnostic test for the early detection of PSM in patients who become febrile after cardiac surgery procedures. During a 4-year period (1999-2002), patients who developed fever (>37.8 degrees C) in the first 60 days after a cardiac surgery procedure were evaluated. Blood cultures were drawn from these patients. PSM was defined as deep infection involving retrosternal tissue and/or the sternal bone directly observed by the surgeon and confirmed microbiologically. Three criteria for positivity of blood cultures were applied: bacteremia, staphylococcal bacteremia, or Staphylococcus aureus bacteremia. For purposes of the analysis, a positive blood culture in patients with PSM was considered a true-positive test and a negative blood culture a false-negative test. Otherwise, in febrile patients without PSM in the postsurgery period, a positive blood culture was considered a false-positive test and a negative blood culture a true-negative test. Blood cultures were drawn from 266 febrile patients in the postsurgery period. PSM occurred in 38 patients (26 cases due to S. aureus, 8 to Staphylococcus epidermidis, 3 to gram-negative enteric bacteria, and one to Pseudomonas aeruginosa). Within the 60-day postsurgical period, blood culture as a diagnostic test was most accurate in patients with S. aureus bacteremia, providing 68% sensitivity, 98% specificity, a positive predictive value of 87%, and a negative predictive value of 95%. If the analysis was limited to the period during which patients are at maximum risk for PSM (day 7-20), the values in patients with S. aureus bacteremia were as follows: 73% sensitivity, 98% specificity, 90% positive predictive value, and 93% negative predictive value. Blood culture is an accurate test for the early diagnosis of PSM in febrile patients after cardiac surgery, particularly in institutions where S. aureus is prevalent in this context. A negative blood culture practically excludes PSM and, during the period of maximum risk for PSM, the presence of S. aureus bacteremia should compel early surgical management.

Validation of automatic wheeze detection in patients with obstructed airways and in healthy subjects.

PubMed

Guntupalli, Kalpalatha K; Alapat, Philip M; Bandi, Venkata D; Kushnir, Igal

2008-12-01

Computerized lung-sound analysis is a sensitive and quantitative method to identify wheezing by its typical pattern on spectral analysis. We evaluated the accuracy of the VRI, a multi-sensor, computer-based device with an automated technique of wheeze detection. The method was validated in 100 sound files from seven subjects with asthma or chronic obstructive pulmonary disease and seven healthy subjects by comparison of auscultation findings, examination of audio files, and computer detection of wheezes. Three blinded physicians identified 40 sound files with wheezes and 60 sound files without wheezes. Sensitivity and specificity were 83% and 85%, respectively. Negative predictive value and positive predictive value were 89% and 79%, respectively. Overall inter-rater agreement was 84%. False positive cases were found to contain sounds that simulate wheezes, such as background noises with high frequencies or strong noises from the throat that could be heard and identified without a stethoscope. The present findings demonstrate that the wheeze detection algorithm has good accuracy, sensitivity, specificity, negative predictive value and positive predictive value for wheeze detection in regional analyses with a single sensor and multiple sensors. Results are similar to those reported in the literature. The device is user-friendly, requires minimal patient effort, and, distinct from other devices, it provides a dynamic image of breath sound distribution with wheeze detection output in less than 1 minute.

Hemispheric Asymmetries in Striatal Reward Responses Relate to Approach-Avoidance Learning and Encoding of Positive-Negative Prediction Errors in Dopaminergic Midbrain Regions.

PubMed

Aberg, Kristoffer Carl; Doell, Kimberly C; Schwartz, Sophie

2015-10-28

Some individuals are better at learning about rewarding situations, whereas others are inclined to avoid punishments (i.e., enhanced approach or avoidance learning, respectively). In reinforcement learning, action values are increased when outcomes are better than predicted (positive prediction errors [PEs]) and decreased for worse than predicted outcomes (negative PEs). Because actions with high and low values are approached and avoided, respectively, individual differences in the neural encoding of PEs may influence the balance between approach-avoidance learning. Recent correlational approaches also indicate that biases in approach-avoidance learning involve hemispheric asymmetries in dopamine function. However, the computational and neural mechanisms underpinning such learning biases remain unknown. Here we assessed hemispheric reward asymmetry in striatal activity in 34 human participants who performed a task involving rewards and punishments. We show that the relative difference in reward response between hemispheres relates to individual biases in approach-avoidance learning. Moreover, using a computational modeling approach, we demonstrate that better encoding of positive (vs negative) PEs in dopaminergic midbrain regions is associated with better approach (vs avoidance) learning, specifically in participants with larger reward responses in the left (vs right) ventral striatum. Thus, individual dispositions or traits may be determined by neural processes acting to constrain learning about specific aspects of the world. Copyright © 2015 the authors 0270-6474/15/3514491-10$15.00/0.

Comparison of the BD GeneOhm Methicillin-Resistant Staphylococcus aureus (MRSA) PCR Assay to Culture by Use of BBL CHROMagar MRSA for Detection of MRSA in Nasal Surveillance Cultures from Intensive Care Unit Patients▿

PubMed Central

Snyder, James W.; Munier, Gina K.; Johnson, Charles L.

2010-01-01

This study compared the BD GeneOhm methicillin-resistant Staphylococcus aureus (MRSA) real-time PCR assay to culture by the use of BBL CHROMagar MRSA for the detection of MRSA in 627 nasal surveillance specimens collected from intensive care unit (ICU) patients. The PCR assay had a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 96.7%, 70.3%, and 100%, respectively. Nine of 19 false-positive PCR specimens grew methicillin-susceptible S. aureus (MSSA) from broth enrichment culture, of which two demonstrated evidence of mecA gene dropout. Compared to culture by the use of BBL CHROMagar MRSA, the BD GeneOhm MRSA PCR assay demonstrated sensitivity and specificity above 95% for the detection of MRSA nasal colonization and provided shorter turnaround time in generating positive and negative final results. PMID:20181916

Can integrated 18F-FDG PET/MR replace sentinel lymph node resection in malignant melanoma?

PubMed

Schaarschmidt, Benedikt Michael; Grueneisen, Johannes; Stebner, Vanessa; Klode, Joachim; Stoffels, Ingo; Umutlu, Lale; Schadendorf, Dirk; Heusch, Philipp; Antoch, Gerald; Pöppel, Thorsten Dirk

2018-06-06

To compare the sensitivity and specificity of 18F-fluordesoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), 18F-FDG PET/magnetic resonance (18F-FDG PET/MR) and 18F-FDG PET/MR including diffusion weighted imaging (DWI) in the detection of sentinel lymph node metastases in patients suffering from malignant melanoma. Fifty-two patients with malignant melanoma (female: n = 30, male: n = 22, mean age 50.5 ± 16.0 years, mean tumor thickness 2.28 ± 1.97 mm) who underwent 18F-FDG PET/CT and subsequent PET/MR & DWI for distant metastasis staging were included in this retrospective study. After hybrid imaging, lymphoscintigraphy including single photon emission computed tomography/CT (SPECT/CT) was performed to identify the sentinel lymph node prior to sentinel lymph node biopsy (SLNB). In a total of 87 sentinel lymph nodes in 64 lymph node basins visible on SPECT/CT, 17 lymph node metastases were detected by histopathology. In separate sessions PET/CT, PET/MR, and PET/MR & DWI were assessed for sentinel lymph node metastases by two independent readers. Discrepant results were resolved in a consensus reading. Sensitivities, specificities, positive predictive values and negative predictive values were calculated with histopathology following SPECT/CT guided SLNB as a reference standard. Compared with histopathology, lymph nodes were true positive in three cases, true negative in 65 cases, false positive in three cases and false negative in 14 cases in PET/CT. PET/MR was true positive in four cases, true negative in 63 cases, false positive in two cases and false negative in 13 cases. Hence, we observed a sensitivity, specificity, positive predictive value and negative predictive value of 17.7, 95.6, 50.0 and 82.3% for PET/CT and 23.5, 96.9, 66.7 and 82.3% for PET/MR. In DWI, 56 sentinel lymph node basins could be analyzed. Here, the additional analysis of DWI led to two additional false positive findings, while the number of true positive findings could not be increased. In conclusion, integrated 18F-FDG PET/MR does not reliably differentiate N-positive from N-negative melanoma patients. Additional DWI does not increase the sensitivity of 18F-FDG PET/MR. Hence, sentinel lymph node biopsy cannot be replaced by 18F-FDG-PE/MR or 18F-FDG-PET/CT.

Determination of IgE antibodies to the benzylpenicilloyl determinant: a comparison of the sensitivity and specificity of three radio allergo sorbent test methods.

PubMed

Garcia, J J; Blanca, M; Moreno, F; Vega, J M; Mayorga, C; Fernandez, J; Juarez, C; Romano, A; de Ramon, E

1997-01-01

The quantitation of in vitro IgE antibodies to the benzylpenicilloyl determinant (BPO) is a useful tool for evaluating suspected penicillin allergic subjects. Although many different methods have been employed, few studies have compared their diagnostic specificity and sensitivity. In this study, the sensitivity and specificity of three different radio allergo sorbent test (RAST) methods for quantitating specific IgE antibodies to the BPO determinant were compared. Thirty positive control sera (serum samples from penicillin allergic subjects with a positive clinical history and a positive penicillin skin test) and 30 negative control sera (sera from subjects with no history of penicillin allergy and negative skin tests) were tested for BPO-specific IgE antibodies by RAST using three different conjugates coupled to the solid phase: benzylpenicillin conjugated to polylysine (BPO-PLL), benzylpenicillin conjugated to human serum albumin (BPO-HSA), and benzylpenicillin conjugated to an aminospacer (BPO-SP). Receiver operator control curves (ROC analysis) were carried out by determining different cut-off points between positive and negative values. Contingence tables were constructed and sensitivity, specificity, negative predictive values (PV-), and positive predictive values (PV+) were calculated. Pearson correlation coefficients (r) and intraclass correlation coefficients (ICC) were determined and the differences between methods were compared by chi 2 analysis. Analysis of the areas defined by the ROC curves showed statistical differences among the three methods. When cut-off points for optimal sensitivity and specificity were chosen, the BPO-HSA assay was less sensitive and less specific and had a lower PV- and PV+ than the BPO-PLL and BPO-SP assays. Assessment of r and ICC indicated that the correlation was very high, but the concordance between the PLL and SP methods was higher than between the PLL and HSA or SP and HSA methods. We conclude that for quantitating IgE antibodies by RAST to the BPO determinant, BPO-SP or BPO-PLL conjugates offer advantages in sensitivity and specificity compared with BPO-HSA. These results support and extend previous in vitro studies by our group and highlight the importance of the carrier for RAST assays.

Optimism and positive and negative feelings in parents of young children with developmental delay.

PubMed

Kurtz-Nelson, E; McIntyre, L L

2017-07-01

Parents' positive and negative feelings about their young children influence both parenting behaviour and child problem behaviour. Research has not previously examined factors that contribute to positive and negative feelings in parents of young children with developmental delay (DD). The present study sought to examine whether optimism, a known protective factor for parents of children with DD, was predictive of positive and negative feelings for these parents. Data were collected from 119 parents of preschool-aged children with developmental delay. Two separate hierarchical linear regression analyses were conducted to determine if optimism significantly predicted positive feelings and negative feelings and whether optimism moderated relations between parenting stress and parent feelings. Increased optimism was found to predict increased positive feelings and decreased negative feelings after controlling for child problem behaviour and parenting stress. In addition, optimism was found to moderate the relation between parenting stress and positive feelings. Results suggest that optimism may impact how parents perceive their children with DD. Future research should examine how positive and negative feelings impact positive parenting behaviour and the trajectory of problem behaviour specifically for children with DD. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Where’s Waldo? How perceptual, cognitive, and emotional brain processes cooperate during learning to categorize and find desired objects in a cluttered scene

PubMed Central

Chang, Hung-Cheng; Grossberg, Stephen; Cao, Yongqiang

2014-01-01

The Where’s Waldo problem concerns how individuals can rapidly learn to search a scene to detect, attend, recognize, and look at a valued target object in it. This article develops the ARTSCAN Search neural model to clarify how brain mechanisms across the What and Where cortical streams are coordinated to solve the Where’s Waldo problem. The What stream learns positionally-invariant object representations, whereas the Where stream controls positionally-selective spatial and action representations. The model overcomes deficiencies of these computationally complementary properties through What and Where stream interactions. Where stream processes of spatial attention and predictive eye movement control modulate What stream processes whereby multiple view- and positionally-specific object categories are learned and associatively linked to view- and positionally-invariant object categories through bottom-up and attentive top-down interactions. Gain fields control the coordinate transformations that enable spatial attention and predictive eye movements to carry out this role. What stream cognitive-emotional learning processes enable the focusing of motivated attention upon the invariant object categories of desired objects. What stream cognitive names or motivational drives can prime a view- and positionally-invariant object category of a desired target object. A volitional signal can convert these primes into top-down activations that can, in turn, prime What stream view- and positionally-specific categories. When it also receives bottom-up activation from a target, such a positionally-specific category can cause an attentional shift in the Where stream to the positional representation of the target, and an eye movement can then be elicited to foveate it. These processes describe interactions among brain regions that include visual cortex, parietal cortex, inferotemporal cortex, prefrontal cortex (PFC), amygdala, basal ganglia (BG), and superior colliculus (SC). PMID:24987339

Positive Clinical Psychology: a new vision and strategy for integrated research and practice.

PubMed

Wood, Alex M; Tarrier, Nicholas

2010-11-01

This review argues for the development of a Positive Clinical Psychology, which has an integrated and equally weighted focus on both positive and negative functioning in all areas of research and practice. Positive characteristics (such as gratitude, flexibility, and positive emotions) can uniquely predict disorder beyond the predictive power of the presence of negative characteristics, and buffer the impact of negative life events, potentially preventing the development of disorder. Increased study of these characteristics can rapidly expand the knowledge base of clinical psychology and utilize the promising new interventions to treat disorder through promoting the positive. Further, positive and negative characteristics cannot logically be studied or changed in isolation as (a) they interact to predict clinical outcomes, (b) characteristics are neither "positive" or "negative", with outcomes depending on specific situation and concomitant goals and motivations, and (c) positive and negative well-being often exist on the same continuum. Responding to criticisms of the Positive Psychology movement, we do not suggest the study of positive functioning as a separate field of clinical psychology, but rather that clinical psychology itself changes to become a more integrative discipline. An agenda for research and practice is proposed including reconceptualizing well-being, forming stronger collaborations with allied disciplines, rigorously evaluating the new positive interventions, and considering a role for clinical psychologists in promoting well-being as well as treating distress. Copyright © 2010 Elsevier Ltd. All rights reserved.

Comparison of Medicare Claims vs. Physician Adjudication for Identifying Stroke Outcomes in the Women’s Health Initiative

PubMed Central

Lakshminarayan, Kamakshi; Larson, Joseph C.; Virnig, Beth; Fuller, Candace; Allen, Norrina Bai; Limacher, Marian; Winkelmayer, Wolfgang C.; Safford, Monika M.; Burwen, Dale R.

2014-01-01

Background and Purpose Many studies use medical record review for ascertaining outcomes. One large, longitudinal study, the Women’s Health Initiative (WHI) ascertains strokes using participant self-report and subsequent physician review of medical records. This is resource-intensive. Herein, we assess whether Medicare data can reliably assess stroke events in the WHI. Methods Subjects were WHI participants with fee-for-service Medicare. Four stroke definitions were created for Medicare data using discharge diagnoses in hospitalization claims. Definition 1: stroke codes in any position; Definition 2: primary position stroke codes; Definitions 3 & 4: hemorrhagic and ischemic stroke codes respectively. WHI data were randomly split into training (50%) and test sets. A concordance matrix was used to examine agreement between WHI and Medicare stroke diagnosis. A WHI stroke and a Medicare stroke were considered a match if they occurred within +/− 7 days of each other. Refined analyses excluded Medicare events where medical records were unavailable for comparison. Results Training data (n=24,428): There were 577 WHI strokes and 557 Medicare strokes using definition 1. Of these, 478 were a match. Algorithm performance: Specificity 99.7%; Negative Predictive Value 99.7%; Sensitivity 82.8%; Positive Predictive Value 85.8%; kappa 0.84. Performance was similar for test data. While specificity and negative predictive value exceeded 99%, sensitivity ranged from 75 to 88% and positive predictive value ranged from 80 to 90% across stroke definitions. Conclusion Medicare data appear useful for population-based stroke research; however the performance characteristics depend on the definition selected. PMID:24525955

Relationships and cardiovascular risk: perceived spousal ambivalence in specific relationship contexts and its links to inflammation.

PubMed

Uchino, Bert N; Bosch, Jos A; Smith, Timothy W; Carlisle, McKenzie; Birmingham, Wendy; Bowen, Kimberly S; Light, Kathleen C; Heaney, Jennifer; O'Hartaigh, Briain

2013-10-01

Although perceiving one's social ties as sources of ambivalence has been linked to negative health outcomes, the more specific contexts by which such relationships influence health remain less studied. We thus examined if perceived spousal relationship quality in three theoretically important contexts (i.e., support, capitalization, everyday life) predicted inflammation. Ninety-four married couples completed measures of perceived spousal positivity and negativity in support, capitalization, and everyday contexts. These scores were used to derive an index of relationship ambivalence whereby interactions were rated as containing both positive and negative aspects. Serum levels of IL-6, fibrinogen, and CRP were assessed from plasma. Perceiving ambivalence toward one's spouse in a support context was linked to greater inflammation even when considering health behaviors, relationship-specific romantic attachment style, spouse negativity/positivity ratings, and overall marital satisfaction. Perceiving ambivalence toward a spouse during capitalization predicted higher fibrinogen levels only, whereas no links were found with perceived spousal ambivalence in everyday life contexts. Perceptions of ambivalence during support may be a particularly important relational context in which marital ties influence health. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Smiling on the Inside: The Social Benefits of Suppressing Positive Emotions in Outperformance Situations.

PubMed

Schall, Marina; Martiny, Sarah E; Goetz, Thomas; Hall, Nathan C

2016-05-01

Although expressing positive emotions is typically socially rewarded, in the present work, we predicted that people suppress positive emotions and thereby experience social benefits when outperformed others are present. We tested our predictions in three experimental studies with high school students. In Studies 1 and 2, we manipulated the type of social situation (outperformance vs. non-outperformance) and assessed suppression of positive emotions. In both studies, individuals reported suppressing positive emotions more in outperformance situations than in non-outperformance situations. In Study 3, we manipulated the social situation (outperformance vs. non-outperformance) as well as the videotaped person's expression of positive emotions (suppression vs. expression). The findings showed that when outperforming others, individuals were indeed evaluated more positively when they suppressed rather than expressed their positive emotions, and demonstrate the importance of the specific social situation with respect to the effects of suppression. © 2016 by the Society for Personality and Social Psychology, Inc.

A high resolution computer tomography scoring system to predict culture-positive pulmonary tuberculosis in the emergency department.

PubMed

Yeh, Jun-Jun; Neoh, Choo-Aun; Chen, Cheng-Ren; Chou, Christine Yi-Ting; Wu, Ming-Ting

2014-01-01

This study evaluated the use of high-resolution computed tomography (HRCT) to predict the presence of culture-positive pulmonary tuberculosis (PTB) in adult patients with pulmonary lesions in the emergency department (ED). The study included a derivation phase and validation phase with a total of 8,245 patients with pulmonary disease. There were 132 patients with culture-positive PTB in the derivation phase and 147 patients with culture-positive PTB in the validation phase. Imaging evaluation of pulmonary lesions included morphology and segmental distribution. The post-test probability ratios between both phases in three prevalence areas were analyzed. In the derivation phase, a multivariate analysis model identified cavitation, consolidation, and clusters/nodules in right or left upper lobe (except anterior segment) and consolidation of the superior segment of the right or left lower lobe as independent positive factors for culture-positive PTB, while consolidation of the right or left lower lobe (except superior segment) were independent negative factors. An ideal cutoff point based on the receiver operating characteristic (ROC) curve analysis was obtained at a score of 1. The sensitivity, specificity, positivity predictive value, and negative predictive value from derivation phase were 98.5% (130/132), 99.7% (3997/4008), 92.2% (130/141), and 99.9% (3997/3999). Based on the predicted positive likelihood ratio value of 328.33 in derivation phase, the post-test probability was observed to be 91.5% in the derivation phase, 92.5% in the validation phase, 94.5% in a high TB prevalence area, 91.0% in a moderate prevalence area, and 76.8% in moderate-to-low prevalence area. Our model using HRCT, which is feasible to perform in the ED, can promptly diagnose culture-positive PTB in moderate and moderate-to-low prevalence areas.

The diagnostic accuracy of physical examination compared to lung ultrasound for determining lung congestion in hemodialysis patients who have reached their dry weight

NASA Astrophysics Data System (ADS)

Rahardjo, K. D.; Dharmaeizar; Nainggolan, G.; Harimurti, K.

2017-08-01

Research has shown that hemodialysis patients with lung congestion have high morbidity and mortality. Patients were assumed to be free of lung congestion if they had reached their post-dialysis dry weight. Most often, to determine if the patient was free of lung congestion, physical examination was used. However, the accuracy of physical examination in detecting lung congestion has not been established. To compare the capabilities of physical examination and lung ultrasound in detection of lung congestion, cross-sectional data collection was conducted on hemodialysis patients. Analysis was done to obtain proportion, sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio. Sixty patients participated in this study. The inter observer variation of 20 patients revealed a kappa value of 0.828. When all 60 patients were taken into account, we found that 36 patients (57.1%) had lung congestion. Mild lung congestion was found in 24 (38.1%), and 12 (19%) had a moderate degree of congestion. In the analysis comparing jugular venous pressure to lung ultrasound, we found that sensitivity was 0.47 (0.31-0.63), specificity was 0.73 (0.54-0.86), positive predictive value (PPV) was 0.51 (0.36-0.67), negative predictive value (NPV) was 0.70 (0.49-0.84), positive likelihood ratio (PLR) was 1.75 (0.88-3.47), and the negative likelihood ratio (NLR) was 0.72 (0.47-1.12). In terms of lung auscultation, we found that sensitivity was 0.56 (0.39-0.71), specificity was 0.54 (0.35-0.71), PPV was 0.61 (0.44-0.76), NPV was 0.48 (0.31-0.66), PLR was 1.21 (0.73-2.0), and NLR was 0.82 (0.49-1.38). The results of our study showed that jugular venous distention and lung auscultation examination are not reliable means of detecting lung congestion.

Evaluation of Sanofi Diagnostics Pasteur Chlamydia Microplate EIA shortened assay and comparison with cell culture and Syva Chlamydia MicroTrak II EIA in high- and low-risk populations.

PubMed

Chan, E L; Brandt, K; Horsman, G

1995-11-01

Seven hundred thirty-two female urogenital samples were collected for Chlamydia trachomatis testing by both the Sanofi Diagnostics Pasteur (Chaska, Minn.) Chlamydia Microplate EIA by the shortened protocol and the Syva (San Jose, Calif.) MicroTrak II EIA, and the results were compared with those obtained by cell culture. For the analysis of samples from female patients, the patients were divided into high- and low-risk categories. An additional 121 male urethral samples were collected and tested by the Sanofi Microplate EIA and cell culture; for the analysis of samples from male patients, the patients were divided into asymptomatic and symptomatic categories. All specimens positive by enzyme immunoassay (EIA) were confirmed by a blocking assay following the respective manufacturer's instructions. Specimens negative by EIA that fell within a gray zone 30% below the cutoff and negative cultures with one or more corresponding positive EIA results were tested further by cytocentrifugation and direct immunofluorescent assay. The overall sensitivity, specificity, positive predictive value, and negative predictive value for Syva versus culture were 94, 98.8, 85.5 and 99.6%, respectively. After resolution, the results were 94.5, 99.6, 94.5, and 99.6%, respectively. The parallel results for the Sanofi Microplate EIA versus culture were 94.0, 98.7, and 83.9, and 99.6%, respectively, and after being resolved, the results were 94.9, 100, 100, and 99.6%, respectively. In the small male population tested, the resolved results of the Sanofi Microplate EIA versus culture demonstrated sensitivity, specificity, positive predictive value, and negative predictive value of 100, 100, 100, and 100%, respectively. The present study demonstrated that the Sanofi Microplate EIA shortened protocol is highly sensitive and specific in comparison with cell culture and the Syva MicroTrak II EIA.

Is laughter a better vocal change detector than a growl?

PubMed

Pinheiro, Ana P; Barros, Carla; Vasconcelos, Margarida; Obermeier, Christian; Kotz, Sonja A

2017-07-01

The capacity to predict what should happen next and to minimize any discrepancy between an expected and an actual sensory input (prediction error) is a central aspect of perception. Particularly in vocal communication, the effective prediction of an auditory input that informs the listener about the emotionality of a speaker is critical. What is currently unknown is how the perceived valence of an emotional vocalization affects the capacity to predict and detect a change in the auditory input. This question was probed in a combined event-related potential (ERP) and time-frequency analysis approach. Specifically, we examined the brain response to standards (Repetition Positivity) and to deviants (Mismatch Negativity - MMN), as well as the anticipatory response to the vocal sounds (pre-stimulus beta oscillatory power). Short neutral, happy (laughter), and angry (growls) vocalizations were presented both as standard and deviant stimuli in a passive oddball listening task while participants watched a silent movie and were instructed to ignore the vocalizations. MMN amplitude was increased for happy compared to neutral and angry vocalizations. The Repetition Positivity was enhanced for happy standard vocalizations. Induced pre-stimulus upper beta power was increased for happy vocalizations, and predicted the modulation of the standard Repetition Positivity. These findings indicate enhanced sensory prediction for positive vocalizations such as laughter. Together, the results suggest that positive vocalizations are more effective predictors in social communication than angry and neutral ones, possibly due to their high social significance. Copyright © 2017 Elsevier Ltd. All rights reserved.

Limb-Enhancer Genie: An accessible resource of accurate enhancer predictions in the developing limb

DOE PAGES

Monti, Remo; Barozzi, Iros; Osterwalder, Marco; ...

2017-08-21

Epigenomic mapping of enhancer-associated chromatin modifications facilitates the genome-wide discovery of tissue-specific enhancers in vivo. However, reliance on single chromatin marks leads to high rates of false-positive predictions. More sophisticated, integrative methods have been described, but commonly suffer from limited accessibility to the resulting predictions and reduced biological interpretability. Here we present the Limb-Enhancer Genie (LEG), a collection of highly accurate, genome-wide predictions of enhancers in the developing limb, available through a user-friendly online interface. We predict limb enhancers using a combination of > 50 published limb-specific datasets and clusters of evolutionarily conserved transcription factor binding sites, taking advantage ofmore » the patterns observed at previously in vivo validated elements. By combining different statistical models, our approach outperforms current state-of-the-art methods and provides interpretable measures of feature importance. Our results indicate that including a previously unappreciated score that quantifies tissue-specific nuclease accessibility significantly improves prediction performance. We demonstrate the utility of our approach through in vivo validation of newly predicted elements. Moreover, we describe general features that can guide the type of datasets to include when predicting tissue-specific enhancers genome-wide, while providing an accessible resource to the general biological community and facilitating the functional interpretation of genetic studies of limb malformations.« less

The sensitivity and the specifity of rapid antigen test in streptococcal upper respiratory tract infections.

PubMed

Gurol, Yesim; Akan, Hulya; Izbirak, Guldal; Tekkanat, Zuhal Tazegun; Gunduz, Tehlile Silem; Hayran, Osman; Yilmaz, Gulden

2010-06-01

It is aimed to detect the sensitivity and specificity of rapid antigen detection of group A beta hemolytic streptococci from throat specimen compared with throat culture. The other goal of the study is to help in giving clinical decisions in upper respiratory tract infections according to the age group, by detection of sensitivity and positive predictive values of the rapid tests and throat cultures. Rapid antigen detection and throat culture results for group A beta hemolytic streptococci from outpatients attending to our university hospital between the first of November 2005 and 31st of December 2008 were evaluated retrospectively. Throat samples were obtained by swabs from the throat and transported in the Stuart medium and Quickvue Strep A [Quidel, San Diego, USA] cassette test was applied and for culture, specimen was inoculated on 5% blood sheep agar and identified according to bacitracin and trimethoprim-sulphametaxazole susceptibility from beta hemolytic colonies. During the dates between the first of November 2005 and 31st of December 2008, from 453 patients both rapid antigen detection and throat culture were evaluated. Rapid antigen detection sensitivity and specificity were found to be 64.6% and 96.79%, respectively. The positive predictive value was 80.95% whereas negative predictive value was 92.82%. Kappa index was 0.91. When the results were evaluated according to the age groups, the sensitivity and the positive predictive value of rapid antigen detection in children were 70%, 90.3% and in adults 59.4%, 70.4%. When bacterial infection is concerned to prevent unnecessary antibiotic use, rapid streptococcal antigen test (RSAT) is a reliable method to begin immediate treatment. To get the maximum sensitivity of RSAT, the specimen collection technique used and education of the health care workers is important. While giving clinical decision, it must be taken into consideration that the sensitivity and the positive predictive value of the RSAT is quite lower in adult age group than in pediatric age group. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Evaluation of serological and molecular tests used to identify Toxoplasma gondii infection in pregnant women attended in a public health service in São Paulo state, Brazil.

PubMed

Murata, Fernando Henrique Antunes; Ferreira, Marina Neves; Pereira-Chioccola, Vera Lucia; Spegiorin, Lígia Cosentino Junqueira Franco; Meira-Strejevitch, Cristina da Silva; Gava, Ricardo; Silveira-Carvalho, Aparecida Perpétuo; de Mattos, Luiz Carlos; Brandão de Mattos, Cinara Cássia

2017-09-01

Toxoplasmosis during pregnancy can have severe consequences. The use of sensitive and specific serological and molecular methods is extremely important for the correct diagnosis of the disease. We compared the ELISA and ELFA serological methods, conventional PCR (cPCR), Nested PCR and quantitative PCR (qPCR) in the diagnosis of Toxoplasma gondii infection in pregnant women without clinical suspicion of toxoplasmosis (G1=94) and with clinical suspicion of toxoplasmosis (G2=53). The results were compared using the Kappa index, and the sensitivity, specificity, positive predictive value and negative predictive value were calculated. The results of the serological methods showed concordance between the ELISA and ELFA methods even though ELFA identified more positive cases than ELISA. Molecular methods were discrepant with cPCR using B22/23 primers having greater sensitivity and lower specificity compared to the other molecular methods. Copyright © 2017 Elsevier Inc. All rights reserved.

Focal point determination in magnetic resonance-guided focused ultrasound using tracking coils.

PubMed

Svedin, Bryant T; Beck, Michael J; Hadley, J Rock; Merrill, Robb; de Bever, Joshua T; Bolster, Bradley D; Payne, Allison; Parker, Dennis L

2017-06-01

To develop a method for rapid prediction of the geometric focus location in MR coordinates of a focused ultrasound (US) transducer with arbitrary position and orientation without sonicating. Three small tracker coil circuits were designed, constructed, attached to the transducer housing of a breast-specific MR-guided focused US (MRgFUS) system with 5 degrees of freedom, and connected to receiver channel inputs of an MRI scanner. A one-dimensional sequence applied in three orthogonal directions determined the position of each tracker, which was then corrected for gradient nonlinearity. In a calibration step, low-level heating located the US focus in one transducer position orientation where the tracker positions were also known. Subsequent US focus locations were determined from the isometric transformation of the trackers. The accuracy of this method was verified by comparing the tracking coil predictions to thermal center of mass calculated using MR thermometry data acquired at 16 different transducer positions for MRgFUS sonications in a homogeneous gelatin phantom. The tracker coil predicted focus was an average distance of 2.1 ± 1.1 mm from the thermal center of mass. The one-dimensional locator sequence and prediction calculations took less than 1 s to perform. This technique accurately predicts the geometric focus for a transducer with arbitrary position and orientation without sonicating. Magn Reson Med 77:2424-2430, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

HR Positions on the Internet.

ERIC Educational Resources Information Center

Coghill, Carey Cox; Kirk, James J.

The question of whether the online job market reflects the trends predicted for the job market was examined in a study of a random sample of 690 Internet job postings over a 6-month period. Each listing was categorized by type of position, desired qualifications, salary, and job specifications. Of the human resources (HR) jobs posted, 7.2% were…

Bronchial and non-bronchial systemic arteries: value of multidetector CT angiography in diagnosis and angiographic embolisation feasibility analysis.

PubMed

Lin, Yuning; Chen, Ziqian; Yang, Xizhang; Zhong, Qun; Zhang, Hongwen; Yang, Li; Xu, Shangwen; Li, Hui

2013-12-01

The aim of this study is to evaluate the diagnostic performance of multidetector CT angiography (CTA) in depicting bronchial and non-bronchial systemic arteries in patients with haemoptysis and to assess whether this modality helps determine the feasibility of angiographic embolisation. Fifty-two patients with haemoptysis between January 2010 and July 2011 underwent both preoperative multidetector CTA and digital subtraction angiography (DSA) imaging. Diagnostic performance of CTA in depicting arteries causing haemoptysis was assessed on a per-patient and a per-artery basis. The feasibility of the endovascular treatment evaluated by CTA was analysed. Sensitivity, specificity, and positive and negative predictive values for those analyses were determined. Fifty patients were included in the artery-presence-number analysis. In the per-patient analysis, neither CTA (P = 0.25) nor DSA (P = 1.00) showed statistical difference in the detection of arteries causing haemoptysis. The sensitivity, specificity, and positive and negative predictive values were 94%, 100%, 100%, and 40%, respectively, for the presence of pathologic arteries evaluated by CTA, and 98%, 100%, 100%, and 67%, respectively, for DSA. On the per-artery basis, CTA correctly identified 97% (107/110). Fifty-two patients were included in the feasibility analysis. The performance of CTA in predicting the feasibility of angiographic embolisation was not statistically different from the treatment performed (P = 1.00). The sensitivity, specificity, and positive and negative predictive values were 96%, 80%, 98% and 67%, respectively, for CTA. Multidetector CTA is an accurate imaging method in depicting the presence and number of arteries causing haemoptysis. This modality is also useful for determining the feasibility of angiographic embolisation for haemoptysis. © 2013 The Authors. Journal of Medical Imaging and Radiation Oncology © 2013 The Royal Australian and New Zealand College of Radiologists.

Sequence-Specific Model for Peptide Retention Time Prediction in Strong Cation Exchange Chromatography.

PubMed

Gussakovsky, Daniel; Neustaeter, Haley; Spicer, Victor; Krokhin, Oleg V

2017-11-07

The development of a peptide retention prediction model for strong cation exchange (SCX) separation on a Polysulfoethyl A column is reported. Off-line 2D LC-MS/MS analysis (SCX-RPLC) of S. cerevisiae whole cell lysate was used to generate a retention dataset of ∼30 000 peptides, sufficient for identifying the major sequence-specific features of peptide retention mechanisms in SCX. In contrast to RPLC/hydrophilic interaction liquid chromatography (HILIC) separation modes, where retention is driven by hydrophobic/hydrophilic contributions of all individual residues, SCX interactions depend mainly on peptide charge (number of basic residues at acidic pH) and size. An additive model (incorporating the contributions of all 20 residues into the peptide retention) combined with a peptide length correction produces a 0.976 R 2 value prediction accuracy, significantly higher than the additive models for either HILIC or RPLC. Position-dependent effects on peptide retention for different residues were driven by the spatial orientation of tryptic peptides upon interaction with the negatively charged surface functional groups. The positively charged N-termini serve as a primary point of interaction. For example, basic residues (Arg, His, Lys) increase peptide retention when located closer to the N-terminus. We also found that hydrophobic interactions, which could lead to a mixed-mode separation mechanism, are largely suppressed at 20-30% of acetonitrile in the eluent. The accuracy of the final Sequence-Specific Retention Calculator (SSRCalc) SCX model (∼0.99 R 2 value) exceeds all previously reported predictors for peptide LC separations. This also provides a solid platform for method development in 2D LC-MS protocols in proteomics and peptide retention prediction filtering of false positive identifications.

Comparative study between cytotoxicity and flowcytometry crossmatches before and after renal transplantation.

PubMed

Abdel Rahman, Afaf S; Fahim, Nehal M A; El Sayed, Abeer A; El Hady, Soha A R; Ahmad, Yasser S

2005-01-01

Renal transplantation, in most countries, is based on human leukocyte antigen (HLA) matching of the donor kidney with the recipient. Traditional human leukocyte antigen matching is based on defining human leukocyte antigen specificities by antibodies utilizing cytotoxicity crossmatch techniques. Newer techniques have emerged, which challenge the accuracy of serological typing and crossmatching. We compared the results of the standard complement-dependent cytotoxicity crossmatch (CDCXM) with the anti-human globulin augmented cytotoxicity (AHG-CDC), and Flowcytometry crossmatch (FCXM) for the detection of anti-HLA antibodies in 150 pre-transplant patients. The development of post-transplantation sensitization was screened utilizing these three techniques within two weeks post-operative and correlated with rejection episodes. Comparison between the results of CDCXM and AHG-CDC in 150 recipients, revealed no significant correlation (P>0.05). When comparing these results with that of FCXM in 50 recipients a significant correlation was shown (P<0.05). Relative to CDCXM, the sensitivity of AHG-CDC was 100%, specificity 97.4%, positive predictive value 92.3%, and negative predictive value 100%. On the other hand, the sensitivity of FCXM was 100%, specificity 76.3%, positive predictive value 57.1%, and negative predictive value 100%. According to the results of CDCXM, AHG-CDC, and FCXM, no difference was detected between pre- and posttransplant anti-HLA sensitization within two weeks after the operation. Patients with negative cytotoxicity crossmatch (CDCXM and AHG-CDC) and positive FCXM may have an increased risk of early graft loss and may represent a relative contraindication to transplantation. Given the important theoretical advantages of FCXM over the CDC XM, further testing of the clinical relevance is warranted.

Predictive models in the diagnosis and treatment of autoimmune epilepsy.

PubMed

Dubey, Divyanshu; Singh, Jaysingh; Britton, Jeffrey W; Pittock, Sean J; Flanagan, Eoin P; Lennon, Vanda A; Tillema, Jan-Mendelt; Wirrell, Elaine; Shin, Cheolsu; So, Elson; Cascino, Gregory D; Wingerchuk, Dean M; Hoerth, Matthew T; Shih, Jerry J; Nickels, Katherine C; McKeon, Andrew

2017-07-01

To validate predictive models for neural antibody positivity and immunotherapy response in epilepsy. We conducted a retrospective study of epilepsy cases at Mayo Clinic (Rochester-MN; Scottsdale-AZ, and Jacksonville-FL) in whom autoimmune encephalopathy/epilepsy/dementia autoantibody testing profiles were requested (06/30/2014-06/30/2016). An Antibody Prevalence in Epilepsy (APE) score, based on clinical characteristics, was assigned to each patient. Among patients who received immunotherapy, a Response to Immunotherapy in Epilepsy (RITE) score was assigned. Favorable seizure outcome was defined as >50% reduction of seizure frequency at the first follow-up. Serum and cerebrospinal fluid (CSF) from 1,736 patients were sent to the Mayo Clinic Neuroimmunology Laboratory for neural autoantibody evaluation. Three hundred eighty-seven of these patients met the diagnostic criteria for epilepsy. Central nervous system (CNS)-specific antibodies were detected in 44 patients. Certain clinical features such as new-onset epilepsy, autonomic dysfunction, viral prodrome, faciobrachial dystonic seizures/oral dyskinesia, inflammatory CSF profile, and mesial temporal magnetic resonance imaging (MRI) abnormalities had a significant association with positive antibody results. A significantly higher proportion of antibody-positive patients had an APE score ≥4 (97.7% vs. 21.6%, p < 0.01). Sensitivity and specificity of an APE score ≥4 to predict presence of specific neural auto-antibody were 97.7% and 77.9%, respectively. In the subset of patients who received immunotherapy (77), autonomic dysfunction, faciobrachial dystonic seizures/oral dyskinesia, early initiation of immunotherapy, and presence of antibodies targeting plasma membrane proteins (cell-surface antigens) were associated with favorable seizure outcome. Sensitivity and specificity of a RITE score ≥7 to predict favorable seizure outcome were 87.5% and 83.8%, respectively. APE and RITE scores can aid diagnosis, treatment, and prognostication of autoimmune epilepsy. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

Asymptomatic bacteriuria in pregnant women attending Boo-Ali Hospital Tehran Iran: Urine analysis vs. urine culture.

PubMed

Etminan-Bakhsh, Mina; Tadi, Sima; Darabi, Roksana

2017-11-01

Asymptomatic bacteriuria is one of the common problems in pregnancy. Asymptomatic bacteriuria is associated with pyelonephritis, preterm labor and low birth weight infants. The physiological and anatomical changes in pregnancy facilitate urinary tract infection (UTI) during pregnancy. Several tests are available for diagnosis of asymptomatic bacteriuria. The urine culture is a gold standard diagnostic test for asymptomatic bacteriuria but it is expensive and time-consuming. Screening methods may be useful in detecting high-risk pregnant women for asymptomatic bacteriuria. The aim of the present study was to compare urine analysis as a rapid screening test to urine culture in diagnosis of asymptomatic bacteriuria. A total of 123 pregnant women attending the obstetrics clinic of Boo-Ali hospital in Tehran, Iran from March 2013 to September 2014 were included in the present diagnostic cross-sectional study. One hundred twenty three mid-stream urine samples were inoculated into cultures and were processed by dipstick (nitrite test and leucocyte esterase test) and microscopic pus cell count. The sensitivity, specificity, positive predictive value and negative predictive value of nitrite test, leucocyte esterase test and microscopic pus cell count were compared with urine culture in diagnosis of asymptomatic bacteriuria by using SPSS version 19. Of 123 urine samples, significant asymptomatic bacteriuria (≥10 4 cfu/Ml) was detected in 8 (6.5%) subjects. The sensitivity and specificity of nitrite test were 37% and 100% respectively. The sensitivity of pus cell count alone and leucocyte esterase test alone were 100% but the specificity of them were 64% and 65% respectively. We found high negative predictive value by Pus cell count and the leucocyte esterase test (100%) and low positive predictive value by them (16% and 17% respectively). Urine culture is the most useful test for diagnosis of asymptomatic bacteriuria. None of our screening tests had a sensitivity and specificity of 100%, whereas we can only refer the pregnant women with positive leucocyte esterase test and significant pyuria to the urine culture.

Social information processing in children: specific relations to anxiety, depression, and affect.

PubMed

Luebbe, Aaron M; Bell, Debora J; Allwood, Maureen A; Swenson, Lance P; Early, Martha C

2010-01-01

Two studies examined shared and unique relations of social information processing (SIP) to youth's anxious and depressive symptoms. Whether SIP added unique variance over and above trait affect in predicting internalizing symptoms was also examined. In Study 1, 215 youth (ages 8-13) completed symptom measures of anxiety and depression and a vignette-based interview measure of SIP. Anxiety and depression were each related to a more negative information-processing style. Only depression was uniquely related to a less positive information processing style. In Study 2, 127 youth (ages 10-13) completed measures of anxiety, depression, SIP, and trait affect. SIP's relations to internalizing symptoms were replicated. Over and above negative affect, negative SIP predicted both anxiety and depression. Low positive SIP added variance over and above positive affect in predicting only depression. Finally, SIP functioning partially mediated the relations of affect to internalizing symptoms.

Risk management and precaution: insights on the cautious use of evidence.

PubMed Central

Hrudey, Steve E; Leiss, William

2003-01-01

Risk management, done well, should be inherently precautionary. Adopting an appropriate degree of precaution with respect to feared health and environmental hazards is fundamental to risk management. The real problem is in deciding how precautionary to be in the face of inevitable uncertainties, demanding that we understand the equally inevitable false positives and false negatives from screening evidence. We consider a framework for detection and judgment of evidence of well-characterized hazards, using the concepts of sensitivity, specificity, positive predictive value, and negative predictive value that are well established for medical diagnosis. Our confidence in predicting the likelihood of a true danger inevitably will be poor for rare hazards because of the predominance of false positives; failing to detect a true danger is less likely because false negatives must be rarer than the danger itself. Because most controversial environmental hazards arise infrequently, this truth poses a dilemma for risk management. PMID:14527835

Contingent use of fetal fibronectin testing and cervical length measurement in women with preterm labour.

PubMed

Audibert, François; Fortin, Suzanne; Delvin, Edgard; Djemli, Anissa; Brunet, Suzanne; Dubé, Johanne; Fraser, William D

2010-04-01

To evaluate the contingent use of fetal fibronectin (fFN) testing and cervical length (CL) measurement to predict preterm delivery, and to validate the use of phosphorylated IGFBP-1 as a predictor of preterm delivery. We recruited 71 women with a clinical diagnosis of preterm labour between 24 and 34 weeks, and tested for the presence of fFN and IGFBP-1 in the cervicovaginal secretions of all women immediately before CL measurement. Among the 66 women with complete outcome, four were excluded from the final analysis as two had assessment for fFN but no CL measurement, and another two had CL measured but no screening for fFN. Among 62 women with complete results, the mean gestational age at recruitment was 29.4 +/- 2.5 weeks. Six women (9.6%) delivered within two weeks of assessment, and 14 (22.5%) delivered before 34 weeks. A positive fFN test resulted in a sensitivity of 83%, a specificity of 84%, a positive predictive value of 36%, and a negative predictive value of 98% for delivery within two weeks; for CL < 25 mm, these figures were 50%, 52%, 10%, and 91%, respectively, and for a positive IGFBP-1, they were 17%, 93%, 20%, and 91%, respectively. A policy of contingent use of fFN (in which the test was assumed to be positive if CL < or = 15 mm, and fFN was only measured if the CL was between 16 and 30 mm) gave sensitivity, specificity, positive and negative predictive values of 80%, 61%, 17%, and 97%, respectively for delivery within two weeks. Using this contingent use protocol, only one third of women needed fFN screening after CL measurement. In this study, IGFBP-1 screening did not predict preterm delivery and fFN screening provided the best predictive capacity. A policy of contingent use of testing for fFN after CL measurement, or contingent use of CL measurement after fFN screening (depending on available resources) is a promising approach to limit use of resources.

Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicenter prospective observational study.

PubMed

Reid, S; Lu, C; Hardy, N; Casikar, I; Reid, G; Cario, G; Chou, D; Almashat, D; Condous, G

2014-12-01

To use office gel sonovaginography (SVG) to predict posterior deep infiltrating endometriosis (DIE) in women undergoing laparoscopy. This was a multicenter prospective observational study carried out between January 2009 and February 2013. All women were of reproductive age, had a history of chronic pelvic pain and underwent office gel SVG assessment for the prediction of posterior compartment DIE prior to laparoscopic endometriosis surgery. Gel SVG findings were compared with laparoscopic findings to determine the diagnostic accuracy of office gel SVG for the prediction of posterior compartment DIE. In total, 189 women underwent preoperative gel SVG and laparoscopy for endometriosis. At laparoscopy, 57 (30%) women had posterior DIE and 43 (23%) had rectosigmoid/anterior rectal DIE. For the prediction of rectosigmoid/anterior rectal (i.e. bowel) DIE, gel SVG had an accuracy of 92%, sensitivity of 88%, specificity of 93%, positive predictive value (PPV) of 79%, negative predictive value (NPV) of 97%, positive likelihood ratio (LR+) of 12.9 and negative likelihood ratio (LR-) of 0.12 (P = 3.98E-25); for posterior vaginal wall and rectovaginal septum (RVS) DIE, respectively, the accuracy was 95% and 95%, sensitivity was 18% and 18%, specificity was 99% and 100%, PPV was 67% and 100%, NPV was 95% and 95%, LR+ was 32.4 and infinity and LR- was 0.82 and 0.82 (P = 0.009 and P = 0.003). Office gel SVG appears to be an effective outpatient imaging technique for the prediction of bowel DIE, with a higher accuracy for the prediction of rectosigmoid compared with anterior rectal DIE. Although the sensitivity for vaginal and RVS DIE was limited, gel SVG had a high specificity and NPV for all forms of posterior DIE, indicating that a negative gel SVG examination is highly suggestive of the absence of DIE at laparoscopy. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Influence and adjustment goals: sources of cultural differences in ideal affect.

PubMed

Tsai, Jeanne L; Miao, Felicity F; Seppala, Emma; Fung, Helene H; Yeung, Dannii Y

2007-06-01

Previous studies have found that in American culture high-arousal positive states (HAP) such as excitement are valued more and low-arousal positive states (LAP) such as calm are valued less than they are in Chinese culture. What specific factors account for these differences? The authors predicted that when people and cultures aimed to influence others (i.e., assert personal needs and change others' behaviors to meet those needs), they would value HAP more and LAP less than when they aimed to adjust to others (i.e., suppress personal needs and change their own behaviors to meet others' needs). They test these predictions in 1 survey and 3 experimental studies. The findings suggest that within and across American and Chinese contexts, differences in ideal affect are due to specific interpersonal goals. (c) 2007 APA, all rights reserved.

Evidence that specific executive functions predict symptom variance among schizophrenia patients with a predominantly negative symptom profile.

PubMed

Donohoe, Gary; Corvin, Aiden; Robertson, Ian H

2006-01-01

Although deficits in executive functioning in schizophrenia have been consistently reported, their precise relationship to symptomatology remains unclear. Recent approaches to executive functioning in nonschizophrenia studies have aimed to "fractionate" the individual cognitive processes involved. In this study, we hypothesised that if these processes are fractionable, then particular symptom syndromes may be selectively related to executive deficits. In particular, it was hoped that this approach could clarify whether negative and positive symptoms of schizophrenia are differentially related to particular aspects of executive/attentional functions. A total of 32 patients with schizophrenia and 16 matched controls were assessed on a series of tasks designed to tap the theoretically derived executive functions of Inhibition, Shifting set, Working memory, and Sustained attention. Negative symptoms were significantly predicted by performance on an "Inhibition" task (Stroop), and not by performance on any other task. Furthermore, for a subgroup of patients with predominantly negative symptoms variance in positive symptoms was only significantly predicted by performance on a set-shifting task (Visual Elevator), and not by performance on other tasks, including inhibition. Our results support the contention that negative symptoms can, at least partly, be conceived of as cognitive behaviours expressing specific executive deficits. Specifically, we discuss the possibility that negative symptoms may, in part, express a failure in response monitoring. We further suggest that the disordered metacognition resulting in positive symptoms may be mediated by cognitive flexibility in patients with a predominantly negative symptom profile.

Predictive factors of pathologic complete response of HER2-positive breast cancer after preoperative chemotherapy with trastuzumab: development of a specific predictor and study of its utilities using decision curve analysis.

PubMed

Jankowski, Clémentine; Guiu, S; Cortet, M; Charon-Barra, C; Desmoulins, I; Lorgis, V; Arnould, L; Fumoleau, P; Coudert, B; Rouzier, R; Coutant, C; Reyal, F

2017-01-01

The aim of this study was to assess the Institut Gustave Roussy/M.D. Anderson Cancer Center (IGR/MDACC) nomogram in predicting pathologic complete response (pCR) to preoperative chemotherapy in a cohort of human epidermal growth factor receptor 2 (HER2)-positive tumors treated with preoperative chemotherapy with trastuzumab. We then combine clinical and pathological variables associated with pCR into a new nomogram specific to HER2-positive tumors treated by preoperative chemotherapy with trastuzumab. Data from 270 patients with HER2-positive tumors treated with preoperative chemotherapy with trastuzumab at the Institut Curie and at the Georges François Leclerc Cancer Center were used to assess the IGR/MDACC nomogram and to subsequently develop a new nomogram for pCR based on multivariate logistic regression. Model performance was quantified in terms of calibration and discrimination. We studied the utility of the new nomogram using decision curve analysis. The IGR/MDACC nomogram was not accurate for the prediction of pCR in HER2-positive tumors treated by preoperative chemotherapy with trastuzumab, with poor discrimination (AUC = 0.54, 95% CI 0.51-0.58) and poor calibration (p = 0.01). After uni- and multivariate analysis, a new pCR nomogram was built based on T stage (TNM), hormone receptor status, and Ki67 (%). The model had good discrimination with an area under the curve (AUC) at 0.74 (95% CI 0.70-0.79) and adequate calibration (p = 0.93). By decision curve analysis, the model was shown to be relevant between thresholds of 0.3 and 0.7. To the best of our knowledge, ours is the first nomogram to predict pCR in HER2-positive tumors treated by preoperative chemotherapy with trastuzumab. To ensure generalizability, this model needs to be externally validated.

PREDICT: a new UK prognostic model that predicts survival following surgery for invasive breast cancer.

PubMed

Wishart, Gordon C; Azzato, Elizabeth M; Greenberg, David C; Rashbass, Jem; Kearins, Olive; Lawrence, Gill; Caldas, Carlos; Pharoah, Paul D P

2010-01-01

The aim of this study was to develop and validate a prognostication model to predict overall and breast cancer specific survival for women treated for early breast cancer in the UK. Using the Eastern Cancer Registration and Information Centre (ECRIC) dataset, information was collated for 5,694 women who had surgery for invasive breast cancer in East Anglia from 1999 to 2003. Breast cancer mortality models for oestrogen receptor (ER) positive and ER negative tumours were derived from these data using Cox proportional hazards, adjusting for prognostic factors and mode of cancer detection (symptomatic versus screen-detected). An external dataset of 5,468 patients from the West Midlands Cancer Intelligence Unit (WMCIU) was used for validation. Differences in overall actual and predicted mortality were <1% at eight years for ECRIC (18.9% vs. 19.0%) and WMCIU (17.5% vs. 18.3%) with area under receiver-operator-characteristic curves (AUC) of 0.81 and 0.79 respectively. Differences in breast cancer specific actual and predicted mortality were <1% at eight years for ECRIC (12.9% vs. 13.5%) and <1.5% at eight years for WMCIU (12.2% vs. 13.6%) with AUC of 0.84 and 0.82 respectively. Model calibration was good for both ER positive and negative models although the ER positive model provided better discrimination (AUC 0.82) than ER negative (AUC 0.75). We have developed a prognostication model for early breast cancer based on UK cancer registry data that predicts breast cancer survival following surgery for invasive breast cancer and includes mode of detection for the first time. The model is well calibrated, provides a high degree of discrimination and has been validated in a second UK patient cohort.

Comparison of sensitivity and specificity of 4 methods for detection of Giardia duodenalis in feces: immunofluorescence and PCR are superior to microscopy of concentrated iodine-stained samples.

PubMed

Gotfred-Rasmussen, Helle; Lund, Marianne; Enemark, Heidi L; Erlandsen, Mogens; Petersen, Eskild

2016-03-01

For decades, microscopy of feces after formol-ethylacetate (FEA) concentration and iodine staining has been the routine test for intestinal protozoa. Lately, polymerase chain reaction or fluorescence-labeled parasite-specific antibodies have been introduced, but their place in everyday routine diagnostics has not yet been established. We compared FEA and salt-sugar flotation (SSF) concentration followed by microscopy of iodine-stained concentrate and immunofluorescence assay (IFA) and real-time polymerase chain reaction (qPCR) for detection of Giardia duodenalis in human feces. The median number of Giardia cysts found by FEA in 19 Giardia-positive samples was 50 cysts per gram (CPG), by SSF 350 CPG, by IFA 76,700 CPG, and by qPCR 316,000 CPG. We next tested 455 consecutive samples for presence of Giardia cysts. Using IFA as reference, qPCR had a sensitivity of 91%, specificity of 95.1%, a false-positive rate of 50%, a false-negative rate of 0.48%, a positive predictive value of 50%, and a negative predictive value of 99.5%. In conclusion, qPCR and IFA were significantly more sensitive than microscopy of iodine-stained concentrates using either FEA or SSF. We suggest, when using qPCR, that positive samples are verified by IFA to prevent false-positive results. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Evaluation of Sienna Cancer Diagnostics hTERT Antibody on 500 Consecutive Urinary Tract Specimens.

PubMed

Allison, Derek B; Sharma, Rajni; Cowan, Morgan L; VandenBussche, Christopher J

2018-06-06

Telomerase activity can be detected in up to 90% of urothelial carcinomas (UC). Telomerase activity can also be detected in urinary tract cytology (UTC) specimens and indicate an increased risk of UC. We evaluated the performance of a commercially available antibody that putatively binds the telomerase reverse transcriptase (hTERT) subunit on 500 UTC specimens. Unstained CytospinTM preparations were created from residual urine specimens and were stained using the anti-hTERT antibody (SCD-A7). Two algorithms were developed for concatenating the hTERT result and cytologic diagnosis: a "no indeterminates algorithm," in which a negative cytology and positive hTERT result are considered positive, and a "high-specificity algorithm," in which a negative cytology and positive hTERT result are considered indeterminate (and thus negative for comparison to the gold standard). The "no indeterminates algorithm" and "high-specificity algorithm" yielded a sensitivity of 60.6 and 52.1%, a specificity of 70.4 and 90.7%, a positive predictive value of 39.1 and 63.8%, and a negative predictive value of 85.0 and 85.8%, respectively. A positive hTERT result may identify a subset of patients with an increased risk of high-grade UC (HGUC) who may otherwise not be closely followed, while a negative hTERT immunocytochemistry result is associated with a reduction in risk for HGUC. © 2018 The Author(s) Published by S. Karger AG, Basel.

Thoracic computed tomography is an effective screening modality in patients with penetrating injuries to the chest.

PubMed

Strumwasser, Aaron; Chong, Vincent; Chu, Eveline; Victorino, Gregory P

2016-09-01

The precise role of thoracic CT in penetrating chest trauma remains to be defined. We hypothesized that thoracic CT effectively screens hemodynamically normal patients with penetrating thoracic trauma to surgery vs. expectant management (NOM). A ten-year review of all penetrating torso cases was retrospectively analyzed from our urban University-based trauma center. We included hemodynamically normal patients (systolic blood pressure ≥90) with penetrating chest injuries that underwent screening thoracic CT. Hemodynamically unstable patients and diaphragmatic injuries were excluded. The sensitivity, specificity, positive predictive value and negative predictive value were calculated. A total of 212 patients (mean injury severity score=24, Abbreviated Injury Score for Chest=3.9) met inclusion criteria. Of these, 84.3% underwent NOM, 9.1% necessitated abdominal exploration, 6.6% underwent exploration for retained hemothorax/empyema, 6.6% underwent immediate thoracic exploration for significant injuries on chest CT, and 1.0% underwent delayed thoracic exploration for missed injuries. Thoracic CT had a sensitivity of 82%, specificity of 99%, positive predictive value of 90%, a negative predictive value of 99%, and an accuracy of 99% in predicting surgery vs. NOM. Thoracic CT has a negative predictive value of 99% in triaging hemodynamically normal patients with penetrating chest trauma. Screening thoracic CT successfully excludes surgery in patients with non-significant radiologic findings. Copyright © 2016. Published by Elsevier Ltd.

Sensitivity and specificity of the 'knee-up test' for estimation of the American Spinal Injury Association Impairment Scale in patients with acute motor incomplete cervical spinal cord injury.

PubMed

Yugué, Itaru; Okada, Seiji; Maeda, Takeshi; Ueta, Takayoshi; Shiba, Keiichiro

2018-04-01

A retrospective study. Precise classification of the neurological state of patients with acute cervical spinal cord injury (CSCI) can be challenging. This study proposed a useful and simple clinical method to help classify patients with incomplete CSCI. Spinal Injuries Centre, Japan. The sensitivity and specificity of the 'knee-up test' were evaluated in patients with acute CSCI classified as American Spinal Injury Association Impairment Scale (AIS) C or D. The result is positive if the patient can lift the knee in one or both legs to an upright position, whereas the result is negative if the patient is unable to lift the knee in either leg to an upright position. The AIS of these patients was classified according to a strict computerised algorithm designed by Walden et al., and the knee-up test was tested by non-expert examiners. Among the 200 patients, 95 and 105 were classified as AIS C and AIS D, respectively. Overall, 126 and 74 patients demonstrated positive and negative results, respectively, when evaluated using the knee-up test. A total of 104 patients with positive results and 73 patients with negative results were classified as AIS D and AIS C, respectively. The sensitivity, specificity, positive predictive and negative predictive values of this test for all patients were 99.1, 76.8, 82.5 and 98.7, respectively. The knee-up test may allow easy and highly accurate estimation, without the need for special skills, of AIS classification for patients with incomplete CSCI.

Usefulness of enzyme immunoassay (EIA) for screening of anti HIV antibodies in urinary specimens: A comparative analysis.

PubMed

Sahni, A K; Nagendra, A; Roy, Partha; Patrikar, S

2014-07-01

Standard HIV testing is done using serum or plasma. FDA approved ELISA to screen urine for IgG antibodies to HIV-1 in 1996. It is a simple, noninvasive test and is appropriate for developing countries where health care personnel may not be professionally trained or where clean needles for drawing blood may not always be available. 436 individuals with high-risk behavior and strong clinical suspicion of HIV infection were screened for IgG antibodies to HIV-1 in urine by ELISA. Urine HIV testing was performed by enzyme immunoassay, at the ongoing Voluntary Confidential Counseling and Testing Center (VCCTC) at a large tertiary care microbiology lab. The individuals enrolled for the study had high-risk exposure to the virus and majorities were from a state with a high incidence of HIV infection. In all individuals, both serum and urine were tested for IgG antibodies to HIV-1. Overall, 135 individuals (30.96%) were HIV-positive, of whom 96 (71%) had never previously tested positive; 87% of those who tested positive received their results, and most were referred for medical care. Sensitivity, specificity and predictive values of HIV-1 urine ELISA test kit were determined. Sensitivity was found to be 89.6%; 95% CI [82.9-94.0], specificity 97.3%; 95% CI [94.6-98.8], positive predictive value 93.8%; 95% CI [87.8-97.1] and negative predictive value 95.4%; 95% CI [92.3-97.4]. Efficiency, sensitivity, and specificity of the urine-based screening for HIV-1 test kits were excellent as compared to the reference test.

Diagnostic value of 99mTc-bombesin scintigraphy for differentiation of malignant from benign breast lesions.

PubMed

Shariati, Farzaneh; Aryana, Kamran; Fattahi, Asiehsadat; Forghani, Mohammad N; Azarian, Azita; Zakavi, Seyed R; Sadeghi, Ramin; Ayati, Narjes; Sadri, Keyvan

2014-06-01

In this study, we evaluated the diagnostic accuracy of (99m)Tc-bombesin scintigraphy for differentiation of benign from malignant palpable breast lesions. (99m)Tc-Bombesin is a tracer with high affinity for gastrin-releasing peptide receptor, which is overexpressed on a variety of human tumors including breast carcinoma. We examined 33 consecutive women who were referred to our center with suspicious palpable breast lesions but had no definitive diagnosis in other imaging procedures. A volume of 370-444 MBq of (99m)Tc-bombesin was injected and dynamic 1-min images were taken for 20 min immediately after injection in anterior view. Thereafter, two static images in anterior and prone-lateral views were taken for 5 min. Finally, single-photon emission computed tomography images were taken for each patient. Definitive diagnosis was based on biopsy and histopathological evaluation. The scan findings were positive in 19 patients and negative in 11 on visual assessment of the planar and single-photon emission computed tomography images. Pathologic examination confirmed breast carcinoma in 12 patients with positive scans and benign pathology for 18 patients. The overall sensitivity, specificity, negative and positive predictive values, and accuracy of this radiotracer for diagnosis of breast cancer were 100, 66.1, 100, 63, and 76%, respectively. Semiquantitative analysis improved the specificity of the visual assessment from 66 to 84%. Our study showed that (99m)Tc-bombesin scintigraphy has a high sensitivity and negative predictive value for detecting malignant breast lesions, but the specificity and positive predictive value of this radiotracer for differentiation of malignant breast abnormalities from benign ones are relatively low.

Diffusion-Weighted Magnetic Resonance Imaging of Cholesteatoma Using PROPELLER at 1.5T: A Single-Centre Retrospective Study.

PubMed

Clarke, Sharon E; Mistry, Dipan; AlThubaiti, Talal; Khan, M Naeem; Morris, David; Bance, Manohar

2017-05-01

The purpose of this study was to evaluate the sensitivity, specificity, and positive and negative predictive values of the diffusion-weighted periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) technique in the detection of cholesteatoma at our institution with surgical confirmation in all cases. A retrospective review of 21 consecutive patients who underwent diffusion-weighted PROPELLER magnetic resonance imaging (MRI) on a 1.5T MRI scanner prior to primary or revision/second-look surgery for suspected cholesteatoma from 2009-2012 was performed. Diffusion-weighted PROPELLER had a sensitivity of 75%, specificity of 60%, positive predictive value of 86%, and negative predictive value of 43%. In the 15 patients for whom the presence or absence of cholesteatoma was correctly predicted, there were 2 cases where the reported locations of diffusion restriction did not correspond to the location of the cholesteatoma observed at surgery. On the basis of our retrospective study, we conclude that diffusion-weighted PROPELLER MRI is not sufficiently accurate to replace second look surgery at our institution. Copyright © 2016 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

Prediction of consensus binding mode geometries for related chemical series of positive allosteric modulators of adenosine and muscarinic acetylcholine receptors.

PubMed

Sakkal, Leon A; Rajkowski, Kyle Z; Armen, Roger S

2017-06-05

Following insights from recent crystal structures of the muscarinic acetylcholine receptor, binding modes of Positive Allosteric Modulators (PAMs) were predicted under the assumption that PAMs should bind to the extracellular surface of the active state. A series of well-characterized PAMs for adenosine (A 1 R, A 2A R, A 3 R) and muscarinic acetylcholine (M 1 R, M 5 R) receptors were modeled using both rigid and flexible receptor CHARMM-based molecular docking. Studies of adenosine receptors investigated the molecular basis of the probe-dependence of PAM activity by modeling in complex with specific agonist radioligands. Consensus binding modes map common pharmacophore features of several chemical series to specific binding interactions. These models provide a rationalization of how PAM binding slows agonist radioligand dissociation kinetics. M 1 R PAMs were predicted to bind in the analogous M 2 R PAM LY2119620 binding site. The M 5 R NAM (ML-375) was predicted to bind in the PAM (ML-380) binding site with a unique induced-fit receptor conformation. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Validity of Teacher-Based Vision Screening and Factors Associated with the Accuracy of Vision Screening in Vietnamese Children.

PubMed

Paudel, Prakash; Kovai, Vilas; Naduvilath, Thomas; Phuong, Ha Thanh; Ho, Suit May; Giap, Nguyen Viet

2016-01-01

To assess validity of teacher-based vision screening and elicit factors associated with accuracy of vision screening in Vietnam. After brief training, teachers independently measured visual acuity (VA) in 555 children aged 12-15 years in Ba Ria - Vung Tau Province. Teacher VA measurements were compared to those of refractionists. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for uncorrected VA (UVA) and presenting VA (PVA) 20/40 or worse in either eye. Chi-square, Fisher's exact test and multivariate logistic regression were used to assess factors associated with accuracy of vision screening. Level of significance was set at 5%. Trained teachers in Vietnam demonstrated 86.7% sensitivity, 95.7% specificity, 86.7% positive predictive value and 95.7% negative predictive value in identifying children with visual impairment using the UVA measurement. PVA measurement revealed low accuracy for teachers, which was significantly associated with child's age, sex, spectacle wear and myopic status, but UVA measurement showed no such associations. Better accuracy was achieved in measurement of VA and identification of children with visual impairment using UVA measurement compared to PVA. UVA measurement is recommended for teacher-based vision screening programs.

[The role of endotracheal aspirate culture in the diagnosis of ventilator-associated pneumonia: a meta analysis].

PubMed

Wang, Fei; He, Bei

2013-01-01

To investigate the role of endotracheal aspirate (EA) culture in the diagnosis and antibiotic management in ventilator-associated pneumonia (VAP). We searched CNKI, Wanfang, PUBMED and EMBASE databases published from January 1990 to December 2011, to find relevant literatures on VAP microbiological diagnostic techniques including EA and bronchoalveolar lavage (BALF). The following key words were used: ventilator associated pneumonia, diagnosis and adult. Meta-analysis was performed and the sensitivity and specificity of EA on VAP diagnosis were calculated. Our literature search identified 1665 potential articles, 8 of which fulfilled our selection criteria including 561 patients with paired cultures. Using BALF quantitative culture as reference standard, the sensitivity and specificity of EA were 72% and 71%. When considering quantitative culture of EA only, the sensitivity and specificity improved to 90% and 65%, while the positive and the negative predictive values were 68% and 89% respectively. However, the sensitivity and specificity of semi-quantitative culture of EA were only 50% and 80%, with a positive predictive value of 77% and a negative predictive value of 58% respectively. EA culture had relatively poor sensitivity and specificity, although quantitative culture of EA only could improve the sensitivity. Initiating therapy on the basis of EA quantitative culture may still result in excessive antibiotic usage. Our data suggested that EA could provide some information for clinical decision but could not replace the role of BALF quantitative culture in VAP diagnosis.

Cardiovascular risk scores for coronary atherosclerosis.

PubMed

Yalcin, Murat; Kardesoglu, Ejder; Aparci, Mustafa; Isilak, Zafer; Uz, Omer; Yiginer, Omer; Ozmen, Namik; Cingozbay, Bekir Yilmaz; Uzun, Mehmet; Cebeci, Bekir Sitki

2012-10-01

The objective of this study was to compare frequently used cardiovascular risk scores in predicting the presence of coronary artery disease (CAD) and 3-vessel disease. In 350 consecutive patients (218 men and 132 women) who underwent coronary angiography, the cardiovascular risk level was determined using the Framingham Risk Score (FRS), the Modified Framingham Risk Score (MFRS), the Prospective Cardiovascular Münster (PROCAM) score, and the Systematic Coronary Risk Evaluation (SCORE). The area under the curve for receiver operating characteristic curves showed that FRS had more predictive value than the other scores for CAD (area under curve, 0.76, P < or = 0.001), but all scores had good specificity and positive predictive value. For 3-vessel disease, the FRS had better predictive value than the other scores (area under curve, 0.74, P < or = 0.001), but all scores had good specificity and negative predictive value. The risk scores (FRS, MFRS, PROCAM, and SCORE) may predict the presence and severity of coronary atherosclerosis.The FRS had better predictive value than the other scores.

Predicting out-of-office blood pressure level using repeated measurements in the clinic: an observational cohort study

PubMed Central

Sheppard, James P.; Holder, Roger; Nichols, Linda; Bray, Emma; Hobbs, F.D. Richard; Mant, Jonathan; Little, Paul; Williams, Bryan; Greenfield, Sheila; McManus, Richard J.

2014-01-01

Objectives: Identification of people with lower (white-coat effect) or higher (masked effect) blood pressure at home compared to the clinic usually requires ambulatory or home monitoring. This study assessed whether changes in SBP with repeated measurement at a single clinic predict subsequent differences between clinic and home measurements. Methods: This study used an observational cohort design and included 220 individuals aged 35–84 years, receiving treatment for hypertension, but whose SBP was not controlled. The characteristics of change in SBP over six clinic readings were defined as the SBP drop, the slope and the quadratic coefficient using polynomial regression modelling. The predictive abilities of these characteristics for lower or higher home SBP readings were investigated with logistic regression and repeated operating characteristic analysis. Results: The single clinic SBP drop was predictive of the white-coat effect with a sensitivity of 90%, specificity of 50%, positive predictive value of 56% and negative predictive value of 88%. Predictive values for the masked effect and those of the slope and quadratic coefficient were slightly lower, but when the slope and quadratic variables were combined, the sensitivity, specificity, positive and negative predictive values for the masked effect were improved to 91, 48, 24 and 97%, respectively. Conclusion: Characteristics obtainable from multiple SBP measurements in a single clinic in patients with treated hypertension appear to reasonably predict those unlikely to have a large white-coat or masked effect, potentially allowing better targeting of out-of-office monitoring in routine clinical practice. PMID:25144295

Evaluation of the Predictive Validity of Thermography in Identifying Extravasation With Intravenous Chemotherapy Infusions

PubMed Central

Murayama, Ryoko; Tanabe, Hidenori; Oe, Makoto; Motoo, Yoshiharu; Wagatsuma, Takanori; Michibuchi, Michiko; Kinoshita, Sachiko; Sakai, Keiko; Konya, Chizuko; Sugama, Junko; Sanada, Hiromi

2017-01-01

Early detection of extravasation is important, but conventional methods of detection lack objectivity and reliability. This study evaluated the predictive validity of thermography for identifying extravasation during intravenous antineoplastic therapy. Of 257 patients who received chemotherapy through peripheral veins, extravasation was identified in 26. Thermography was performed every 15 to 30 minutes during the infusions. Sensitivity, specificity, positive predictive value, and negative predictive value using thermography were 84.6%, 94.8%, 64.7%, and 98.2%, respectively. This study showed that thermography offers an accurate prediction of extravasation. PMID:29112585

Simultaneous prediction of binding free energy and specificity for PDZ domain-peptide interactions

NASA Astrophysics Data System (ADS)

Crivelli, Joseph J.; Lemmon, Gordon; Kaufmann, Kristian W.; Meiler, Jens

2013-12-01

Interactions between protein domains and linear peptides underlie many biological processes. Among these interactions, the recognition of C-terminal peptides by PDZ domains is one of the most ubiquitous. In this work, we present a mathematical model for PDZ domain-peptide interactions capable of predicting both affinity and specificity of binding based on X-ray crystal structures and comparative modeling with R osetta. We developed our mathematical model using a large phage display dataset describing binding specificity for a wild type PDZ domain and 91 single mutants, as well as binding affinity data for a wild type PDZ domain binding to 28 different peptides. Structural refinement was carried out through several R osetta protocols, the most accurate of which included flexible peptide docking and several iterations of side chain repacking and backbone minimization. Our findings emphasize the importance of backbone flexibility and the energetic contributions of side chain-side chain hydrogen bonds in accurately predicting interactions. We also determined that predicting PDZ domain-peptide interactions became increasingly challenging as the length of the peptide increased in the N-terminal direction. In the training dataset, predicted binding energies correlated with those derived through calorimetry and specificity switches introduced through single mutations at interface positions were recapitulated. In independent tests, our best performing protocol was capable of predicting dissociation constants well within one order of magnitude of the experimental values and specificity profiles at the level of accuracy of previous studies. To our knowledge, this approach represents the first integrated protocol for predicting both affinity and specificity for PDZ domain-peptide interactions.

Evaluation of the WinROP system for identifying retinopathy of prematurity in Czech preterm infants.

PubMed

Timkovic, Juraj; Pokryvkova, Martina; Janurova, Katerina; Barinova, Denisa; Polackova, Renata; Masek, Petr

2017-03-01

Retinopathy of Prematurity (ROP) is a potentially serious condition that can afflict preterm infants. Timely and correct identification of individuals at risk of developing a serious form of ROP is therefore of paramount importance. WinROP is an online system for predicting ROP based on birth weight and weight increments. However, the results vary significantly for various populations. It has not been evaluated in the Czech population. This study evaluates the test characteristics (specificity, sensitivity, positive and negative predictive values) of the WinROP system in Czech preterm infants. Data on 445 prematurely born infants included in the ROP screening program at the University Hospital Ostrava, Czech Republic, were retrospectively entered into the WinROP system and the outcomes of the WinROP and regular screening were compared. All 24 infants who developed high-risk (Type 1 or Type 2) ROP were correctly identified by the system. The sensitivity and negative predictive values for this group were 100%. However, the specificity and positive predictive values were substantially lower, resulting in a large number of false positives. Extending the analysis to low risk ROP, the system did not provide such reliable results. The system is a valuable tool for identifying infants who are not likely to develop high-risk ROP and this could help to substantially reduce the number of preterm infants in need of regular ROP screening. It is not suitable for predicting the development of less serious forms of ROP which is however in accordance with the declared aims of the WinROP system.

Role of specimen US for predicting resection margin status in breast conserving therapy

PubMed Central

MOSCHETTA, M.; TELEGRAFO, M.; INTRONA, T.; COI, L.; RELLA, L.; RANIERI, V.; CIRILLI, A.; IANORA, A.A. STABILE; ANGELELLI, G.

2015-01-01

Aim To assess the diagnostic accuracy of specimen ultrasound (US) for predicting resection margin status in women undergoing breast conserving therapy for US-detected cancer, having the histological findings as the reference standard. Patients and methods A total of 132 consecutive patients (age range, 34–87 years; mean, 51 years) underwent breast-conserving surgery for US-detected invasive breast cancer. All surgical specimens underwent US examination. The presence of lesion within the specimen and its distance from the specimen margins were assessed considering a threshold distance between the lesion and specimen margins of 10 mm. US findings were then compared with the pathological ones and specimen US. Sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative predictive values (NPV) for predicting histological margin status were evaluated, having the histological findings as the reference standard. Results The histological examination detected invasive ductal carcinoma in 96/132 (73%) cases, invasive lobular carcinoma in 32/132 (24%), mucinous carcinoma in 4/132 (3%). The pathological margin analysis revealed 96/132 (73%) negative margins and 36 (27%) close/positive margins. US examination detected all 132 breast lesions within the surgical specimens. 110 (83%) negative margins and 22 (17%) positive margins were found on US. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 44%, 94%, 80%, 73% and 82%, respectively, were found for specimen US. Conclusions Specimen US represents a time and cost saving imaging tool for evaluating the presence of US detected-breast lesion within surgical specimen and for predicting the histological margin status. PMID:26712255

Self-esteem and hope mediate the relations between social support and post-traumatic stress disorder and growth in adolescents following the Ya'an earthquake.

PubMed

Zhou, Xiao; Wu, Xinchun; Zhen, Rui

2018-01-01

Although posttraumatic stress disorders (PTSD) and posttraumatic growth (PTG) can co-exist, and several theories suggest that social support, self-esteem, and hope can predict both PTSD and PTG, no study to date has examined the combined role of social support, self-esteem, and hope in PTSD and PTG. The present study aimed to simultaneously examine the mediating roles of self-esteem and hope in the relations between social support and PTSD, and between social support and PTG. This study included 397 adolescents living in Lushan County, China, who were affected by the Ya'an earthquake. The participants completed the self-report questionnaires at two and a half years after the earthquake. Structural equation models were built to examine the roles of social support, self-esteem, and hope in PTSD and PTG. Social support directly and negatively predicted PTSD and positively predicted PTG. Moreover, social support negatively predicted PTSD via self-esteem, and positively predicted PTG via hope. In addition, social support positively predicted PTG through multiple mediating paths from self-esteem to hope. PTSD and PTG had different predictive paths. Specifically, social support reduced PTSD through enhanced self-esteem and promoted PTG through hope, or through the path from self-esteem to hope.

The Scope of Our Affective Influences: When and How Naturally Occurring Positive, Negative, and Neutral Affects Alter Judgment.

PubMed

Gasper, Karen; Danube, Cinnamon L

2016-03-01

To determine how naturally arising affect alters judgment, we examined whether (a) affective states exert a specific, rather than a general, influence on valenced-specific judgments; (b) neutral affect is associated with increased neutral judgments, independent of positive, negative, and ambivalent affects, and whether neutral judgments are associated with behavioral disengagement; and (c) the informational value of naturally arising states may be difficult to alter via salience and relevance manipulations. The results support several conclusions: (a) Affective states exerted a judgment-specific effect-positive affect was most strongly associated with positive judgments, negative affect with negative judgments, and neutral affect with neutral judgments. (b) Neutral affect influenced judgments, taking into account positive, negative, and ambivalent affects; and neutral judgments predicted behavioral disengagement. (c) With the exception of negative affect, naturally arising affective states typically influenced judgments regardless of their salience and relevance. © 2016 by the Society for Personality and Social Psychology, Inc.

Social and economic ideologies differentially predict prejudice across the political spectrum, but social issues are most divisive.

PubMed

Crawford, Jarret T; Brandt, Mark J; Inbar, Yoel; Chambers, John R; Motyl, Matt

2017-03-01

Liberals and conservatives both express prejudice toward ideologically dissimilar others (Brandt et al., 2014). Previous work on ideological prejudice did not take advantage of evidence showing that ideology is multidimensional, with social and economic ideologies representing related but separable belief systems. In 5 studies (total N = 4912), we test 3 competing hypotheses of a multidimensional account of ideological prejudice. The dimension-specific symmetry hypothesis predicts that social and economic ideologies differentially predict prejudice against targets who are perceived to vary on the social and economic political dimensions, respectively. The social primacy hypothesis predicts that such ideological worldview conflict is experienced more strongly along the social than economic dimension. The social-specific asymmetry hypothesis predicts that social conservatives will be more prejudiced than social liberals, with no specific hypotheses for the economic dimension. Using multiple target groups, multiple prejudice measures (e.g., global evaluations, behavior), and multiple social and economic ideology measures (self-placement, issue positions), we found relatively consistent support for the dimension-specific symmetry and social primacy hypotheses, and no support for the social-specific asymmetry hypothesis. These results suggest that worldview conflict and negative intergroup attitudes and behaviors are dimension-specific, but that the social dimension appears to inspire more political conflict than the economic dimension. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Differentiating the origin of outflow tract ventricular arrhythmia using a simple, novel approach.

PubMed

Efimova, Elena; Dinov, Borislav; Acou, Willem-Jan; Schirripa, Valentina; Kornej, Jelena; Kosiuk, Jedrzej; Rolf, Sascha; Sommer, Philipp; Richter, Sergio; Bollmann, Andreas; Hindricks, Gerhard; Arya, Arash

2015-07-01

Numerous electrocardiographic (ECG) criteria have been proposed to identify localization of outflow tract ventricular arrhythmias (OT-VAs); however, in some cases, it is difficult to accurately localize the origin of OT-VA using the surface ECG. The purpose of this study was to assess a simple criterion for localization of OT-VAs during electrophysiology study. We measured the interval from the onset of the earliest QRS complex of premature ventricular contractions (PVCs) to the distal right ventricular apical signal (the QRS-RVA interval) in 66 patients (31 men aged 53.3 ± 14.0 years; right ventricular outflow tract [RVOT] origin in 37) referred for ablation of symptomatic outflow tract PVCs. We prospectively validated this criterion in 39 patients (22 men aged 52 ± 15 years; RVOT origin in 19). Compared with patients with RVOT PVCs, the QRS-RVA interval was significantly longer in patients with left ventricular outflow tract (LVOT) PVCs (70 ± 14 vs 33.4±10 ms, P < .001). Receiver operating characteristic analysis showed that a QRS-RVA interval ≥49 ms had sensitivity, specificity, and positive and negative predictive values of 100%, 94.6%, 93.5%, and 100%, respectively, for prediction of an LVOT origin. The same analysis in the validation cohort showed sensitivity, specificity, and positive and negative predictive values of 94.7%, 95%, 95%, and 94.7%, respectively. When these data were combined, a QRS-RVA interval ≥49 ms had sensitivity, specificity, and positive and negative predictive values of 98%, 94.6%, 94.1%, and 98.1%, respectively, for prediction of an LVOT origin. A QRS-RVA interval ≥49 ms suggests an LVOT origin. The QRS-RVA interval is a simple and accurate criterion for differentiating the origin of outflow tract arrhythmia during electrophysiology study; however, the accuracy of this criterion in identifying OT-VA from the right coronary cusp is limited. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Tongue Blade Bite Test Predicts Mandible Fractures

PubMed Central

Neiner, John; Free, Rachael; Caldito, Gloria; Moore-Medlin, Tara; Nathan, Cherie-Ann

2015-01-01

The aim of the study is to evaluate the utility of a simple tongue blade bite test in predicting mandible fractures and use this test as an alternative screening tool for further workup. This is a retrospective chart review. An institutional review board approved the retrospective review of patients evaluated by the Department of Otolaryngology at a single institution for facial trauma performed from November 1, 2011, to February 27, 2014. Patients who had a bite test documented were included in the study. CT was performed in all cases and was used as the gold standard to diagnose mandible fractures. Variables analyzed included age, sex, fracture type/location on CT, bite test positivity, and operative intervention. A total of 86 patients met the inclusion criteria and of those 12 were pediatric patients. Majority of the patients were male (80.2%) and adult (86.0%; average age: 34.3 years). Fifty-seven patients had a negative bite test and on CT scans had no mandible fracture. Twenty-three patients had a positive bite test and a CT scan confirmed fracture. The bite test revealed a sensitivity of 88.5% (95% CI: 69.8–97.6%), specificity of 95.0% (95% CI:86.1–99%), positive predictive value [PPV] of 88.5% (95% CI: 69.8–97.6%), and negative predictive value [NPV] of 95.0% (95% CI: 86.1–99.0%). Among pediatric patients, the sensitivity was 100% (95% CI: 29.9–100%), specificity was 88.9% (95% CI: 68.4–100%), PPV was 75.0% (95% CI: 19.4–99.4%), and NPV was 100% (95% CI: 63.1–100%). The tongue blade bite test is a quick inexpensive diagnostic tool for the otolaryngologist with high sensitivity and specificity for predicting mandible fractures. In the pediatric population, where avoidance of unnecessary CT scans is of highest priority, a wider range of data collection should be undertaken to better assess its utility. PMID:27162567

Relook endoscopy predicts the development of esophageal and antropyloric stenosis better than immediate endoscopy in patients with caustic ingestion.

PubMed

Kochhar, Rakesh; Ashat, Munish; Reddy, Yalaka Rami; Dhaka, Narender; Manrai, Manish; Sinha, Saroj K; Dutta, Usha; Yadav, Thakur D; Gupta, Vikas

2017-07-01

Background and aims  Early ( < 24 hours) esophagogastroduodenoscopy (EGD) is used to prognosticate mucosal injury after caustic ingestion. We aimed to compare differences in endoscopic grading on EGDs performed on day 5 and day 1 and to assess the impact of relook endoscopy findings on the development of esophageal and/or antropyloric cicatrization. Patients and methods  Consecutive patients admitted within 24 hours of caustic ingestion between 2009 and 2014 underwent EGD and had their mucosal changes graded. Injuries of grade ≤ 2a were classified as mild and ≥ 2b were classified as severe. Patients were followed up for the development of cicatrization and managed per protocol. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) were calculated to compare day 1 and day 5 EGD findings. Results  A total of 62 patients (35 men; mean age 33 ± 15) underwent both day 1 and day 5 EGDs. Antropyloric stenosis developed in 16 patients, esophageal strictures in nine, and four had both esophageal and antropyloric strictures. Compared with day 1 EGD, endoscopic grading of severe injury on day 5 had higher specificity (83 % vs. 65 %), higher PPV (60 % vs. 41 %), and higher positive LR (5.65 vs. 2.66) for predicting the development of esophageal stricture. Similarly, day 5 endoscopic grading had higher specificity (95 % vs. 61 %), higher PPV (88 % vs. 54 %), and higher positive LR (16 vs. 2.5) for predicting the development of antropyloric stenosis. Conclusion  Endoscopic assessment on day 5 is a better predictor of esophageal and gastric cicatrization than day 1 EGD, which significantly overestimates the grade of injury. © Georg Thieme Verlag KG Stuttgart · New York.

Position specific variation in the rate of evolution in transcription factor binding sites

PubMed Central

Moses, Alan M; Chiang, Derek Y; Kellis, Manolis; Lander, Eric S; Eisen, Michael B

2003-01-01

Background The binding sites of sequence specific transcription factors are an important and relatively well-understood class of functional non-coding DNAs. Although a wide variety of experimental and computational methods have been developed to characterize transcription factor binding sites, they remain difficult to identify. Comparison of non-coding DNA from related species has shown considerable promise in identifying these functional non-coding sequences, even though relatively little is known about their evolution. Results Here we analyse the genome sequences of the budding yeasts Saccharomyces cerevisiae, S. bayanus, S. paradoxus and S. mikatae to study the evolution of transcription factor binding sites. As expected, we find that both experimentally characterized and computationally predicted binding sites evolve slower than surrounding sequence, consistent with the hypothesis that they are under purifying selection. We also observe position-specific variation in the rate of evolution within binding sites. We find that the position-specific rate of evolution is positively correlated with degeneracy among binding sites within S. cerevisiae. We test theoretical predictions for the rate of evolution at positions where the base frequencies deviate from background due to purifying selection and find reasonable agreement with the observed rates of evolution. Finally, we show how the evolutionary characteristics of real binding motifs can be used to distinguish them from artefacts of computational motif finding algorithms. Conclusion As has been observed for protein sequences, the rate of evolution in transcription factor binding sites varies with position, suggesting that some regions are under stronger functional constraint than others. This variation likely reflects the varying importance of different positions in the formation of the protein-DNA complex. The characterization of the pattern of evolution in known binding sites will likely contribute to the effective use of comparative sequence data in the identification of transcription factor binding sites and is an important step toward understanding the evolution of functional non-coding DNA. PMID:12946282

Use of polymerase chain reaction for the detection of Chlamydia trachomatis in ocular and nasopharyngeal specimens from infants with conjunctivitis.

PubMed

Hammerschlag, M R; Roblin, P M; Gelling, M; Tsumura, N; Jule, J E; Kutlin, A

1997-03-01

Chlamydia trachomatis is the most common identifiable infectious cause of neonatal conjunctivitis. Nonculture tests including enzyme immunoassays and direct fluorescent antibody tests have been shown to perform well for the diagnosis of chlamydial conjunctivitis with sensitivities and specificities > or = 90%. However, the performance with respiratory specimens has been less than satisfactory. We compared a new, commercially available polymerase chain reaction (PCR) assay, Roche AMPLICOR (Roche Diagnostic Systems, Branchburg, NJ) with culture for the detection of C. trachomatis in conjunctival and nasopharyngeal specimens from infants with conjunctivitis. We also evaluated AMPLICOR for the detection of C. trachomatis in the urine of mothers of positive infants. Ocular and nasopharyngeal specimens from 75 infants with conjunctivitis were obtained for culture and PCR. AMPLICOR was equivalent to culture for eye specimens and more sensitive than culture for nasopharyngeal specimens. The sensitivity, specificity and positive and negative predictive values of PCR compared with culture for conjunctival specimens were 92.3, 100, 100 and 98.4%, respectively. The sensitivity, specificity and positive and negative predictive values for nasopharyngeal specimens were 100, 97.2, 60 and 100%, respectively. We also detected C. trachomatis by PCR in the urine of 12 mothers of culture positive infants. PCR performed comparably to culture for detection of C. trachomatis in conjunctival and nasopharyngeal specimens from infants with conjunctivitis.

Ascertainment and verification of end-stage renal disease and end-stage liver disease in the north american AIDS cohort collaboration on research and design.

PubMed

Kitahata, Mari M; Drozd, Daniel R; Crane, Heidi M; Van Rompaey, Stephen E; Althoff, Keri N; Gange, Stephen J; Klein, Marina B; Lucas, Gregory M; Abraham, Alison G; Lo Re, Vincent; McReynolds, Justin; Lober, William B; Mendes, Adell; Modur, Sharada P; Jing, Yuezhou; Morton, Elizabeth J; Griffith, Margaret A; Freeman, Aimee M; Moore, Richard D

2015-01-01

The burden of HIV disease has shifted from traditional AIDS-defining illnesses to serious non-AIDS-defining comorbid conditions. Research aimed at improving HIV-related comorbid disease outcomes requires well-defined, verified clinical endpoints. We developed methods to ascertain and verify end-stage renal disease (ESRD) and end-stage liver disease (ESLD) and validated screening algorithms within the largest HIV cohort collaboration in North America (NA-ACCORD). Individuals who screened positive among all participants in twelve cohorts enrolled between January 1996 and December 2009 underwent medical record review to verify incident ESRD or ESLD using standardized protocols. We randomly sampled 6% of contributing cohorts to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ESLD and ESRD screening algorithms in a validation subcohort. Among 43,433 patients screened for ESRD, 822 screened positive of which 620 met clinical criteria for ESRD. The algorithm had 100% sensitivity, 99% specificity, 82% PPV, and 100% NPV for ESRD. Among 41,463 patients screened for ESLD, 2,024 screened positive of which 645 met diagnostic criteria for ESLD. The algorithm had 100% sensitivity, 95% specificity, 27% PPV, and 100% NPV for ESLD. Our methods proved robust for ascertainment of ESRD and ESLD in persons infected with HIV.

Clinical value of polymerase chain reaction in the diagnosis of joint tuberculosis by detecting the DNA of Mycobacterium tuberculosis.

PubMed

Sun, Yong-sheng; Lou, Si-quan; Wen, Jian-min; Lv, Wei-xin; Jiao, Chang-geng; Yang, Su-min; Xu, Hai-bin

2011-02-01

To assess the clinical value of polymerase chain reaction (PCR) in the diagnosis and differential diagnosis of joint tuberculosis (TB). PCR was used blindly to detect the DNA of Mycobacterium tuberculosis (M.TB) in five specimens of M.TB, 5 of BCG, and 10 of other bacteria. Then, M. TB in 98 samples from patients with joint TB and 100 samples from patients with non-tubercular joint disorders were detected by PCR, acid-fast staining and culture,. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PCR were calculated. The χ2 test was used for statistical analysis of the frequency of various factors. At the same time, some problems with PCR were also systematically analyzed. (1) In the "standard samples", both M. TB and BCG showed positive while other bacteria were negative. (2) In 98 cases from patients with joint TB, 81 were positive by PCR, 6 by acid-fast staining, and 17 by culture. In 100 cases from patients with non-tuberculous joint disorders, 9 were positive by PCR, and none by either acid-fast staining or culture. Sensitivity, specificity, accuracy, positive and negative predictive value of PCR were 82.65% (81/98), 91.00% (91/100), 86.87% (172/198), 90.00% (81/90) and 84.26% (91/108), respectively. (3) The positive rates for PCR, acid-fast staining and culture in detection of M. TB were 82.65% (81/98), 6.12% (6/98), and 17.34% (17/98), respectively. There were statistically significant differences between the three methods (P < 0.001). (4) The process of PCR is automatic, and can be completed within 3 to 6 hours, whereas 4 to 8 weeks are required for the conventional culture of M. TB. PCR is a sensitive, specific, rapid, simple and minimally invasive method for detection of M. TB in samples from joint TB, and can play an important role in early and rapid diagnosis and differential diagnosis of joint TB. But it also has some limitations, such as false positivity and false negativity. © 2011 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.

Can interleukin-2 and interleukin-1β be specific biomarkers of negative symptoms in schizophrenia?

PubMed

González-Blanco, Leticia; García-Portilla, María P; García-Álvarez, Leticia; de la Fuente-Tomás, Lorena; Iglesias García, Celso; Sáiz, Pilar A; Rodríguez-González, Susana; Coto-Montes, Ana; Bobes, Julio

2018-04-30

Evidence suggests the existence of cytokine disturbances in patients with schizophrenia but their association with psychopathology is still unclear. The aim of the current study was to determine if pro-inflammatory cytokine levels (tumor necrosis factor-α, interleukin (IL)-6, IL-2, IL-1β, IL-1RA) are increased in stable outpatients compared with healthy subjects, and to analyze if they could be specific biomarkers of clinical dimensions in schizophrenia. We studied 73 stable outpatients with schizophrenia in their first 10 years of illness and 73 age- and sex-matched healthy controls. An accurate assessment of clinical dimensions (positive, negative, depressive, cognitive) was performed in patients. Only IL-6 levels were significantly increased in patients after controlling for body mass index, waist circumference, smoking, and psychopharmacological treatment, compared with healthy subjects. After adjusting for several confounders, multiple linear regression models identified that Positive and Negative Syndrome Scale negative symptoms, general psychopathology, and global severity are predicted by IL-1β concentrations, while motivation and pleasure domain of Clinical Assessment Interview for Negative Symptoms and Personal and Social Performance global functioning scores are predicted by IL-2 levels. Cognitive performance, positive, and depressive symptom severity did not correlate with any cytokine. Our findings suggested that IL-6 concentrations are elevated in stable patients with schizophrenia. Whereas IL-2 specifically marks severity of the motivation and pleasure domain of negative symptoms, IL-1β is not specific to this dimension as it also predicts severity of general and global symptomatology. Copyright © 2018 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

Diagnostic capability of scanning laser polarimetry with variable cornea compensator in Indian patients with early primary open-angle glaucoma.

PubMed

Parikh, Rajul S; Parikh, Shefali R; Kumar, Rajesh S; Prabakaran, S; Babu, J Gansesh; Thomas, Ravi

2008-07-01

To evaluate the diagnostic ability of scanning laser polarimetry (GDx variable corneal compensator [VCC]) for early glaucoma in Asian Indian eyes. Cross-sectional observational study. Two groups of patients (early glaucoma and normal) who satisfied the inclusion and exclusion criteria were included. Early glaucoma was diagnosed in presence of open angles, characteristic glaucomatous optic disc changes correlating with the visual field (VF) on automated perimetry (VF defect fulfilling at least 2 of 3 Anderson and Patella's criteria with mean deviation >or= -6 decibels). Normal subjects had visual acuity >or= 20/30 and intraocular pressure < 22 mmHg, with a normal optic disc and fields and no ocular abnormality. All patients underwent complete ophthalmic evaluation, including VF examination (24-2/30-2 Swedish interactive threshold algorithm standard program) and imaging with GDx VCC. Sensitivity, specificity, positive predictive value and negative predictive value, area under the receiving operating characteristic curve, and likelihood ratios (LRs) were calculated for various GDx VCC parameters. Seventy-four eyes (74 patients) with early glaucoma and 104 eyes (104 normal subjects) were enrolled. TSNIT Std Dev (temporal-superior-nasal-inferior-temporal standard deviation) had the best combination of sensitivity and specificity-61.3 and 95.2, respectively-followed by nerve fiber index score > 50 (sensitivity, 52.7%; specificity, 99%). Nerve fiber index score > 50 had positive and negative predictive values of 74.3% and 97.6%, respectively, for an assumed glaucoma prevalence of 5%. Nerve fiber index score > 50 had a positive LR (+LR) of 54.8 for early glaucoma. GDx VCC has moderate sensitivity, with high specificity, in the diagnosis of early glaucoma. The high +LR for the nerve fiber index score can provide valuable diagnostic information for individual patients.

Sensitivity and specificity of dosing alerts for dosing errors among hospitalized pediatric patients

PubMed Central

Stultz, Jeremy S; Porter, Kyle; Nahata, Milap C

2014-01-01

Objectives To determine the sensitivity and specificity of a dosing alert system for dosing errors and to compare the sensitivity of a proprietary system with and without institutional customization at a pediatric hospital. Methods A retrospective analysis of medication orders, orders causing dosing alerts, reported adverse drug events, and dosing errors during July, 2011 was conducted. Dosing errors with and without alerts were identified and the sensitivity of the system with and without customization was compared. Results There were 47 181 inpatient pediatric orders during the studied period; 257 dosing errors were identified (0.54%). The sensitivity of the system for identifying dosing errors was 54.1% (95% CI 47.8% to 60.3%) if customization had not occurred and increased to 60.3% (CI 54.0% to 66.3%) with customization (p=0.02). The sensitivity of the system for underdoses was 49.6% without customization and 60.3% with customization (p=0.01). Specificity of the customized system for dosing errors was 96.2% (CI 96.0% to 96.3%) with a positive predictive value of 8.0% (CI 6.8% to 9.3). All dosing errors had an alert over-ridden by the prescriber and 40.6% of dosing errors with alerts were administered to the patient. The lack of indication-specific dose ranges was the most common reason why an alert did not occur for a dosing error. Discussion Advances in dosing alert systems should aim to improve the sensitivity and positive predictive value of the system for dosing errors. Conclusions The dosing alert system had a low sensitivity and positive predictive value for dosing errors, but might have prevented dosing errors from reaching patients. Customization increased the sensitivity of the system for dosing errors. PMID:24496386

Are diet-specific compensatory health beliefs predictive of dieting intentions and behaviour?

PubMed

Radtke, Theda; Kaklamanou, Daphne; Scholz, Urte; Hornung, Rainer; Armitage, Christopher J

2014-05-01

Compensatory Health Beliefs (CHBs) - beliefs that an unhealthy behaviour can be compensated for by healthy behaviour - are hypothesised to be activated automatically to help people resolve conflicts between their desires (e.g. eat chocolate) and their long-term goals (e.g. dieting). The aim of the present research was to investigate diet-specific CHBs within the context of a theoretical framework, the Health Action Process Approach (HAPA), to examine the extent to which diet-specific CHBs contribute to dieting intentions and dietary intake. Seventy-five dieting women were recruited in Switzerland and England and were asked to complete measures of diet-specific CHBs, risk perception, outcome expectancies, self-efficacy, intention, and behaviour. Path modelling showed that, overall, diet-specific CHBs were not related to dieting intentions (β=.10) or behaviour (β=.06) over and above variables specified in the HAPA. However, risk perception moderated the relationship between diet-specific CHBs and intention (β=.26). Diet-specific CHBs positively predicted intention in women with high risk perception, but not in women with low risk perception. This positive relationship might be explained by the assumption that CHBs play different roles at different stages of the health-behaviour change process. Future studies should further examine moderators and stage-specific differences of the associations between CHBs, intention and health-behaviour change. Copyright © 2014 Elsevier Ltd. All rights reserved.

Interleukin-27 is a novel candidate diagnostic biomarker for bacterial infection in critically ill children.

PubMed

Wong, Hector R; Cvijanovich, Natalie Z; Hall, Mark; Allen, Geoffrey L; Thomas, Neal J; Freishtat, Robert J; Anas, Nick; Meyer, Keith; Checchia, Paul A; Lin, Richard; Bigham, Michael T; Sen, Anita; Nowak, Jeffrey; Quasney, Michael; Henricksen, Jared W; Chopra, Arun; Banschbach, Sharon; Beckman, Eileen; Harmon, Kelli; Lahni, Patrick; Shanley, Thomas P

2012-10-29

Differentiating between sterile inflammation and bacterial infection in critically ill patients with fever and other signs of the systemic inflammatory response syndrome (SIRS) remains a clinical challenge. The objective of our study was to mine an existing genome-wide expression database for the discovery of candidate diagnostic biomarkers to predict the presence of bacterial infection in critically ill children. Genome-wide expression data were compared between patients with SIRS having negative bacterial cultures (n = 21) and patients with sepsis having positive bacterial cultures (n = 60). Differentially expressed genes were subjected to a leave-one-out cross-validation (LOOCV) procedure to predict SIRS or sepsis classes. Serum concentrations of interleukin-27 (IL-27) and procalcitonin (PCT) were compared between 101 patients with SIRS and 130 patients with sepsis. All data represent the first 24 hours of meeting criteria for either SIRS or sepsis. Two hundred twenty one gene probes were differentially regulated between patients with SIRS and patients with sepsis. The LOOCV procedure correctly predicted 86% of the SIRS and sepsis classes, and Epstein-Barr virus-induced gene 3 (EBI3) had the highest predictive strength. Computer-assisted image analyses of gene-expression mosaics were able to predict infection with a specificity of 90% and a positive predictive value of 94%. Because EBI3 is a subunit of the heterodimeric cytokine, IL-27, we tested the ability of serum IL-27 protein concentrations to predict infection. At a cut-point value of ≥5 ng/ml, serum IL-27 protein concentrations predicted infection with a specificity and a positive predictive value of >90%, and the overall performance of IL-27 was generally better than that of PCT. A decision tree combining IL-27 and PCT improved overall predictive capacity compared with that of either biomarker alone. Genome-wide expression analysis has provided the foundation for the identification of IL-27 as a novel candidate diagnostic biomarker for predicting bacterial infection in critically ill children. Additional studies will be required to test further the diagnostic performance of IL-27. The microarray data reported in this article have been deposited in the Gene Expression Omnibus under accession number GSE4607.

Ordinal convolutional neural networks for predicting RDoC positive valence psychiatric symptom severity scores.

PubMed

Rios, Anthony; Kavuluru, Ramakanth

2017-11-01

The CEGS N-GRID 2016 Shared Task in Clinical Natural Language Processing (NLP) provided a set of 1000 neuropsychiatric notes to participants as part of a competition to predict psychiatric symptom severity scores. This paper summarizes our methods, results, and experiences based on our participation in the second track of the shared task. Classical methods of text classification usually fall into one of three problem types: binary, multi-class, and multi-label classification. In this effort, we study ordinal regression problems with text data where misclassifications are penalized differently based on how far apart the ground truth and model predictions are on the ordinal scale. Specifically, we present our entries (methods and results) in the N-GRID shared task in predicting research domain criteria (RDoC) positive valence ordinal symptom severity scores (absent, mild, moderate, and severe) from psychiatric notes. We propose a novel convolutional neural network (CNN) model designed to handle ordinal regression tasks on psychiatric notes. Broadly speaking, our model combines an ordinal loss function, a CNN, and conventional feature engineering (wide features) into a single model which is learned end-to-end. Given interpretability is an important concern with nonlinear models, we apply a recent approach called locally interpretable model-agnostic explanation (LIME) to identify important words that lead to instance specific predictions. Our best model entered into the shared task placed third among 24 teams and scored a macro mean absolute error (MMAE) based normalized score (100·(1-MMAE)) of 83.86. Since the competition, we improved our score (using basic ensembling) to 85.55, comparable with the winning shared task entry. Applying LIME to model predictions, we demonstrate the feasibility of instance specific prediction interpretation by identifying words that led to a particular decision. In this paper, we present a method that successfully uses wide features and an ordinal loss function applied to convolutional neural networks for ordinal text classification specifically in predicting psychiatric symptom severity scores. Our approach leads to excellent performance on the N-GRID shared task and is also amenable to interpretability using existing model-agnostic approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

The role of repetitive thought in determining posttraumatic growth and distress following interpersonal trauma.

PubMed

Allbaugh, Lucy Jane; Wright, Margaret O'Dougherty; Folger, Susan F

2016-01-01

Repetitive thought (RT) strategies have been linked to a range of negative outcomes following traumatic interpersonal events but are proposed to serve an adaptive function under particular circumstances. This study examined outcomes following RT within a transdiagnostic framework, and explored the potentially adaptive nature of trait-like and event-related RT. The centrality of a traumatic event to one's identity was explored as a context under which the adaptive nature of RT might change. Young adults with interpersonal violence experiences (N = 163) reported use of trait-like and event-related RT, centrality of the event, depressive, anxious, and posttraumatic stress symptoms (PTSS), posttraumatic depreciation and posttraumatic growth. Hierarchical multiple regression analyses were used to examine main and moderating effects of four types of RT and event centrality on outcome variables. Centrality positively predicted depressive symptoms and PTSS, depreciation, and growth. Brooding RT positively predicted all negative outcomes. Reflecting RT positively predicted anxious symptoms and PTSS and depreciation. Only deliberate RT positively predicted growth. Centrality did not moderate any examined relationships. Findings highlight the importance of addressing specific types of RT in interventions with survivors and of considering centrality as a robust contributor to outcomes following interpersonal violence.

The Lateral Habenula and Its Input to the Rostromedial Tegmental Nucleus Mediates Outcome-Specific Conditioned Inhibition.

PubMed

Laurent, Vincent; Wong, Felix L; Balleine, Bernard W

2017-11-08

Animals can readily learn that stimuli predict the absence of specific appetitive outcomes; however, the neural substrates underlying such outcome-specific conditioned inhibition remain largely unexplored. Here, using female and male rats as subjects, we examined the involvement of the lateral habenula (LHb) and of its inputs onto the rostromedial tegmental nucleus (RMTg) in inhibitory learning. In these experiments, we used backward conditioning and contingency reversal to establish outcome-specific conditioned inhibitors for two distinct appetitive outcomes. Then, using the Pavlovian-instrumental transfer paradigm, we assessed the effects of manipulations of the LHb and the LHb-RMTg pathway on that inhibitory encoding. In control animals, we found that an outcome-specific conditioned inhibitor biased choice away from actions delivering that outcome and toward actions earning other outcomes. Importantly, this bias was abolished by both electrolytic lesions of the LHb and selective ablation of LHb neurons using Cre-dependent Caspase3 expression in Cre-expressing neurons projecting to the RMTg. This deficit was specific to conditioned inhibition; an excitatory predictor of a specific outcome-biased choice toward actions delivering the same outcome to a similar degree whether the LHb or the LHb-RMTg network was intact or not. LHb lesions also disrupted the ability of animals to inhibit previously encoded stimulus-outcome contingencies after their reversal, pointing to a critical role of the LHb and of its inputs onto the RMTg in outcome-specific conditioned inhibition in appetitive settings. These findings are consistent with the developing view that the LHb promotes a negative reward prediction error in Pavlovian conditioning. SIGNIFICANCE STATEMENT Stimuli that positively or negatively predict rewarding outcomes influence choice between actions that deliver those outcomes. Previous studies have found that a positive predictor of a specific outcome biases choice toward actions delivering that outcome. In contrast, a negative predictor of an outcome biases choice away from actions earning that outcome and toward other actions. Here we reveal that the lateral habenula is critical for negative predictors, but not positive predictors, to affect choice. Furthermore, these effects were found to require activation of lateral habenula inputs to the rostromedial tegmental nucleus. These results are consistent with the view that the lateral habenula establishes inhibitory relationships between stimuli and food outcomes and computes a negative prediction error in Pavlovian conditioning. Copyright © 2017 the authors 0270-6474/17/3710932-11$15.00/0.

Predictability of lesion durability for AF ablation using phased radiofrequency: Power, temperature, and duration impact creation of transmural lesions.

PubMed

Hocini, Mélèze; Condie, Cathy; Stewart, Mark T; Kirchhof, Nicole; Foell, Jason D

2016-07-01

Long-term clinical outcomes for atrial fibrillation ablation depend on the creation of durable transmural lesions during pulmonary vein isolation and on substrate modification. Focal conventional radiofrequency (RF) ablation studies have demonstrated that tissue temperature and power are important factors for lesion formation. However, the impact and predictability of temperature and power on contiguous, transmural lesion formation with a phased RF system has not been described. The purpose of this study was to determine the sensitivity, specificity, and predictability of power and temperature to create contiguous, transmural lesions with the temperature-controlled, multielectrode phased RF PVAC GOLD catheter. Single ablations with the PVAC GOLD catheter were performed in the superior vena cava of 22 pigs. Ablations from 198 PVAC GOLD electrodes were evaluated by gross examination and histopathology for lesion transmurality and contiguity. Lesions were compared to temperature and power data from the phased RF GENius generator. Effective contact was defined as electrodes with a temperature of ≥50°C and a power of ≥3 W. Eighty-five percent (168 of 198) of the lesions were transmural and 79% (106 of 134) were contiguous. Electrode analysis showed that >30 seconds of effective contact identified transmural lesions with 85% sensitivity (95% confidence interval [CI] 78%-89%), 93% specificity (95% CI 76%-99%), and 99% positive predictive value (95% CI 94%-100%). Sensitivity for lesion contiguity was 95% (95% CI 89%-98%), with 62% specificity (95% CI 42%-78%) and 90% positive predictive value (95% CI 83%-95%). No char or coagulum was observed on the catheter or tissue. PVAC GOLD safely, effectively, and predictably creates transmural and contiguous lesions. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Latex agglutination using the periplasmic proteins antigen of Brucella melitensis is a successful, rapid, and specific serodiagnostic test for ovine brucellosis

PubMed Central

Ismael, Alaa Bassuny; Swelum, Ayman Abdel-Aziz; Mostafa, Salama A-H; Alhumiany, Abdel-Rahman A

2016-01-01

Brucellosis, especially caused by Brucella melitensis, is considered the most-widespread zoonosis in the world, particularly in developing countries. This study was planned to develop an accurate test for diagnosis of ovine brucellosis using a specific hot saline extracted soluble Brucella melitensis periplasmic proteins (SBPPs). The efficacy of the latex agglutination test (LAT) using SBPPs compared to the Rose Bengal test (RBT), buffered plate agglutination test (BPAT), serum agglutination test (SAT), and an indirect enzyme-linked immunosorbent assay (i-ELISA) was evaluated in the field diagnosis of ovine brucellosis. The test performance was evaluated by estimating sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), disease prevalence (DP), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) using test agreement and bacteriological culture in 1777 samples. The false-positive result was significantly (P ⩽0.05) lower in LAT than RBT, BPAT, SAT, and i-ELISA. With reference to test agreement, the Se, Sp, PPV, and PLR were highest (P ⩽0.05) in LAT 99.33%, 99.88%, 98.68%, and 827.25%, respectively. With reference to bacteriological culture, the LAT and i-ELISA tests showed a significant difference in Se with SAT. However, no significant difference in specificity was detected. The DP was 8.44% in the five tests. In conclusion, LAT using SBPPs of B. melitensis could be a suitable serodiagnostic field test for ovine brucellosis, with high sensitivity and specificity. PMID:27207442

Latex agglutination using the periplasmic proteins antigen of Brucella melitensis is a successful, rapid, and specific serodiagnostic test for ovine brucellosis.

PubMed

Ismael, Alaa Bassuny; Swelum, Ayman Abdel-Aziz; Mostafa, Salama A-H; Alhumiany, Abdel-Rahman A

2016-09-01

Brucellosis, especially caused by Brucella melitensis, is considered the most-widespread zoonosis in the world, particularly in developing countries. This study was planned to develop an accurate test for diagnosis of ovine brucellosis using a specific hot saline extracted soluble Brucella melitensis periplasmic proteins (SBPPs). The efficacy of the latex agglutination test (LAT) using SBPPs compared to the Rose Bengal test (RBT), buffered plate agglutination test (BPAT), serum agglutination test (SAT), and an indirect enzyme-linked immunosorbent assay (i-ELISA) was evaluated in the field diagnosis of ovine brucellosis. The test performance was evaluated by estimating sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), disease prevalence (DP), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) using test agreement and bacteriological culture in 1777 samples. The false-positive result was significantly (P ⩽0.05) lower in LAT than RBT, BPAT, SAT, and i-ELISA. With reference to test agreement, the Se, Sp, PPV, and PLR were highest (P ⩽0.05) in LAT 99.33%, 99.88%, 98.68%, and 827.25%, respectively. With reference to bacteriological culture, the LAT and i-ELISA tests showed a significant difference in Se with SAT. However, no significant difference in specificity was detected. The DP was 8.44% in the five tests. In conclusion, LAT using SBPPs of B. melitensis could be a suitable serodiagnostic field test for ovine brucellosis, with high sensitivity and specificity. © The Author(s) 2016.

Accidental falls in hospital inpatients: evaluation of sensitivity and specificity of two risk assessment tools.

PubMed

Lovallo, Carmela; Rolandi, Stefano; Rossetti, Anna Maria; Lusignani, Maura

2010-03-01

This paper is a report of a study comparing the effectiveness of two falls risk assessment tools (Conley Scale and Hendrich Risk Model) by using them simultaneously with the same sample of hospital inpatients. Different risk assessment tools are available in literature. However, neither recent critical reviews nor international guidelines on fall prevention have identified tools that can be generalized to all categories of hospitalized patients. A prospective observational study was carried out in acute medical, surgical wards and rehabilitation units. From October 2007 to January 2008, 1148 patients were assessed with both instruments, subsequently noting the occurrence of falls. The sensitivity, specificity, positive and negative predictive values, and Receiver Operating Characteristics curves were calculated. The number of patients correctly identified with the Conley Scale (n = 41) was higher than with the Hendrich Model (n = 27). The Conley Scale gave sensitivity and specificity values of 69.49% and 61% respectively. The Hendrich Model gave a sensitivity value of 45.76% and a specificity value of 71%. Positive and negative predictive values were comparable. The Conley Scale is indicated for use in the medical sector, on the strength of its high sensitivity. However, since its specificity is very low, it is deemed useful to submit individual patients giving positive results to more in-depth clinical evaluation in order to decide whether preventive measures need to be taken. In surgical sectors, the low sensitivity values given by both scales suggest that further studies are warranted.

Development and testing of monoclonal antibody-based rapid immunodiagnostic test kits for direct detection of Vibrio cholerae O139 synonym Bengal.

PubMed

Hasan, J A; Huq, A; Nair, G B; Garg, S; Mukhopadhyay, A K; Loomis, L; Bernstein, D; Colwell, R R

1995-11-01

We report on the development and testing of two monoclonal antibody-based rapid immunodiagnostic test kits, BengalScreen, a coagglutination test, and Bengal DFA, a direct fluorescent-antibody test, for direct detection of Vibrio cholerae O139 synonym Bengal in clinical and environmental specimens. The BengalScreen test requires less than 5 min to complete and can be used in the field. Bengal DFA, being more sensitive than BengalScreen, requires only one reagent and less than 20 min for detection and enumeration of V. cholerae O139 synonym Bengal. In tests for specificity, all 40 strains of V. cholerae O139 reacted with both test kits, whereas 157 strains of heterologous species examined did not, yielding 100% specificity in this study. A field trial was conducted in with both BengalScreen and Bengal DFA, and the results were compared with those obtained by conventional culture methods. BengalScreen demonstrated a sensitivity of 95%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 94%. Results obtained by Bengal DFA, on the other hand, were 100% sensitive and 100% specific and yielded 100% positive and negative predictive values compared with culture methods. In a second evaluation, 93 stool specimens from Mexico that were negative for V. cholerae O139 by culture were also tested with both the BengalScreen and Bengal DFA kits. None of the 93 specimens were positive for V. cholerae O139 by both tests. A concentration method was optimized for screening of environmental water samples for V. cholerae O139 synonym Bengal with rapid test kits. BengalScreen results were unequivocally positive when water samples contained at least 2.0 x 10(3) CFU/ml, whereas Bengal DFA demonstrated an unequivocally positive reaction when the water sample contained at least 1.5 x 10(2) CFU/ml. When Bengal DFA was compared with conventional culture methods for enumeration of V. cholerae O139 synonym Bengal organisms, no difference was observed.

Effectiveness of Computer-Aided Detection in Community Mammography Practice

PubMed Central

Abraham, Linn; Taplin, Stephen H.; Geller, Berta M.; Carney, Patricia A.; D’Orsi, Carl; Elmore, Joann G.; Barlow, William E.

2011-01-01

Background Computer-aided detection (CAD) is applied during screening mammography for millions of US women annually, although it is uncertain whether CAD improves breast cancer detection when used by community radiologists. Methods We investigated the association between CAD use during film-screen screening mammography and specificity, sensitivity, positive predictive value, cancer detection rates, and prognostic characteristics of breast cancers (stage, size, and node involvement). Records from 684 956 women who received more than 1.6 million film-screen mammograms at Breast Cancer Surveillance Consortium facilities in seven states in the United States from 1998 to 2006 were analyzed. We used random-effects logistic regression to estimate associations between CAD and specificity (true-negative examinations among women without breast cancer), sensitivity (true-positive examinations among women with breast cancer diagnosed within 1 year of mammography), and positive predictive value (breast cancer diagnosed after positive mammograms) while adjusting for mammography registry, patient age, time since previous mammography, breast density, use of hormone replacement therapy, and year of examination (1998–2002 vs 2003–2006). All statistical tests were two-sided. Results Of 90 total facilities, 25 (27.8%) adopted CAD and used it for an average of 27.5 study months. In adjusted analyses, CAD use was associated with statistically significantly lower specificity (OR = 0.87, 95% confidence interval [CI] = 0.85 to 0.89, P < .001) and positive predictive value (OR = 0.89, 95% CI = 0.80 to 0.99, P = .03). A non-statistically significant increase in overall sensitivity with CAD (OR = 1.06, 95% CI = 0.84 to 1.33, P = .62) was attributed to increased sensitivity for ductal carcinoma in situ (OR = 1.55, 95% CI = 0.83 to 2.91; P = .17), although sensitivity for invasive cancer was similar with or without CAD (OR = 0.96, 95% CI = 0.75 to 1.24; P = .77). CAD was not associated with higher breast cancer detection rates or more favorable stage, size, or lymph node status of invasive breast cancer. Conclusion CAD use during film-screen screening mammography in the United States is associated with decreased specificity but not with improvement in the detection rate or prognostic characteristics of invasive breast cancer. PMID:21795668

Development and validation of a parent-report measure for detection of cognitive delay in infancy.

PubMed

Schafer, Graham; Genesoni, Lucia; Boden, Greg; Doll, Helen; Jones, Rosamond A K; Gray, Ron; Adams, Eleri; Jefferson, Ros

2014-12-01

To develop a brief, parent-completed instrument (ERIC - Early Report by Infant Caregivers) for detection of cognitive delay in 10- to 24-month-olds born preterm, or of low birthweight, or with perinatal complications, and to establish ERIC's diagnostic properties. Scores for ERIC were collected from the parents of 317 children meeting ≥inclusion criterion (birthweight <1500 g, gestational age <34 completed weeks, 5 min Apgar score <7, or presence of hypoxic-ischaemic encephalopathy) and no exclusion criteria. Children were assessed using a criterion score of below 80 on the Bayley Scales of Infant and Toddler Development-III cognitive scale. Items were retained according to their individual associations with delay. Sensitivity, specificity, and positive and negative predictive values were estimated and a truncated ERIC was developed for use in children <14 months old. ERIC correctly detected developmental delay in 17 out of 18 children in the sample, with 94.4% sensitivity, 76.9% specificity, 19.8% positive predictive value, 99.6% negative predictive value, 4.09 likelihood ratio positive, and 0.07 likelihood ratio negative. ERIC has potential value as a quickly administered diagnostic instrument for the absence of early cognitive delay in 10- to 24-month-old preterm infants and as a screen for cognitive delay. © 2014 Mac Keith Press.

Influence of different positive emotions on persuasion processing: a functional evolutionary approach.

PubMed

Griskevicius, Vladas; Shiota, Michelle N; Neufeld, Samantha L

2010-04-01

Much research has found that positive affect facilitates increased reliance on heuristics in cognition. However, theories proposing distinct evolutionary fitness-enhancing functions for specific positive emotions also predict important differences among the consequences of different positive emotion states. Two experiments investigated how six positive emotions influenced the processing of persuasive messages. Using different methods to induce emotions and assess processing, we showed that the positive emotions of anticipatory enthusiasm, amusement, and attachment love tended to facilitate greater acceptance of weak persuasive messages (consistent with previous research), whereas the positive emotions of awe and nurturant love reduced persuasion by weak messages. In addition, a series of mediation analyses suggested that the effects distinguishing different positive emotions from a neutral control condition were best accounted for by different mediators rather than by one common mediator. These findings build upon approaches that link affective valence to certain types of processing, documenting emotion-specific effects on cognition that are consistent with functional evolutionary accounts of discrete positive emotions. Copyright 2010 APA, all rights reserved.

Queuing Time Prediction Using WiFi Positioning Data in an Indoor Scenario.

PubMed

Shu, Hua; Song, Ci; Pei, Tao; Xu, Lianming; Ou, Yang; Zhang, Libin; Li, Tao

2016-11-22

Queuing is common in urban public places. Automatically monitoring and predicting queuing time can not only help individuals to reduce their wait time and alleviate anxiety but also help managers to allocate resources more efficiently and enhance their ability to address emergencies. This paper proposes a novel method to estimate and predict queuing time in indoor environments based on WiFi positioning data. First, we use a series of parameters to identify the trajectories that can be used as representatives of queuing time. Next, we divide the day into equal time slices and estimate individuals' average queuing time during specific time slices. Finally, we build a nonstandard autoregressive (NAR) model trained using the previous day's WiFi estimation results and actual queuing time to predict the queuing time in the upcoming time slice. A case study comparing two other time series analysis models shows that the NAR model has better precision. Random topological errors caused by the drift phenomenon of WiFi positioning technology (locations determined by a WiFi positioning system may drift accidently) and systematic topological errors caused by the positioning system are the main factors that affect the estimation precision. Therefore, we optimize the deployment strategy during the positioning system deployment phase and propose a drift ratio parameter pertaining to the trajectory screening phase to alleviate the impact of topological errors and improve estimates. The WiFi positioning data from an eight-day case study conducted at the T3-C entrance of Beijing Capital International Airport show that the mean absolute estimation error is 147 s, which is approximately 26.92% of the actual queuing time. For predictions using the NAR model, the proportion is approximately 27.49%. The theoretical predictions and the empirical case study indicate that the NAR model is an effective method to estimate and predict queuing time in indoor public areas.

Queuing Time Prediction Using WiFi Positioning Data in an Indoor Scenario

PubMed Central

Shu, Hua; Song, Ci; Pei, Tao; Xu, Lianming; Ou, Yang; Zhang, Libin; Li, Tao

2016-01-01

Queuing is common in urban public places. Automatically monitoring and predicting queuing time can not only help individuals to reduce their wait time and alleviate anxiety but also help managers to allocate resources more efficiently and enhance their ability to address emergencies. This paper proposes a novel method to estimate and predict queuing time in indoor environments based on WiFi positioning data. First, we use a series of parameters to identify the trajectories that can be used as representatives of queuing time. Next, we divide the day into equal time slices and estimate individuals’ average queuing time during specific time slices. Finally, we build a nonstandard autoregressive (NAR) model trained using the previous day’s WiFi estimation results and actual queuing time to predict the queuing time in the upcoming time slice. A case study comparing two other time series analysis models shows that the NAR model has better precision. Random topological errors caused by the drift phenomenon of WiFi positioning technology (locations determined by a WiFi positioning system may drift accidently) and systematic topological errors caused by the positioning system are the main factors that affect the estimation precision. Therefore, we optimize the deployment strategy during the positioning system deployment phase and propose a drift ratio parameter pertaining to the trajectory screening phase to alleviate the impact of topological errors and improve estimates. The WiFi positioning data from an eight-day case study conducted at the T3-C entrance of Beijing Capital International Airport show that the mean absolute estimation error is 147 s, which is approximately 26.92% of the actual queuing time. For predictions using the NAR model, the proportion is approximately 27.49%. The theoretical predictions and the empirical case study indicate that the NAR model is an effective method to estimate and predict queuing time in indoor public areas. PMID:27879663

Sensitivity and Specificity of Cetuximab-IRDye800CW to Identify Regional Metastatic Disease in Head and Neck Cancer.

PubMed

Rosenthal, Eben L; Moore, Lindsay S; Tipirneni, Kiranya; de Boer, Esther; Stevens, Todd M; Hartman, Yolanda E; Carroll, William R; Zinn, Kurt R; Warram, Jason M

2017-08-15

Purpose: Comprehensive cervical lymphadenectomy can be associated with significant morbidity and poor quality of life. This study evaluated the sensitivity and specificity of cetuximab-IRDye800CW to identify metastatic disease in patients with head and neck cancer. Experimental Design: Consenting patients scheduled for curative resection were enrolled in a clinical trial to evaluate the safety and specificity of cetuximab-IRDye800CW. Patients ( n = 12) received escalating doses of the study drug. Where indicated, cervical lymphadenectomy accompanied primary tumor resection, which occurred 3 to 7 days following intravenous infusion of cetuximab-IRDye800CW. All 471 dissected lymph nodes were imaged with a closed-field, near-infrared imaging device during gross processing of the fresh specimens. Intraoperative imaging of exposed neck levels was performed with an open-field fluorescence imaging device. Blinded assessments of the fluorescence data were compared to histopathology to calculate sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). Results: Of the 35 nodes diagnosed pathologically positive, 34 were correctly identified with fluorescence imaging, yielding a sensitivity of 97.2%. Of the 435 pathologically negative nodes, 401 were correctly assessed using fluorescence imaging, yielding a specificity of 92.7%. The NPV was determined to be 99.7%, and the PPV was 50.7%. When 37 fluorescently false-positive nodes were sectioned deeper (1 mm) into their respective blocks, metastatic cancer was found in 8.1% of the recut nodal specimens, which altered staging in two of those cases. Conclusions: Fluorescence imaging of lymph nodes after systemic cetuximab-IRDye800CW administration demonstrated high sensitivity and was capable of identifying additional positive nodes on deep sectioning. Clin Cancer Res; 23(16); 4744-52. ©2017 AACR . ©2017 American Association for Cancer Research.

Role of atopy patch test for diagnosis of food allergy-related gastrointestinal symptoms in children.

PubMed

Boonyaviwat, Onsuree; Pacharn, Punchama; Jirapongsananuruk, Orathai; Vichyanond, Pakit; Visitsunthorn, Nualanong

2015-12-01

Double-blind, placebo-controlled food challenge is the gold standard for diagnosing food allergy. However, it is a time-consuming procedure and requires onsite medical supervision and resuscitating medicines and devices on hand. The objective of this study was to compare the atopy patch test (APT) with the oral food challenge test (OFC) in children with suspected food allergy-related gastrointestinal (GI) symptoms. A prospective self-controlled study enrolled children with a history of suspected food allergy-related GI symptoms. Skin prick test (SPT) and APT using lyophilized and commercial allergen extracts for cow's milk, egg, wheat, soy, and shrimp were evaluated, and OFC was performed. Thirty-nine patients (25 boys, median age 2.4 yrs) with 76 events of suspected food allergy-related GI symptoms were enrolled. SPT was positive in 11/76 events (14.5%). Sensitivity, specificity, predictive values, and likelihood ratio were calculated related to the food challenge outcome. Of 41 OFC, 30 (73.2%) were positive. APT using lyophilized allergen extracts yielded high sensitivity (80%) and high positive predictive value (85.7%). APT using commercial allergen extracts yielded low sensitivity (30%) but high specificity (90%). The negative predictive value of APT using lyophilized and commercial allergen extracts was 53.8% and 32.2%, respectively. All cases with positive APT using lyophilized allergen extracts together with positive SPT also had positive OFC. In contrast to commercial extracts, APT with lyophilized allergen extracts is reliable, safe, and maybe useful for the diagnosis of suspected food allergy-related GI symptoms in children. OFC is still needed in most of the cases. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Usefulness of ambulatory radionuclide monitoring of left ventricular function early after acute myocardial infarction for predicting residual myocardial ischemia

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

Breisblatt, W.M.; Weiland, F.L.; McLain, J.R.

1988-11-15

Ambulatory radionuclide monitoring of left ventricular function was performed with the nuclear Vest device in 35 patients early after acute myocardial infarction. Patients were evaluated during post-infarction treadmill, other activities that included mental stress and cold pressor challenge, and with stress thallium imaging and cardiac catheterization. Of the 35 patients evaluated, 14 had ischemic responses on treadmill testing and 21 had negative responses. By contrast, 20 had redistribution by thallium imaging suggesting ischemia. Vest studies demonstrated 56 responses suggestive of ischemia in 23 patients. Twenty-two occurred during exercise and 13 with mental stress. Seventy-five percent were silent and only 39%more » had associated electrocardiographic changes. Vest responses were compared in patients whose thallium scan was indicative of ischemia (thallium-positive) and those without ischemia (thallium-negative). Ejection fraction was higher in the thallium-positive group (0.52 +/- 0.11), as compared with thallium-negative patients (0.44 +/- 0.1). With exercise, ejection fraction decreased for the thallium-positive patients from 0.52 +/- 0.11 to 0.40 +/- 0.09 at peak exercise. For thallium-negative patients, ejection fraction changes were not significant. During mental stress, ejection fraction decreased from 0.51 +/- 0.11 to 0.45 +/- 0.12 for thallium-positive patients while thallium-negative patients were unchanged. Vest-measured decreases in ejection fraction of greater than or equal to 5 units during exercise were highly sensitive (90%), specific (73%) and predictive (82%) of a positive thallium scan. The same response for mental stress was specific (87%) and predictive (85%) of a positive scan result.« less

Evaluation of GeneXpert MTB/RIF for detection of Mycobacterium tuberculosis complex and rpo B gene in respiratory and non-respiratory clinical specimens at a tertiary care teaching hospital in Saudi Arabia.

PubMed

Somily, Ali M; Barry, Mazin A; Habib, Hanan A; Alotaibi, Fawzia E; Al-Zamil, Fahad A; Khan, Mohammed A; Sarwar, Mohammed S; Bakhash, Nawab D; Alrabiaah, Abdulkarim A; Shakoor, Zahid A; Senok, Abiola C

2016-12-01

To assess the performance of Xpert MTB/RIF, an automated molecular test for Mycobacterium tuberculosis (MTB) and resistance to rifampin (RIF), against smear microscopy and culture method for diagnosis of MTB infection. Methods: This is a retrospective analysis of 103 respiratory and 137 non-respiratory patient specimens suspected of tuberculosis at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia performed between April 2014 and March 2015. Each sample underwent smear microscopy, mycobacterial culture, and GeneXpert MTB/RIF test. Results: Fifteen out of 103 respiratory samples were smear and culture positive, whereas 9 out of 137 non-respiratory samples were smear positive. Out of 9 smear positive specimens, 8 were also culture positive. All 15 culture positive respiratory samples were detected by Xpert MTB/RIF (sensitivity  and positive predictive value [PPV]=100%). Similarly, all 8 culture positive non-respiratory specimens were identified by Xpert MTB/RIF (sensitivity 100%; PPV 88.8%). The Xpert MTB/RIF detected only one false positive result in 88 smear negative respiratory specimens (specificity 98.9%; negative predictive value [NPV]= 100%). All 125 smear negative non-respiratory specimens tested negative by culture and Xpert MTB/RIF (sensitivity, specificity, PPV, NPV= 100%). Conclusion: The performance of Xpert MTB/RIF was comparable to the gold standard culture method for identification of MTB in both respiratory and non-respiratory clinical specimens.

Evaluation of GeneXpert MTB/RIF for detection of Mycobacterium tuberculosis complex and rpo B gene in respiratory and non-respiratory clinical specimens at a tertiary care teaching hospital in Saudi Arabia

PubMed Central

Somily, Ali M.; Barry, Mazin A.; Habib, Hanan A.; Alotaibi, Fawzia E.; Al-Zamil, Fahad A.; Khan, Mohammed A.; Sarwar, Mohammed S.; Bakhash, Nawab D.; Alrabiaah, Abdulkarim A.; Shakoor, Zahid A.; Senok, Abiola C.

2016-01-01

Objectives To assess the performance of Xpert MTB/RIF, an automated molecular test for Mycobacterium tuberculosis (MTB) and resistance to rifampin (RIF), against smear microscopy and culture method for diagnosis of MTB infection. Methods This is a retrospective analysis of 103 respiratory and 137 non-respiratory patient specimens suspected of tuberculosis at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia performed between April 2014 and March 2015. Each sample underwent smear microscopy, mycobacterial culture, and GeneXpert MTB/RIF test. Results Fifteen out of 103 respiratory samples were smear and culture positive, whereas 9 out of 137 non-respiratory samples were smear positive. Out of 9 smear positive specimens, 8 were also culture positive. All 15 culture positive respiratory samples were detected by Xpert MTB/RIF (sensitivity and positive predictive value [PPV]=100%). Similarly, all 8 culture positive non-respiratory specimens were identified by Xpert MTB/RIF (sensitivity 100%; PPV 88.8%). The Xpert MTB/RIF detected only one false positive result in 88 smear negative respiratory specimens (specificity 98.9%; negative predictive value [NPV]= 100%). All 125 smear negative non-respiratory specimens tested negative by culture and Xpert MTB/RIF (sensitivity, specificity, PPV, NPV= 100%). Conclusion The performance of Xpert MTB/RIF was comparable to the gold standard culture method for identification of MTB in both respiratory and non-respiratory clinical specimens. PMID:27874159

Role of Xpert MTB/RIF in differentiating tuberculosis from sarcoidosis in patients with mediastinal lymphadenopathy undergoing EBUS-TBNA: a study of 147 patients.

PubMed

Dhooria, Sahajal; Gupta, Nalini; Bal, Amanjit; Sehgal, Inderpaul Singh; Aggarwal, Ashutosh Nath; Sethi, Sunil; Behera, Digambar; Agarwal, Ritesh

2016-10-07

In patients with intrathoracic lymphadenopathy, differentiating tuberculosis from sarcoidosis is often difficult. We hypothesized that Xpert MTB/RIF assay, a semi-automated hemi-nested PCR would help in this regard. To evaluate the performance of Xpert MTB/RIF in the differential diagnosis of tuberculosis and sarcoidosis. This was a retrospective analysis of patients with intrathoracic lymphadenopathy who underwent endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA), and were diagnosed as either tuberculosis or sarcoidosis. The results of Xpert MTB/RIF assay, tuberculin skin test and endosonographic characteristics (heterogeneous echotexture and coagulation necrosis sign) of the lymph nodes were compared between the two groups. During the study period, 465 EBUS procedures were performed and a diagnosis of sarcoidosis (n=94) or tuberculosis (n=53) was made in 147 patients. Xpert MTB/RIF was positive in 26 (49.1%) and two (2.1%) patients with tuberculosis and sarcoidosis, respectively. The sensitivity, specificity, positive and negative predictive values of Xpert MTB/RIF in the diagnosis of tuberculosis were 49.1 %, 97.9%, 92.9% and 77.3%, respectively. The presence of any of the four features namely positive Xpert MTB/RIF, positive tuberculin skin test, heterogeneous echotexture of the lymph nodes, or the presence of endosonographic coagulation necrosis sign yielded a sensitivity and negative predictive value of 83.0% and 88.0%, respectively in the diagnosis of tuberculosis versus sarcoidosis. Xpert MTB/RIF has good specificity and positive predictive value in the diagnosis of tuberculosis, and is a useful investigation in separating tuberculosis from sarcoidosis.

Comparison of ELISA and Microscopy for detection of Cryptosporidium in stool

PubMed Central

Sharma, Madhu; Chaudhary, Uma; Yadav, Aparna

2014-01-01

Background: Cryptosporidiosis, a diarrheal disease caused by the protozoan parasite Cryptosporidium spp. has become recognized as one of the most common causes of water borne diseases in humans. Aims and Objectives: To compare the sensitivity of ELISA and Microscopy for detection of Cryptosporidium in stool samples Materials and Methods: The study was conducted in the Department of Microbiology of PT. B.D. Sharma PGIMS Rohtak, between January 2011 to june 2011 on 50 stool samples, which were processed for detection of cryptosporidial antigen by ELISA and detection of cysts by microscopy (Modified Ziehl and Nelsen staining). Study and Design: This was a prospective study conducted in the Department of Microbiology in PT. BD Sharma, PGIMS, Rohtak, India. Result: Out of total, 50 stool samples eighteen (36%) samples were found positive for Cryptosporidium cysts by microscopy in comparison to 3(6%) stool samples which were found positive for cryptosporidial antigen by ELISA. Samples found positive with ELISA were also positive with microscopy. Sensitivity, specificity, positive predictive value and negative predictive value for ELISA was 16.7%, 100%, 100% and 68% respectively. Conclusion: The study concludes that stool microscopic Modified acid fast staining is more sensitive method than ELISA for detection of Cryptosporidium in stool samples but the specificity of ELISA was more than microscopy. PMID:25584216

Performance characteristics of prostate-specific antigen density and biopsy core details to predict oncological outcome in patients with intermediate to high-risk prostate cancer underwent robot-assisted radical prostatectomy.

PubMed

Yashi, Masahiro; Nukui, Akinori; Tokura, Yuumi; Takei, Kohei; Suzuki, Issei; Sakamoto, Kazumasa; Yuki, Hideo; Kambara, Tsunehito; Betsunoh, Hironori; Abe, Hideyuki; Fukabori, Yoshitatsu; Nakazato, Yoshimasa; Kaji, Yasushi; Kamai, Takao

2017-06-23

Many urologic surgeons refer to biopsy core details for decision making in cases of localized prostate cancer (PCa) to determine whether an extended resection and/or lymph node dissection should be performed. Furthermore, recent reports emphasize the predictive value of prostate-specific antigen density (PSAD) for further risk stratification, not only for low-risk PCa, but also for intermediate- and high-risk PCa. This study focused on these parameters and compared respective predictive impact on oncologic outcomes in Japanese PCa patients. Two-hundred and fifty patients with intermediate- and high-risk PCa according to the National Comprehensive Cancer Network (NCCN) classification, that underwent robot-assisted radical prostatectomy at a single institution, and with observation periods of longer than 6 months were enrolled. None of the patients received hormonal treatments including antiandrogens, luteinizing hormone-releasing hormone analogues, or 5-alpha reductase inhibitors preoperatively. PSAD and biopsy core details, including the percentage of positive cores and the maximum percentage of cancer extent in each positive core, were analyzed in association with unfavorable pathologic results of prostatectomy specimens, and further with biochemical recurrence. The cut-off values of potential predictive factors were set through receiver-operating characteristic curve analyses. In the entire cohort, a higher PSAD, the percentage of positive cores, and maximum percentage of cancer extent in each positive core were independently associated with advanced tumor stage ≥ pT3 and an increased index tumor volume > 0.718 ml. NCCN classification showed an association with a tumor stage ≥ pT3 and a Gleason score ≥8, and the attribution of biochemical recurrence was also sustained. In each NCCN risk group, these preoperative factors showed various associations with unfavorable pathological results. In the intermediate-risk group, the percentage of positive cores showed an independent predictive value for biochemical recurrence. In the high-risk group, PSAD showed an independent predictive value. PSAD and biopsy core details have different performance characteristics for the prediction of oncologic outcomes in each NCCN risk group. Despite the need for further confirmation of the results with a larger cohort and longer observation, these factors are important as preoperative predictors in addition to the NCCN classification for a urologic surgeon to choose a surgical strategy.

Mother-Child Positivity and Negativity: Family-Wide and Child-Specific Main Effects and Interactions Predict Child Adjustment

ERIC Educational Resources Information Center

Oliver, Bonamy R.; Pike, Alison

2018-01-01

Links between positive and negative aspects of the parent-child relationship and child adjustment are undisputed. Scholars recognize the importance of parental differential treatment (PDT) of siblings, yet, less is known about PDT in the context of the shared (family-wide) parent-child relationship climate, or about the extent to which positivity…

Children's Acquisition of Nouns and Verbs in Italian: Contrasting the Roles of Frequency and Positional Salience in Maternal Language

ERIC Educational Resources Information Center

Longobardi, Emiddia; Rossi-Arnaud, Clelia; Spataro, Pietro; Putnick, Diane L.; Bornstein, Marc H.

2015-01-01

Because of its structural characteristics, specifically the prevalence of verb types in infant-directed speech and frequent pronoun-dropping, the Italian language offers an attractive opportunity to investigate the predictive effects of input frequency and positional salience on children's acquisition of nouns and verbs. We examined this…

Estimating the diagnostic accuracy of rheumatoid factor in UK primary care: a study using the Clinical Practice Research Datalink.

PubMed

Miller, Anne; Nightingale, Alison L; Sammon, Cormac J; Mahtani, Kamal R; Holt, Tim A; McHugh, Neil J; Luqmani, Raashid A

2015-10-01

To investigate the diagnostic accuracy of RF as a test for RA in primary care and its impact on referral times using the Clinical Practice Research Datalink. We identified all patients with a first RF test recorded in the Clinical Practice Research Datalink between 1 January 2000 and 31 December 2008 and those diagnosed with RA within 2 years of testing. We calculated likelihood ratios (LRs), sensitivity, specificity and predictive values of RF for a diagnosis of RA. We compared time to hospital referral in those testing positive and negative using Kaplan-Meier failure curves and log-rank tests. Of 62 436 first RF tests, 4679 (7.5%) were positive. There were 1753 incident cases of RA, of which 57.8% were seropositive. The positive LR for RF was 9.5 (95% CI 9.0, 10.0) and the negative LR was 0.5 (95% CI 0.4, 0.5). Sensitivity and specificity were 57.8% (95% CI 55.4%, 60.1%) and 93.9% (95% CI 93.7%, 94.1%) and the positive predictive value and negative predictive value were 21.4% (95% CI 20.3%, 22.6%) and 98.7% (95% CI 98.6%, 98.8%), respectively. Median time to first hospital contact after the first RF test in those with seropositive vs seronegative results was 54 days (95% CI 49, 58) vs 150 (95% CI 147, 152). Only 2.8% of patients undergoing RF testing were diagnosed with RA, suggesting that RF is used to screen patients with musculoskeletal symptoms rather than those with more specific features of RA. A positive RF test may be helpful in diagnosing RA in primary care but performs badly in excluding RA and may delay referral. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Audit of paired anal cytology and histopathology outcomes in patients referred to a public sexual health clinic.

PubMed

Williams, Vincent M; Metcalf, Cecily; French, Martyn A; McCloskey, Jenny C

2010-09-01

The level of agreement between anal cytology and histopathology is not clear with only a few studies evaluating the reliability of anal specimen reporting. Australian data in relation to this are limited. The results of paired anal cytology and histopathology specimens received between 2002 and 2008 from patients who were referred within the sexual health clinic were retrieved from the anatomical pathology database. A total of 248 paired samples from 154 (21 females, 133 males) participants were extracted. Concurrent high risk human papilloma virus (hrHPV) DNA assay and HIV status for the study group were also collected. Data were tabulated according to reported grade of squamous abnormality based on the Bethesda system. Using the biopsy result as the gold standard the specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) for cytology were calculated and the association between grade of abnormality, HIV status and hrHPV infection estimated. Concordance between cytology and histology showed that in 204 (85%) paired samples both tests were categorised as abnormal (Kappa statistic 0.73, P = 0.013). The cytology result showed a sensitivity of 96%, specificity 14%, PPV 89% and NPV 31% when compared with histopathology. HrHPV assay was positive in 192 (80%) samples. High-grade squamous abnormalities were reported in biopsy specimens from 60% (n = 42/67) of HIV-positive subjects and 25% (n = 22/87) of HIV-negative subjects. HIV-positive individuals were more likely to be hrHPV positive, odds ratio (OR) 6.21 [95% confidence interval (CI) 2.69 to 14.34], when compared with HIV-negative subjects. Anal cytology is highly sensitive for the detection of abnormal squamous cells. While cytology has low specificity for predicting the grade of abnormality compared with biopsy outcome, its application as a screening method in asymptomatic at risk populations warrants further study.

Assessing the capacity of social determinants of health data to augment predictive models identifying patients in need of wraparound social services.

PubMed

Kasthurirathne, Suranga N; Vest, Joshua R; Menachemi, Nir; Halverson, Paul K; Grannis, Shaun J

2018-01-01

A growing variety of diverse data sources is emerging to better inform health care delivery and health outcomes. We sought to evaluate the capacity for clinical, socioeconomic, and public health data sources to predict the need for various social service referrals among patients at a safety-net hospital. We integrated patient clinical data and community-level data representing patients' social determinants of health (SDH) obtained from multiple sources to build random forest decision models to predict the need for any, mental health, dietitian, social work, or other SDH service referrals. To assess the impact of SDH on improving performance, we built separate decision models using clinical and SDH determinants and clinical data only. Decision models predicting the need for any, mental health, and dietitian referrals yielded sensitivity, specificity, and accuracy measures ranging between 60% and 75%. Specificity and accuracy scores for social work and other SDH services ranged between 67% and 77%, while sensitivity scores were between 50% and 63%. Area under the receiver operating characteristic curve values for the decision models ranged between 70% and 78%. Models for predicting the need for any services reported positive predictive values between 65% and 73%. Positive predictive values for predicting individual outcomes were below 40%. The need for various social service referrals can be predicted with considerable accuracy using a wide range of readily available clinical and community data that measure socioeconomic and public health conditions. While the use of SDH did not result in significant performance improvements, our approach represents a novel and important application of risk predictive modeling. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Different personal propensities among scientists relate to deeper vs. broader knowledge contributions

PubMed Central

Bateman, Thomas S.; Hess, Andrew M.

2015-01-01

Scientific journal publications, and their contributions to knowledge, can be described by their depth (specialized, domain-specific knowledge extensions) and breadth (topical scope, including spanning multiple knowledge domains). Toward generating hypotheses about how scientists’ personal dispositions would uniquely predict deeper vs. broader contributions to the literature, we assumed that conducting broader studies is generally viewed as less attractive (e.g., riskier) than conducting deeper studies. Study 1 then supported our assumptions: the scientists surveyed considered a hypothetical broader study, compared with an otherwise-comparable deeper study, to be riskier, a less-significant opportunity, and of lower potential importance; they further reported being less likely to pursue it and, in a forced choice, most chose to work on the deeper study. In Study 2, questionnaire measures of medical researchers’ personal dispositions and 10 y of PubMed data indicating their publications’ topical coverage revealed how dispositions differentially predict depth vs. breadth. Competitiveness predicted depth positively, whereas conscientiousness predicted breadth negatively. Performance goal orientation predicted depth but not breadth, and learning goal orientation contrastingly predicted breadth but not depth. Openness to experience positively predicted both depth and breadth. Exploratory work behavior (the converse of applying and exploiting one’s current knowledge) predicted breadth positively and depth negatively. Thus, this research distinguishes depth and breadth of published knowledge contributions, and provides new insights into how scientists’ personal dispositions influence research processes and products. PMID:25733900

Different personal propensities among scientists relate to deeper vs. broader knowledge contributions.

PubMed

Bateman, Thomas S; Hess, Andrew M

2015-03-24

Scientific journal publications, and their contributions to knowledge, can be described by their depth (specialized, domain-specific knowledge extensions) and breadth (topical scope, including spanning multiple knowledge domains). Toward generating hypotheses about how scientists' personal dispositions would uniquely predict deeper vs. broader contributions to the literature, we assumed that conducting broader studies is generally viewed as less attractive (e.g., riskier) than conducting deeper studies. Study 1 then supported our assumptions: the scientists surveyed considered a hypothetical broader study, compared with an otherwise-comparable deeper study, to be riskier, a less-significant opportunity, and of lower potential importance; they further reported being less likely to pursue it and, in a forced choice, most chose to work on the deeper study. In Study 2, questionnaire measures of medical researchers' personal dispositions and 10 y of PubMed data indicating their publications' topical coverage revealed how dispositions differentially predict depth vs. breadth. Competitiveness predicted depth positively, whereas conscientiousness predicted breadth negatively. Performance goal orientation predicted depth but not breadth, and learning goal orientation contrastingly predicted breadth but not depth. Openness to experience positively predicted both depth and breadth. Exploratory work behavior (the converse of applying and exploiting one's current knowledge) predicted breadth positively and depth negatively. Thus, this research distinguishes depth and breadth of published knowledge contributions, and provides new insights into how scientists' personal dispositions influence research processes and products.

Linear array ultrasonography to stage rectal neoplasias suitable for local treatment.

PubMed

Ravizza, Davide; Tamayo, Darina; Fiori, Giancarla; Trovato, Cristina; De Roberto, Giuseppe; de Leone, Annalisa; Crosta, Cristiano

2011-08-01

Because of the many therapeutic options available, a reliable staging is crucial for rectal neoplasia management. Adenomas and cancers limited to the submucosa without lymph node involvement may be treated locally. The aim of this study is to evaluate the diagnostic accuracy of endorectal ultrasonography in the staging of neoplasias suitable for local treatment. We considered all patients who underwent endorectal ultrasonography between 2001 and 2010. The study population consisted of 92 patients with 92 neoplasias (68 adenocarcinomas and 24 adenomas). A 5 and 7.5MHz linear array echoendoscope was used. The postoperative histopathologic result was compared with the preoperative staging defined by endorectal ultrasonography. Adenomas and cancers limited to the submucosa were considered together (pT0-1). The sensitivity, specificity, overall accuracy rate, positive predictive value, and negative predictive value of endorectal ultrasonography for pT0-1 were 86%, 95.6%, 91.3%, 94.9% and 88.7%. Those for nodal involvement were 45.4%, 95.5%, 83%, 76.9% and 84%, with 3 false positive results and 12 false negative. For combined pT0-1 and pN0, endorectal ultrasonography showed an 87.5% sensitivity, 95.9% specificity, 92% overall accuracy rate, 94.9% positive predictive value and 90.2% negative predictive value. Endorectal linear array ultrasonography is a reliable tool to detect rectal neoplasias suitable for local treatment. Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Conjunctivitis and Total IgE in Lacrimal Fluid: Lacrytest Screening

PubMed Central

Monzón, Susana; Arrondo, Elena; Bartra, Joan; Torres, Ferran; Basagaña, María; San Miguel, M. del Mar; Alonso, Rosario; Cisteró-Bahima, Anna

2009-01-01

Total tear IgE has been considered to play an important role in allergic conjunctivitis, and measurement has been considered useful for diagnosis. The aim of this study was to ascertain whether Lacrytest®, a new commercialised method to detect IgE levels in lacrimal fluid, could constitute a screening test for the diagnosis of allergic conjunctivitis. This was a cross-sectional study. Patients with seasonal and perennial allergic conjunctivitis, vernal keratoconjunctivitis and a control group were included. Clinical history, ophthalmic examination, skin prick test and conjunctival provocation test were obtained. Lacrytest® was later performed in all groups. Fifty-four patients were enrolled: thirty with IgE-mediated conjunctivitis and, nine with vernal keratoconjunctivitis and fifteen controls. Lacrytest® was negative in all controls, positive in 20% of the IgE-mediated conjunctivitis group and in 88.9% of the vernal keratoconjunctivitis group. Global statistically-significant differences were found among the three groups (P = .003). Sensitivity of the test in the IgE-mediated conjunctivitis group was 20%, specificity 100%, positive predictive value 100%, and negative predictive value 38.46%, while in VKC sensitivity was 88.88%, specificity 100%, positive predictive value 100%, and negative predictive value 93.75%. Our data confirm that this test is not useful for screening allergic conjunctivitis. Lacrytest®, while not providing any useful information to an allergist, could be helpful for ophthalmologists to confirm an IgE-mediated or VKC conjunctivitis. PMID:20975798

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

PubMed

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

2018-01-11

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

A novel clinical index for the assessment of RVD in acute pulmonary embolism: Blood pressure index.

PubMed

Ates, Hale; Ates, Ihsan; Kundi, Harun; Arikan, Mehmet Fettah; Yilmaz, Fatma Meric

2017-10-01

This study aims to investigate the role of the blood pressure index (BPI), which is a new index that we developed, in detection of right ventricular dysfunction (RVD) in acute pulmonary embolism (APE). A total of 539 patients, (253 males and 286 females), diagnosed with APE using computer tomography pulmonary angiography were included in the study. The BPI was obtained by dividing systolic blood pressure (SBP) by diastolic blood pressure (DBP). Mean DBP (75±11mmHg vs 63±15mmHg; p<0.001, respectively) was found to be higher in RVD patients compared to those without RVD, whereas BPI (1.5±0.1 vs 1.9±0.2; p<0.001, respectively) was lower. Examining the performance of BPI in prediction of RVD using receiver operating characteristic curve analysis (area under curve±SE=0.975±0.006; p<0.001), it was found that BPI could predict RVD with very high sensitivity (92.8%) and specificity (100%) and had a positive predictive value of 100% and a negative predictive value of 42.1%. According to the analysis, the highest youden index for the optimal prediction value was found to be 0.478 and the BPI≤1.4 was found to predict mortality 68.6% sensitivity and 80.8% specificity (Area under curve±SE=0.777±0.051; p<0.001). We found that BPI was an index with high positive predictive value and low negative predictive value in detection of RVD. Copyright © 2017 Elsevier Inc. All rights reserved.

Black Hole Sign: Novel Imaging Marker That Predicts Hematoma Growth in Patients With Intracerebral Hemorrhage.

PubMed

Li, Qi; Zhang, Gang; Xiong, Xin; Wang, Xing-Chen; Yang, Wen-Song; Li, Ke-Wei; Wei, Xiao; Xie, Peng

2016-07-01

Early hematoma growth is a devastating neurological complication after intracerebral hemorrhage. We aim to report and evaluate the usefulness of computed tomography (CT) black hole sign in predicting hematoma growth in patients with intracerebral hemorrhage. Patients with intracerebral hemorrhage were screened for the presence of CT black hole sign on admission head CT performed within 6 hours after onset of symptoms. The black hole sign was defined as hypoattenuatting area encapsulated within the hyperattenuating hematoma with a clearly defined border. The sensitivity, specificity, and positive and negative predictive values of CT black hole sign in predicting hematoma expansion were calculated. Logistic regression analyses were used to assess the presence of the black hole sign and early hematoma growth. A total of 206 patients were enrolled. Black hole sign was found in 30 (14.6%) of 206 patients on the baseline CT scan. The black hole sign was more common in patients with hematoma growth (31.9%) than those without hematoma growth (5.8%; P<0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of back hole sign in predicting early hematoma growth were 31.9%, 94.1%, 73.3%, and 73.2%, respectively. The time-to-admission CT scan, baseline hematoma volume, and the presence of black hole sign on admission CT independently predict hematoma growth in multivariate model. The CT black hole sign could be used as a simple and easy-to-use predictor for early hematoma growth in patients with intracerebral hemorrhage. © 2016 American Heart Association, Inc.

Episode-specific drinking-to-cope motivation, daily mood, and fatigue-related symptoms among college students.

PubMed

Armeli, Stephen; O'Hara, Ross E; Ehrenberg, Ethan; Sullivan, Tami P; Tennen, Howard

2014-09-01

The goal of the present study was to examine whether within-person, episode-specific changes in drinking-to-cope (DTC) motivation from the previous evening were associated with concurrent daily mood and fatigue-related symptoms among college student drinkers (N = 1,421; 54% female). We conducted an Internet-based daily diary study in which students reported over 30 days on their previous night's drinking level and motivation and their current mood (i.e., sadness, anxiety, anger/hostility, and positive mood) and fatigue-related symptoms. Hypotheses were tested using hierarchical linear models in which the current day's outcome was predicted by last night's levels of DTC motivation and drinking, controlling for drinking to enhance motivation, sex, current day's physical symptoms and drinking, and yesterday's level of the outcome. Subsequent models also predicted outcomes 2 days following the drinking event. Relative increases in previous night's DTC motivation were associated with higher levels of current day negative mood and fatigue-related symptoms and lower levels of positive mood. Also, the association between episode-specific DTC motivation and negative mood was stronger in the positive direction when individuals reported higher levels of nonsocial drinking from the previous night. Last, episode-specific DTC showed similar associations with sadness and anger/hostility 2 days after the drinking event. The results are generally consistent with the posited attention allocation and ego-depletion mechanisms. Findings suggest that the deleterious effects of repeated episodes of DTC, over time, could help to explain the increased likelihood of alcohol-related problems seen in prior studies.

Efficiency of the Bethesda System for Thyroid Cytopathology.

PubMed

Mora-Guzmán, Ismael; Muñoz de Nova, José Luis; Marín-Campos, Cristina; Jiménez-Heffernan, José Antonio; Cuesta Pérez, Juan Julián; Lahera Vargas, Marcos; Torres Mínguez, Emma; Martín-Pérez, Elena

2018-03-28

Fine-needle aspiration biopsies are a key tool for preoperative assessment of thyroid nodules, and the Bethesda system is the preferred method to report cytological analysis. The purpose of this study is to assess the efficiency of the Bethesda system to identify the malignancy risk of thyroid nodules. Patients who underwent thyroid surgery between June 2010 and June 2017 were included. Samples were classified into 6categories according to rates of malignancy associated with each diagnostic category. In order to investigate the correlation between categories, a statistical analysis compared the categories with pathology reports. Diagnostic indicators were calculated as a screening test (categories IV, V, VI as true-positive) and as a method to identify malignancy (V, VI as true-positive). In a series of 522 patients, we found 184 (35.2%) malignant tumours, papillary carcinoma being the most prevalent with 155 cases (84.2%). Malignant rates for diagnostic categories were: I, 0%; II, 1.5%; III, 6.4%; IV, 31%; V, 86.5%; VI, 100%. A robust correlation was identified between categories on statistical analysis. For the «screening test» analysis, sensitivity was 98.9%, specificity 84.4%, positive predictive value 69.6%, negative predictive value 99.5%, and diagnostic accuracy 88.2%. Analysing the accuracy to detect malignancy, values were: sensitivity 98.6%, specificity 97.6%, positive predictive value 93.5%, negative predictive value 99.5%, diagnostic accuracy 97.9%. The Bethesda system is a clear and reliable approach to report thyroid cytology and therefore is an effective tool to identify malignancy risk and guide clinical management. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Colonic polyps: application value of computer-aided detection in computed tomographic colonography.

PubMed

Zhang, Hui-Mao; Guo, Wei; Liu, Gui-Feng; An, Dong-Hong; Gao, Shuo-Hui; Sun, Li-Bo; Yang, Hai-Shan

2011-02-01

Colonic polyps are frequently encountered in clinics. Computed tomographic colonography (CTC), as a painless and quick detection, has high values in clinics. In this study, we evaluated the application value of computer-aided detection (CAD) in CTC detection of colonic polyps in the Chinese population. CTC was performed with a GE 64-row multidetector computed tomography (MDCT) scanner. Data of 50 CTC patients (39 patients positive for at least one polyp of ≥ 0.5 cm in size and the other 11 patients negative by endoscopic detection) were retrospectively reviewed first without computer-aided detection (CAD) and then with CAD by four radiologists (two were experienced and another two inexperienced) blinded to colonoscopy findings. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of detected colonic polyps, as well as the areas under the ROC curves (Az value) with and without CAD were calculated. CAD increased the overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the colonic polyps detected by experienced and inexperienced readers. The sensitivity in detecting small polyps (5 - 9 mm) with CAD in experienced and inexperienced readers increased from 82% and 44% to 93% and 82%, respectively (P > 0.05 and P < 0.001). With the use of CAD, the overall false positive rate and false negative rate for the detection of polyps by experienced and inexperienced readers decreased in different degrees. Among 13 sessile polyps not detected by CAD, two were ≥ 1.0 cm, eleven were 5 - 9 mm in diameter, and nine were flat-shaped lesions. The application of CAD in combination with CTC can increase the ability to detect colonic polyps, particularly for inexperienced readers. However, CAD is of limited value for the detection of flat polyps.

Comparison of body mass index, waist circumference, and waist to height ratio in the prediction of hypertension and diabetes mellitus: Filipino-American women cardiovascular study.

PubMed

Battie, Cynthia A; Borja-Hart, Nancy; Ancheta, Irma B; Flores, Rene; Rao, Goutham; Palaniappan, Latha

2016-12-01

The relative ability of three obesity indices to predict hypertension (HTN) and diabetes (DM) and the validity of using Asian-specific thresholds of these indices were examined in Filipino-American women (FAW). Filipino-American women ( n  = 382), 40-65 years of age were screened for hypertension (HTN) and diabetes (DM) in four major US cities. Body mass index (BMI), waist circumference (WC) and waist circumference to height ratio (WHtR) were measured. ROC analyses determined that the three obesity measurements were similar in predicting HTN and DM (AUC: 0.6-0.7). The universal WC threshold of ≥ 35 in. missed 13% of the hypertensive patients and 12% of the diabetic patients. The Asian WC threshold of ≥ 31.5 in. increased detection of HTN and DM but with a high rate of false positives. The traditional BMI ≥ 25 kg/m 2 threshold missed 35% of those with hypertension and 24% of those with diabetes. The Asian BMI threshold improved detection but resulted in a high rate of false positives. The suggested WHtR cut-off of ≥ 0.5 missed only 1% of those with HTN and 0% of those with DM. The three obesity measurements had similar but modest ability to predict HTN and DM in FAW. Using Asian-specific thresholds increased accuracy but with a high rate of false positives. Whether FAW, especially at older ages, should be encouraged to reach these lower thresholds needs further investigation because of the high false positive rates.

Skin prick testing and peanut-specific IgE can predict peanut challenge outcomes in preschoolchildren with peanut sensitization.

PubMed

Johannsen, H; Nolan, R; Pascoe, E M; Cuthbert, P; Noble, V; Corderoy, T; Franzmann, A; Loh, R; Prescott, S L

2011-07-01

The rise in peanut allergy is a source of considerable burden in the community. A growing number of preschoolchildren have been identified as peanut sensitized in the course of investigation of other allergic conditions. Although many have never knowingly ingested peanuts and their clinical reactivity is not known, it has been common practice to place these children on avoidance diets for many years. To determine the utility of skin prick tests (SPT) and fluorescent-enzyme immunoassays (FEIA) for identifying either peanut allergy or tolerance in preschoolchildren with peanut sensitization. Forty-nine preschoolchildren (<5 years of age) with peanut sensitization (SPT ≥ 2 mm or peanut-specific IgE ≥ 0.35 kU/L) but unknown clinical reactivity had graded open peanut challenges reaching a total of 11 g. A positive challenge was defined as an objective IgE-mediated reaction during challenge or the 2-h observation. Forty-nine percent (24/49) of children had positive challenges. An SPT of >7 mm on the day of challenge predicted a positive challenge with a sensitivity of 83% and a negative predictive value (NPV) of 84%. An FEIA of >2.0 kU/L showed a sensitivity of 79% and an NPV of 80%. Predicting challenge outcome from a combination of SPT and FEIA (SPT >7 and/or FEIA >2 is positive) increased sensitivity to 96% and NPV to 95%. At least half of preschoolchildren with peanut sensitization and no antecedent history of peanut ingestion can tolerate peanuts. A SPT<7 mm and FEIA<2 kU/L identify children most likely to tolerate peanut, with only a 5% likelihood of failing an oral challenge. This study assists clinicians considering challenges in very young peanut-sensitized children. © 2011 Blackwell Publishing Ltd.

CT Angiography Spot Sign, Hematoma Expansion, and Outcome in Primary Pontine Intracerebral Hemorrhage.

PubMed

Morotti, Andrea; Jessel, Michael J; Brouwers, H Bart; Falcone, Guido J; Schwab, Kristin; Ayres, Alison M; Vashkevich, Anastasia; Anderson, Christopher D; Viswanathan, Anand; Greenberg, Steven M; Gurol, M Edip; Romero, Javier M; Rosand, Jonathan; Goldstein, Joshua N

2016-08-01

The computed tomography angiography (CTA) spot sign is a validated predictor of hematoma expansion and poor outcome in supratentorial intracerebral hemorrhage (ICH), but patients with brainstem ICH have typically been excluded from the analyses. We investigated the frequency of spot sign and its relationship with hematoma expansion and outcome in patients with primary pontine hemorrhage (PPH). We performed a retrospective analysis of PPH cases obtained from a prospectively collected cohort of consecutive ICH patients who underwent CTA. CTA first-pass readings for spot sign presence were analyzed by two trained readers. Baseline and follow-up hematoma volumes on non-contrast CT scans were assessed by semi-automated computer-assisted volumetric analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratio, and accuracy of spot sign for prediction of in-hospital mortality were calculated. 49 subjects met the inclusion criteria of whom 11 (22.4 %) showed a spot sign. In-hospital mortality was higher in spot sign-positive versus spot sign-negative subjects (90.9 vs 47.4 %, p = 0.020). Spot sign showed excellent specificity (95 %) and PPV (91 %) in predicting in-hospital mortality. Absolute hematoma growth, defined as parenchymal and intraventricular hematoma expansion of any amount, was significantly higher in spot sign-positive versus spot sign-negative subjects (13.72 ± 20.93 vs 3.76 ± 8.55 mL, p = 0.045). As with supratentorial ICH, the CTA spot sign is a common finding and is associated with higher risk of hematoma expansion and mortality in PPH. This marker may assist clinicians in prognostic stratification.

Anti-signal recognition particle autoantibody ELISA validation and clinical associations.

PubMed

Aggarwal, Rohit; Oddis, Chester V; Goudeau, Danielle; Fertig, Noreen; Metes, Ilinca; Stephens, Chad; Qi, Zengbiao; Koontz, Diane; Levesque, Marc C

2015-07-01

The aim of this study was to develop and validate a quantitative anti-signal recognition particle (SRP) autoantibody serum ELISA in patients with myositis and longitudinal association with myositis disease activity. We developed a serum ELISA using recombinant purified full-length human SRP coated on ELISA plates and a secondary antibody that bound human IgG to detect anti-SRP binding. Protein immunoprecipitation was used as the gold standard for the presence of anti-SRP. Serum samples from three groups were analysed: SRP(+) myositis subjects by immunoprecipitation, SRP(-) myositis subjects by immunoprecipitation and non-myositis controls. The ELISA's sensitivity, specificity, positive predictive value and negative predictive value were evaluated. Percentage agreement and test-retest reliability were assessed. Serial samples from seven SRP immunoprecipitation-positive subjects were also tested, along with serum muscle enzymes and manual muscle testing. Using immunoprecipitation, we identified 26 SRP(+) myositis patients and 77 SRP(-) controls (including 38 patients with necrotizing myopathy). Non-myositis control patients included SLE (n = 4) and SSc (n = 7) patients. Anti-SRP positivity by ELISA showed strong agreement (97.1%) with immunoprecipitation (κ = 0.94). The sensitivity, specificity, positive predictive value, and negative predictive value of the anti-SRP ELISA were 88, 100, 100 and 96, respectively. The area under the curve was 0.94, and test-retest reliability was strong (r = 0.91, P < 0.001). Serial samples showed that anti-SRP levels paralleled changes in muscle enzymes and manual muscle testing. We developed a quantitative ELISA for detecting serum anti-SRP autoantibodies and validated the assay in myositis. Longitudinal assessment of SRP levels by ELISA may be a useful biomarker for disease activity. © 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.

The effectiveness of breath carbon monoxide analyzer in screening for environmental tobacco smoke exposure in Saudi pregnant women.

PubMed

Alzeidan, Rasmieh Ayed; Mandil, Ahmed Amin; Fayed, Amel Ahmed; Wahabi, Hayfaa Abdulmajeed

2013-10-01

Exposure to environmental tobacco smoke (ETS) has harmful effects on the pregnancy outcomes similar to those observed in actively smoking pregnant women. The aim of this study was to estimate the sensitivity and specificity of the breath carbon monoxide (BCO) analysis in the assessment of smoking status among Saudi pregnant women, including ETS exposure compared to self-reported tobacco smoke exposure. A cross-sectional design was used during January 2012, 560 pregnant women, irrespective of their gestational age, agreed to undergo BCO testing and completed the data collection sheet for the study. Sensitivity, specificity, positive and negative predictive values were calculated to compare the BCO test with self-reported exposure to ETS. Of the study population 151 (27%) women self-reported ETS exposure during the index pregnancy, 409 (73%) self-reported non-exposure. Sensitivity of the test was 32.5% (95% CI; 25.2-40.3%), the Specificity was much higher at 69.2% (95% CI; 64.4-73.5%), the positive predictive value was 28% (95% CI, 21.9-35.1%), and the negative predictive value was 73.5% (95% CI; 68.9-77.7%). The BCO test is an ineffective tool to detect the level of ETS exposure among Saudi pregnant women.

New directions in diagnostic evaluation of insect allergy.

PubMed

Golden, David B K

2014-08-01

Diagnosis of insect sting allergy and prediction of risk of sting anaphylaxis are often difficult because tests for venom-specific IgE antibodies have a limited positive predictive value and do not reliably predict the severity of sting reactions. Component-resolved diagnosis using recombinant venom allergens has shown promise in improving the specificity of diagnostic testing for insect sting allergy. Basophil activation tests have been explored as more sensitive assays for identification of patients with insect allergy and for prediction of clinical outcomes. Measurement of mast cell mediators reflects the underlying risk for more severe reactions and limited clinical response to treatment. Measurement of IgE to recombinant venom allergens can distinguish cross-sensitization from dual sensitization to honeybee and vespid venoms, thus helping to limit venom immunotherapy to a single venom instead of multiple venoms in many patients. Basophil activation tests can detect venom allergy in patients who show no detectable venom-specific IgE in standard diagnostic tests and can predict increased risk of systemic reactions to venom immunotherapy, and to stings during and after stopping venom immunotherapy. The risk of severe or fatal anaphylaxis to stings can also be predicted by measurement of baseline serum tryptase or other mast cell mediators.

[Comparison of two quantitative methods of endobronchial ultrasound real-time elastography for evaluating intrathoracic lymph nodes].

PubMed

Mao, X W; Yang, J Y; Zheng, X X; Wang, L; Zhu, L; Li, Y; Xiong, H K; Sun, J Y

2017-06-12

Objective: To compare the clinical value of two quantitative methods in analyzing endobronchial ultrasound real-time elastography (EBUS-RTE) images for evaluating intrathoracic lymph nodes. Methods: From January 2014 to April 2014, EBUS-RTE examination was performed in patients who received EBUS-TBNA examination in Shanghai Chest Hospital. Each intrathoracic lymph node had a selected EBUS-RTE image. Stiff area ratio and mean hue value of region of interest (ROI) in each image were calculated respectively. The final diagnosis of lymph node was based on the pathologic/microbiologic results of EBUS-TBNA, pathologic/microbiologic results of other examinations and clinical following-up. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were evaluated for distinguishing malignant and benign lesions. Results: Fifty-six patients and 68 lymph nodes were enrolled in this study, of which 35 lymph nodes were malignant and 33 lymph nodes were benign. The stiff area ratio and mean hue value of benign and malignant lesions were 0.32±0.29, 0.62±0.20 and 109.99±28.13, 141.62±17.52, respectively, and statistical differences were found in both of those two methods ( t =-5.14, P <0.01; t =-5.53, P <0.01). The area under curves was 0.813, 0.814 in stiff area ratio and mean hue value, respectively. The optimal diagnostic cut-off value of stiff area ratio was 0.48, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 82.86%, 81.82%, 82.86%, 81.82% and 82.35%, respectively. The optimal diagnostic cut-off value of mean hue value was 126.28, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 85.71%, 75.76%, 78.95%, 83.33% and 80.88%, respectively. Conclusion: Both the stiff area ratio and mean hue value methods can be used for analyzing EBUS-RTE images quantitatively, having the value of differentiating benign and malignant intrathoracic lymph nodes, and the stiff area ratio is better than the mean hue value between the two methods.

Predictive Capability of an iPad-Based Medical Device (medx) for the Diagnosis of Vertigo and Dizziness.

PubMed

Feil, Katharina; Feuerecker, Regina; Goldschagg, Nicolina; Strobl, Ralf; Brandt, Thomas; von Müller, Albrecht; Grill, Eva; Strupp, Michael

2018-01-01

Making the correct diagnosis of patients presenting with vertigo and dizziness in clinical practice is often challenging. In this study we examined the performance of the iPad based program me d x in the prediction of different clinical vertigo and dizziness diagnoses and as a diagnostic tool to distinguish between them. The data collection was done in the outpatient clinic of the German Center of Vertigo and Balance Disorders. The "gold standard diagnosis" was defined as the clinical diagnosis of the specialist during the visit of the patient based on standardized history and clinical examination. Another independent and blinded physician finalized each patient's case in the constellatory diagnostic system of me d x based on an algorithm using all available clinical information. These diagnoses were compared to the "gold standard" by retrospective review of the charts of the patients. The accuracy provided by me d x was defined as the number of correctly classified diagnoses. In addition, the probability of being test positive when a disease was present (sensitivity), of being test negative when a disease was absent (specificity), of having the disease when the test is positive (positive predictive value) and of not having the disease when the test is negative (negative predictive value) for the most common diagnoses were reported. Sixteen possible different vertigo and dizziness diagnoses could be provided by me d x. A total of 610 patients (mean age 58.1 ± 16.3 years, 51.2% female) were included. The accuracy for the most common diagnoses was between 82.1 and 96.6% with a sensitivity of 40 to 80.5% and a specificity of more than 80%. When analyzing the quality of me d x in a multiclass problem for the six most common clinical diagnoses, the sensitivity, specificity, positive and negative predictive values were as follows: Bilateral vestibulopathy (81.6, 97.1, 71.1, and 97.5%), Menière's disease (77.8, 97.6, 87.0, and 95.3%), benign paroxysmal positional vertigo (61.7, 98.3, 86.6, and 93.4%), downbeat nystagmus syndrome (69.6, 97.7, 71.1, and 97.5%), vestibular migraine (34.7, 97.8, 76.1, and 88.3%), and phobic postural vertigo (80.5, 82.5, 52.5, and 94.6%). This study demonstrates that me d x is a new and easy approach to screen for different diagnoses. With the high specificity and negative predictive value, the system helps to rule out differential diagnoses and can therefore also lead to a cost reduction in the health care system. However, the sensitivity was unexpectedly low, especially for vestibular migraine. All in all, this device can only be a complementary tool, in particular for non-experts in the field.

[Waist-to-height ratio is an indicator of metabolic risk in children].

PubMed

Valle-Leal, Jaime; Abundis-Castro, Leticia; Hernández-Escareño, Juan; Flores-Rubio, Salvador

2016-01-01

Abdominal fat, particularly visceral, is associated with a high risk of metabolic complications. The waist-height ratio (WHtR) is used to assess abdominal fat in individuals of all ages. To determine the ability of the waist-to-height ratio to detect metabolic risk in mexican schoolchildren. A study was conducted on children between 6 and 12 years. Obesity was diagnosed as a body mass index (BMI) ≥ 85th percentile, and an ICE ≥0.5 was considered abdominal obesity. Blood levels of glucose, cholesterol and triglycerides were measured. The sensitivity, specificity, positive predictive and negative value, area under curve, the positive likelihood ratio and negative likelihood ratio of the WHtR and BMI were calculated in order to identify metabolic alterations. WHtR and BMI were compared to determine which had the best diagnostic efficiency. Of the 223 children included in the study, 51 had hypertriglyceridaemia, 27 with hypercholesterolaemia, and 9 with hyperglycaemia. On comparing the diagnostic efficiency of WHtR with that of BMI, there was a sensitivity of 100% vs. 56% for hyperglycaemia, 93 vs. 70% for cholesterol, and 76 vs. 59% for hypertriglyceridaemia. The specificity, negative predictive value, positive predictive value, positive likelihood ratio, negative likelihood ratio, and area under curve were also higher for WHtR. The WHtR is a more efficient indicator than BMI in identifying metabolic risk in mexican school-age. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Clinical usefulness of temporal artery biopsy.

PubMed Central

Vilaseca, J; González, A; Cid, M C; Lopez-Vivancos, J; Ortega, A

1987-01-01

To assess the diagnostic usefulness of temporal artery biopsy in temporal arteritis (TA) and establish clinical features capable of predicting its positivity we have retrospectively studied the biopsy specimens and the clinical features of 103 patients who had undergone temporal artery biopsy. Temporal artery biopsy reached a positive predictive value of 90.2% with respect to the final diagnosis based on the criteria proposed by Ellis and Ralston and the clinical course. The simultaneous presence of recent onset headache, jaw claudication, and abnormalities of the temporal arteries on physical examination had a specificity of 94.8% with respect to the histological diagnosis and of 100% with respect to final diagnosis. The presence of any of these clinical features, though of little specificity (34.4%), had a sensitivity of 100% with respect to histological diagnosis, selecting a group of patients in whom temporal artery biopsy has more discriminative value. PMID:3592783

Predicting pneumococcal community-acquired pneumonia in the emergency department: evaluation of clinical parameters.

PubMed

Huijts, S M; Boersma, W G; Grobbee, D E; Gruber, W C; Jansen, K U; Kluytmans, J A J W; Kuipers, B A F; Palmen, F; Pride, M W; Webber, C; Bonten, M J M

2014-12-01

The aim of this study was to quantify the value of clinical predictors available in the emergency department (ED) in predicting Streptococcus pneumoniae as the cause of community-acquired pneumonia (CAP). A prospective, observational, cohort study of patients with CAP presenting in the ED was performed. Pneumococcal aetiology of CAP was based on either bacteraemia, or S. pneumoniae being cultured from sputum, or urinary immunochromatographic assay positivity, or positivity of a novel serotype-specific urinary antigen detection test. Multivariate logistic regression was used to identify independent predictors and various cut-off values of probability scores were used to evaluate the usefulness of the model. Three hundred and twenty-eight (31.0%) of 1057 patients with CAP had pneumococcal CAP. Nine independent predictors for pneumococcal pneumonia were identified, but the clinical utility of this prediction model was disappointing, because of low positive predictive values or a small yield. Clinical criteria have insufficient diagnostic capacity to predict pneumococcal CAP. Rapid antigen detection tests are needed to diagnose S. pneumoniae at the time of hospital admission. © 2014 The Authors Clinical Microbiology and Infection © 2014 European Society of Clinical Microbiology and Infectious Diseases.

The balanced ideological antipathy model: explaining the effects of ideological attitudes on inter-group antipathy across the political spectrum.

PubMed

Crawford, Jarret T; Mallinas, Stephanie R; Furman, Bryan J

2015-12-01

We introduce the balanced ideological antipathy (BIA) model, which challenges assumptions that right-wing authoritarianism (RWA) and social dominance orientation (SDO) predict inter-group antipathy per se. Rather, the effects of RWA and SDO on antipathy should depend on the target's political orientation and political objectives, the specific components of RWA, and the type of antipathy expressed. Consistent with the model, two studies (N = 585) showed that the Traditionalism component of RWA positively and negatively predicted both political intolerance and prejudice toward tradition-threatening and -reaffirming groups, respectively, whereas SDO positively and negatively predicted prejudice (and to some extent political intolerance) toward hierarchy-attenuating and -enhancing groups, respectively. Critically, the Conservatism component of RWA positively predicted political intolerance (but not prejudice) toward each type of target group, suggesting it captures the anti-democratic impulse at the heart of authoritarianism. Recommendations for future research on the relationship between ideological attitudes and inter-group antipathy are discussed. © 2015 by the Society for Personality and Social Psychology, Inc.

HbA1c as a predictor of diabetes after gestational diabetes mellitus.

PubMed

Claesson, Rickard; Ignell, Claes; Shaat, Nael; Berntorp, Kerstin

2017-02-01

We wanted to investigate third-trimester HbA1c as a predictor of diabetes after gestational diabetes mellitus (GDM). Women with GDM were followed up prospectively for five years from pregnancy to detect the development of diabetes. The ability of HbA1c to predict diabetes was evaluated with receiver-operating characteristic (ROC) curves and logistic regression analysis. By five years, 73 of 196 women had been diagnosed with diabetes. An optimal cut-off point for HbA1c of 36mmol/mol (5.4%) could predict diabetes with 45% sensitivity and 92% specificity. For HbA1c ≥39mmol/mol (≥5.7%), sensitivity, specificity, and positive predictive value were 30%, 97%, and 91%, respectively. In logistic regression analysis, adjusting for the diagnostic glucose concentration during pregnancy, HbA1c levels in the upper quartile (≥36mmol/mol) were associated with a 5.5-fold increased risk of diabetes. Third-trimester HbA1c levels in the pre-diabetes range revealed women with post-partum diabetes with high specificity and high positive predictive value. HbA1c testing could be used as a strategy to select high-risk women for lifestyle interventions aimed at prevention of diabetes starting during pregnancy. The results should encourage further validation in other populations using new diagnostic criteria for GDM. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Using genome-wide measurements for computational prediction of SH2–peptide interactions

PubMed Central

Wunderlich, Zeba; Mirny, Leonid A.

2009-01-01

Peptide-recognition modules (PRMs) are used throughout biology to mediate protein–protein interactions, and many PRMs are members of large protein domain families. Recent genome-wide measurements describe networks of peptide–PRM interactions. In these networks, very similar PRMs recognize distinct sets of peptides, raising the question of how peptide-recognition specificity is achieved using similar protein domains. The analysis of individual protein complex structures often gives answers that are not easily applicable to other members of the same PRM family. Bioinformatics-based approaches, one the other hand, may be difficult to interpret physically. Here we integrate structural information with a large, quantitative data set of SH2 domain–peptide interactions to study the physical origin of domain–peptide specificity. We develop an energy model, inspired by protein folding, based on interactions between the amino-acid positions in the domain and peptide. We use this model to successfully predict which SH2 domains and peptides interact and uncover the positions in each that are important for specificity. The energy model is general enough that it can be applied to other members of the SH2 family or to new peptides, and the cross-validation results suggest that these energy calculations will be useful for predicting binding interactions. It can also be adapted to study other PRM families, predict optimal peptides for a given SH2 domain, or study other biological interactions, e.g. protein–DNA interactions. PMID:19502496

Impact of axillary ultrasound and core needle biopsy on the utility of intraoperative frozen section analysis and treatment decision making in women with invasive breast cancer.

PubMed

Caretta-Weyer, Holly; Sisney, Gale A; Beckman, Catherine; Burnside, Elizabeth S; Salkowsi, Lonie R; Strigel, Roberta M; Wilke, Lee G; Neuman, Heather B

2012-09-01

Our objective was to evaluate the impact of preoperative axillary ultrasound and core needle biopsy (CNB) on breast cancer treatment decision making. A secondary aim was to evaluate the impact on the utility of intraoperative sentinel lymph node (SLN) frozen section. A review of 84 patients with clinically negative axilla who underwent axillary ultrasound was performed. Sensitivity, specificity, and positive/negative predictive value for axillary ultrasound with CNB was calculated. Thirty-one (37%) had suspicious nodes. Of 27 amenable to CNB, 12 (14%) were malignant, changing treatment plans. The sensitivity of ultrasound and CNB was 54% and specificity 100%; the positive and negative predictive values were 100% and 80%, respectively. In 41 patients with normal ultrasounds who underwent SLN frozen section, 10 (24%) were positive. Preoperative axillary ultrasound impacts treatment decision making in 14%. With a sensitivity of 54%, it is a useful adjunct to, but not replacement for, SLN biopsy. Frozen section remains of utility even after a negative axillary ultrasound. Copyright © 2012 Elsevier Inc. All rights reserved.

SVM-Based System for Prediction of Epileptic Seizures from iEEG Signal

PubMed Central

Cherkassky, Vladimir; Lee, Jieun; Veber, Brandon; Patterson, Edward E.; Brinkmann, Benjamin H.; Worrell, Gregory A.

2017-01-01

Objective This paper describes a data-analytic modeling approach for prediction of epileptic seizures from intracranial electroencephalogram (iEEG) recording of brain activity. Even though it is widely accepted that statistical characteristics of iEEG signal change prior to seizures, robust seizure prediction remains a challenging problem due to subject-specific nature of data-analytic modeling. Methods Our work emphasizes understanding of clinical considerations important for iEEG-based seizure prediction, and proper translation of these clinical considerations into data-analytic modeling assumptions. Several design choices during pre-processing and post-processing are considered and investigated for their effect on seizure prediction accuracy. Results Our empirical results show that the proposed SVM-based seizure prediction system can achieve robust prediction of preictal and interictal iEEG segments from dogs with epilepsy. The sensitivity is about 90–100%, and the false-positive rate is about 0–0.3 times per day. The results also suggest good prediction is subject-specific (dog or human), in agreement with earlier studies. Conclusion Good prediction performance is possible only if the training data contain sufficiently many seizure episodes, i.e., at least 5–7 seizures. Significance The proposed system uses subject-specific modeling and unbalanced training data. This system also utilizes three different time scales during training and testing stages. PMID:27362758

Comparative evaluation of GPR versus APRI and FIB-4 in predicting different levels of liver fibrosis of chronic hepatitis B.

PubMed

Liu, D-P; Lu, W; Zhang, Z-Q; Wang, Y-B; Ding, R-R; Zhou, X-L; Huang, D; Li, X-F

2018-05-01

It is of great significance to develop and evaluate noninvasive indexes predicting the level of liver fibrosis. The aim of this study was to comparatively evaluate gamma-glutamyl transpeptidase-to-platelet ratio (GPR) versus aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on 4 factors (FIB-4) in predicting different levels of liver fibrosis of chronic hepatitis B (CHB) within the framework of HBeAg-positive and HBeAg-negative patients. A total of 1157 HBeAg-positive and 859 HBeAg-negative CHB patients were enrolled, among whom the pathological stage ≥S2, ≥S3, ≥S4 were defined as significant fibrosis, extensive fibrosis and cirrhosis, respectively. Receiver operating characteristic (ROC) curves were used to evaluate the performance of GPR, APRI and FIB-4 in predicting different levels of liver fibrosis. In HBeAg-positive patients, the area under ROC curves (AUROCs) of GPR in predicting extensive fibrosis and cirrhosis were both significantly larger than those of APRI (P = .0001 and P < .0001). In HBeAg-negative patients, the AUROCs of GPR in predicting significant fibrosis and cirrhosis were significantly larger than those of FIB-4 (P = .0006 and P = .0041). The AUROC of GPR in predicting extensive fibrosis was significantly larger than that of APRI and FIB-4 (P = .0320 and P = .0018). Using a cut-off of GPR > 0.500 as standard, the sensitivities and specificities of GPR in predicting significant fibrosis in HBeAg-positive patients were 59.6% and 81.2%, and for cirrhosis 80.9% and 63.8%, respectively; and those of HBeAg-negative patients were 60.3% and 78.3%, 84.5% and 66.1%, respectively. Regardless of HBeAg-positive or HBeAg-negative status, GPR had the best performance in predicting different levels of liver fibrosis. © 2017 John Wiley & Sons Ltd.

Flow Test to Predict Early Hypotony and Hypertensive Phase After Ahmed Glaucoma Valve (AGV) Surgical Implantation.

PubMed

Cheng, Jason; Beltran-Agullo, Laura; Buys, Yvonne M; Moss, Edward B; Gonzalez, Johanna; Trope, Graham E

2016-06-01

To assess the validity of a preimplantation flow test to predict early hypotony [intraocular pressure (IOP)≤5 mm Hg on 2 consecutive visits and hypertensive phase (HP) (IOP>21 mm Hg) after Ahmed Glaucoma Valve (AGV) implantation. Prospective interventional study on patients receiving an AGV. A preimplantation flow test using a gravity-driven reservoir and an open manometer was performed on all AGVs. Opening pressure (OP) and closing pressure (CP) were defined as the pressure at which fluid was seen to flow or stop flowing through the AGV, respectively. OP and CP were measured twice per AGV. Patients were followed for 12 weeks. In total, 20 eyes from 19 patients were enrolled. At 12 weeks the mean IOP decreased from 29.2±9.1 to 16.8±5.2 mm Hg (P<0.01). The mean AGV OP was 17.5±5.4 mm Hg and the mean CP was 6.7±2.3 mm Hg. Early (within 2 wk postoperative) HP occurred in 37% and hypotony in 16% of cases. An 18 mm Hg cutoff for the OP gave a sensitivity of 0.71, specificity of 0.83, positive predictive value of 0.71, and negative predictive value of 0.83 for predicting an early HP. A 7 mm Hg cutoff for the CP yielded a sensitivity of 1.0, specificity of 0.38, positive predictive value of 0.23, and negative predictive value of 1.0 for predicting hypotony. Preoperative OP and CP may predict early hypotony or HP and may be used as a guide as to which AGV valves to discard before implantation surgery.

Direct detection of the multidrug resistance genome of Haemophilus influenzae in cerebrospinal fluid of children: implications for treatment of meningitis.

PubMed

Saha, Samir K; Darmstadt, Gary L; Baqui, Abdullah H; Islam, Nurul; Qazi, Shamim; Islam, Maksuda; El Arifeen, Shams; Santosham, Mathuram; Black, Robert E; Crook, Derrick W

2008-01-01

Multidrug resistance (MDR), specifically to ampicillin and chloramphenicol, has complicated the treatment of Haemophilus influenzae type b (Hib) meningitis. This is worsened by use of prior antibiotics, which limits identification of the causative agent by culture and increases reliance on antigen detection. We aimed to develop a PCR assay for detecting the family of Haemophilus integrating and conjugative elements (ICEs) represented by ICEHin1056 among antibiotic resistant Hib, and then apply this directly to CSF to diagnose Hib meningitis and predict organism susceptibility, irrespective of culture results. Primers specific for orf 51 of ICEHin1056 were designed and multiplexed with Bex primers, specific for H. influenzae, and tested on culture positive and negative cases. Of 73 Hib isolates, orf 51 PCR amplicons, predicting the presence of ICEs, were found in all 33 MDR isolates while only in 1 of 33 sensitive strains. The remaining 7 ampicillin susceptible, chloramphenicol and tetracycline resistant strains did not produce a PCR product to orf 51. PCR amplification from CSF specimens of these culture positive cases produced identical results with 100% and 97% positive and negative predictive values, respectively. Multiplex PCR to detect Bex and orf 51 identified another 16 MDR Hib cases among 81 culture-negative CSF samples. Direct PCR for orf 51 in CSF identified resistance pattern of 51% more Hib strains than culture alone (110 versus 73). The ability to detect MDR, in culture negative Hib meningitis cases has significant implications for better directing antibiotic treatment of meningitis cases and thus for preventing disability and death.

[Usefulness of ¹⁸F-fluoro-2-deoxyglucose positron emission tomography in evaluation of gastric cancer stage].

PubMed

Yoon, Na Ri; Park, Jae Myung; Jung, Hee Sun; Cho, Yu Kyung; Lee, In Seok; Choi, Myung Gyu; Chung, In Sik; Song, Kyo Young; Park, Cho Hyun

2012-05-01

The usefulness of ¹⁸F-fluoro-2-deoxyglucose (FDG)-PET in detecting primary cancer, lymph node metastasis, and distant metastasis were studied in the gastric cancer patients. The subjects were 392 gastric cancer patients who received FDG-PET and an abdominal CT test prior to surgery. The results of FDG-PET and CT were compared with the surgical and pathologic results. The primary site detection rate of FDG-PET was 74.4%, 50.3% in early gastric cancer and 92.0% in advanced gastric cancer. Detection rate was higher when tumors were larger than 3.5 cm, had deeper depth of invasion, and at a later stage (p<0.05, respectively). In multivariate analysis, tumor size, spread of tumor cells beyond the muscle layer (≥T2), and lymph node metastasis were statistically significant factors in primary site detection rate. The sensitivity, specificity, and positive predictive value of FDG-PET to lymph node metastasis were 59.6%, 88.8%, and 81.1% respectively, sensitivity being lower compared to CT while specificity and positive predictive value were higher. Sensitivity, specificity, and positive predictive value to distant metastasis were, respectively, 66.7%, 99.2%, and 88.0%, similar to CT. In 21 of the 392 patients (5.4%), synchronous double primary cancers were detected. In gastric cancer, usefullness of FDG-PET is limited to the advanced stage. Diagnostic value of this test was not superior to CT. However, FDG-PET may be useful in detecting synchronous double primary cancers.

Diagnostic Accuracy of the Berlin Questionnaire in Detecting Sleep-Disordered Breathing in Patients With a Recent Myocardial Infarction

PubMed Central

Sert Kuniyoshi, Fatima H.; Zellmer, Mark R.; Calvin, Andrew D.; Lopez-Jimenez, Francisco; Albuquerque, Felipe N.; van der Walt, Christelle; Trombetta, Ivani C; Caples, Sean M.; Shamsuzzaman, Abu S.; Bukartyk, Jan; Konecny, Tomas; Gami, Apoor S.; Kara, Tomas

2011-01-01

Background: The Berlin Questionnaire (BQ) has been used to identify patients at high risk for sleep-disordered breathing (SDB) in a variety of populations. However, there are no data regarding the validity of the BQ in detecting the presence of SDB in patients after myocardial infarction (MI). The aim of this study was to determine the performance of the BQ in patients after MI. Methods: We conducted a cross-sectional study of 99 patients who had an MI 1 to 3 months previously. The BQ was administered, scored using the published methods, and followed by completed overnight polysomnography as the “gold standard.” SDB was defined as an apnea-hypopnea index of ≥ 5 events/h. The sensitivity, specificity, and positive and negative predictive values of the BQ were calculated. Results: Of the 99 patients, the BQ identified 64 (65%) as being at high-risk for having SDB. Overnight polysomnography showed that 73 (73%) had SDB. The BQ sensitivity and specificity was 0.68 and 0.34, respectively, with a positive predictive value of 0.68 and a negative predictive value of 0.50. Positive and negative likelihood ratios were 1.27 and 0.68, respectively, and the BQ overall diagnostic accuracy was 63%. Using different apnea-hypopnea index cutoff values did not meaningfully alter these results. Conclusion: The BQ performed with modest sensitivity, but the specificity was poor, suggesting that the BQ is not ideal in identifying SDB in patients with a recent MI. PMID:21596794

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.

Self-management and quality of life in chronic obstructive pulmonary disease (COPD): The mediating effects of positive affect.

PubMed

Benzo, Roberto P; Abascal-Bolado, Beatriz; Dulohery, Megan M

2016-04-01

This study aimed to increase our understanding of general self-management (SM) abilities in COPD by determining if SM can predict disease specific quality of life (QoL), by investigating whether specific SM domains are significant in COPD and by exploring the mediating effect of the positive/negative affect in the association between SM and QoL. Cross-sectional study based on 292 patients with COPD. Measures included demographics, lung function, gait speed, health care utilization, positive/negative affect, SM abilities, breathlessness and disease specific QoL. We performed, correlation, multiple regression models and mediation analysis (positive/negative affect being mediator between SM and QoL association). After controlling for breathlessness, living alone, marital status, hospitalization history, age and lung function, SM related to QoL (p<0.0001). Investment in behaviors (hobbies and social relationships) and self-efficacy are SM domains independently related to QoL in COPD. Positivity measured by the positive/negative affect ratio completely mediates the relationship of SM with QoL. SM is independently associated with disease specific QoL in COPD after adjustment significant covariates but positive/negative affect ratio completely mediates the relationship of SM with QoL. Measuring positive/negative affect and addressing investment behavior and self-efficacy are important in implementing COPD-SM programs. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Prostate Cancer Predictive Simulation Modelling, Assessing the Risk Technique (PCP-SMART): Introduction and Initial Clinical Efficacy Evaluation Data Presentation of a Simple Novel Mathematical Simulation Modelling Method, Devised to Predict the Outcome of Prostate Biopsy on an Individual Basis.

PubMed

Spyropoulos, Evangelos; Kotsiris, Dimitrios; Spyropoulos, Katherine; Panagopoulos, Aggelos; Galanakis, Ioannis; Mavrikos, Stamatios

2017-02-01

We developed a mathematical "prostate cancer (PCa) conditions simulating" predictive model (PCP-SMART), from which we derived a novel PCa predictor (prostate cancer risk determinator [PCRD] index) and a PCa risk equation. We used these to estimate the probability of finding PCa on prostate biopsy, on an individual basis. A total of 371 men who had undergone transrectal ultrasound-guided prostate biopsy were enrolled in the present study. Given that PCa risk relates to the total prostate-specific antigen (tPSA) level, age, prostate volume, free PSA (fPSA), fPSA/tPSA ratio, and PSA density and that tPSA ≥ 50 ng/mL has a 98.5% positive predictive value for a PCa diagnosis, we hypothesized that correlating 2 variables composed of 3 ratios (1, tPSA/age; 2, tPSA/prostate volume; and 3, fPSA/tPSA; 1 variable including the patient's tPSA and the other, a tPSA value of 50 ng/mL) could operate as a PCa conditions imitating/simulating model. Linear regression analysis was used to derive the coefficient of determination (R 2 ), termed the PCRD index. To estimate the PCRD index's predictive validity, we used the χ 2 test, multiple logistic regression analysis with PCa risk equation formation, calculation of test performance characteristics, and area under the receiver operating characteristic curve analysis using SPSS, version 22 (P < .05). The biopsy findings were positive for PCa in 167 patients (45.1%) and negative in 164 (44.2%). The PCRD index was positively signed in 89.82% positive PCa cases and negative in 91.46% negative PCa cases (χ 2 test; P < .001; relative risk, 8.98). The sensitivity was 89.8%, specificity was 91.5%, positive predictive value was 91.5%, negative predictive value was 89.8%, positive likelihood ratio was 10.5, negative likelihood ratio was 0.11, and accuracy was 90.6%. Multiple logistic regression revealed the PCRD index as an independent PCa predictor, and the formulated risk equation was 91% accurate in predicting the probability of finding PCa. On the receiver operating characteristic analysis, the PCRD index (area under the curve, 0.926) significantly (P < .001) outperformed other, established PCa predictors. The PCRD index effectively predicted the prostate biopsy outcome, correctly identifying 9 of 10 men who were eventually diagnosed with PCa and correctly ruling out PCa for 9 of 10 men who did not have PCa. Its predictive power significantly outperformed established PCa predictors, and the formulated risk equation accurately calculated the probability of finding cancer on biopsy, on an individual patient basis. Copyright © 2016 Elsevier Inc. All rights reserved.

[Sensitivity and specificity of the breast screening program in the Isere region based on positive results between 1991 and 1999].

PubMed

Garnier, A; Poncet, F; Billette De Villemeur, A; Exbrayat, C; Bon, M F; Chevalier, A; Salicru, B; Tournegros, J M

2009-06-01

The screening program guidelines specify that the call back rate of women for additional imaging (positive mammogram) should not exceed 7% at initial screening, and 5% at subsequent screening. Materials and methods. Results in the Isere region (12%) have prompted a review of the correlation between the call back rate and indicators of quality (detection rate, sensitivity, specificity, positive predictive value) for the radiologists providing interpretations during that time period. Three groups of radiologists were identified: the group with call back rate of 10% achieved the best results (sensitivity: 92%, detection rate: 0.53%, specificity: 90%). The group with lowest call back rate (7.7%) showed insufficient sensitivity (58%). The last group with call back rate of 18.3%, showed no improvement in sensitivity (82%) and detection rate (0.53%), but showed reduced specificity (82%). The protocol update in 2001 does not resolve this problematic situation and national results continue to demonstrate a high percentage of positive screening mammograms. A significant increase in the number of positive screening examinations compared to recommended guidelines is not advantageous and leads to an overall decrease in the quality of the screening.

Development and internal validation of a side-specific, multiparametric magnetic resonance imaging-based nomogram for the prediction of extracapsular extension of prostate cancer.

PubMed

Martini, Alberto; Gupta, Akriti; Lewis, Sara C; Cumarasamy, Shivaram; Haines, Kenneth G; Briganti, Alberto; Montorsi, Francesco; Tewari, Ashutosh K

2018-04-19

To develop a nomogram for predicting side-specific extracapsular extension (ECE) for planning nerve-sparing radical prostatectomy. We retrospectively analysed data from 561 patients who underwent robot-assisted radical prostatectomy between February 2014 and October 2015. To develop a side-specific predictive model, we considered the prostatic lobes separately. Four variables were included: prostate-specific antigen; highest ipsilateral biopsy Gleason grade; highest ipsilateral percentage core involvement; and ECE on multiparametric magnetic resonance imaging (mpMRI). A multivariable logistic regression analysis was fitted to predict side-specific ECE. A nomogram was built based on the coefficients of the logit function. Internal validation was performed using 'leave-one-out' cross-validation. Calibration was graphically investigated. The decision curve analysis was used to evaluate the net clinical benefit. The study population consisted of 829 side-specific cases, after excluding negative biopsy observations (n = 293). ECE was reported on mpMRI and final pathology in 115 (14%) and 142 (17.1%) cases, respectively. Among these, mpMRI was able to predict ECE correctly in 57 (40.1%) cases. All variables in the model except highest percentage core involvement were predictors of ECE (all P ≤ 0.006). All variables were considered for inclusion in the nomogram. After internal validation, the area under the curve was 82.11%. The model demonstrated excellent calibration and improved clinical risk prediction, especially when compared with relying on mpMRI prediction of ECE alone. When retrospectively applying the nomogram-derived probability, using a 20% threshold for performing nerve-sparing, nine out of 14 positive surgical margins (PSMs) at the site of ECE resulted above the threshold. We developed an easy-to-use model for the prediction of side-specific ECE, and hope it serves as a tool for planning nerve-sparing radical prostatectomy and in the reduction of PSM in future series. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

Organ-specific antibodies in LADA patients for the prediction of insulin dependence.

PubMed

Delitala, Alessandro P; Pes, Giovanni M; Fanciulli, Giuseppe; Maioli, Margherita; Secchi, Giannina; Sanciu, Franca; Delitala, Giuseppe; Manetti, Roberto

2016-08-01

The aim of the present study was to define the frequency of organ-specific and non-organ-specific autoantibodies in a cohort of Latent Autoimmune Diabetes in Adults (LADA) patients and to test whether multiple antibodies positivity could be a predictor of early insulin dependence. We enrolled 210 LADA and 210 type 2 diabetes mellitus (T2D) patients. In all subjects anti-islet antigen-2 (IA-2Ab), anti-thyroperoxidase (TPOAb), anti-zinc transporter 8 (ZnT8Ab), anti-nuclear (ANA), anti-parietal cell (APCA), anti-smooth muscle (ASMA), anti-mitochondrial (AMA), anti-liver kidney microsomes (LKM), and anti-reticulin (ARA) circulating antibodies were assessed. The frequency of TPOAb, ZnT8Ab, APCA, and IA-2Ab positivity was, respectively, detected in 40.0%, 32.4%, 24.7%, and 9.5% of LADA patients, whereas their frequency was significantly lower in T2D patients (11.4%, 1.9%, 9.5%, and 0.0%, respectively, p < 0.001). The frequency of ANA was the same in both groups whereas the frequency of ASMA, ARA, AMA, and LKM was very low (range 0.0-3.3%). The presence of TPOAb associated with ZnT8Ab, IA-2Ab, or APCA allows one to predict the progression of disease with a high specificity but low sensibility. LADA patients show an increased frequency of organ- and non-organ-specific antibodies. Consequently, a screening is worthwhile in these patients. The simultaneous presence of TPOAb with ZnT8, IA-2Ab, or APCA may help differentiate clinical phenotypes and predict faster insulin dependence in LADA patients.

Validation of a dye stain assay for vaginally inserted HEC-filled microbicide applicators

PubMed Central

Katzen, Lauren L.; Fernández-Romero, José A.; Sarna, Avina; Murugavel, Kailapuri G.; Gawarecki, Daniel; Zydowsky, Thomas M.; Mensch, Barbara S.

2011-01-01

Background The reliability and validity of self-reports of vaginal microbicide use are questionable given the explicit understanding that participants are expected to comply with study protocols. Our objective was to optimize the Population Council's previously validated dye stain assay (DSA) and related procedures, and establish predictive values for the DSA's ability to identify vaginally inserted single-use, low-density polyethylene microbicide applicators filled with hydroxyethylcellulose gel. Methods Applicators, inserted by 252 female sex workers enrolled in a microbicide feasibility study in Southern India, served as positive controls for optimization and validation experiments. Prior to validation, optimal dye concentration and staining time were ascertained. Three validation experiments were conducted to determine sensitivity, specificity, negative predictive values and positive predictive values. Results The dye concentration of 0.05% (w/v) FD&C Blue No. 1 Granular Food Dye and staining time of five seconds were determined to be optimal and were used for the three validation experiments. There were a total of 1,848 possible applicator readings across validation experiments; 1,703 (92.2%) applicator readings were correct. On average, the DSA performed with 90.6% sensitivity, 93.9% specificity, and had a negative predictive value of 93.8% and a positive predictive value of 91.0%. No statistically significant differences between experiments were noted. Conclusions The DSA was optimized and successfully validated for use with single-use, low-density polyethylene applicators filled with hydroxyethylcellulose (HEC) gel. We recommend including the DSA in future microbicide trials involving vaginal gels in order to identify participants who have low adherence to dosing regimens. In doing so, we can develop strategies to improve adherence as well as investigate the association between product use and efficacy. PMID:21992983

Can administrative health utilisation data provide an accurate diabetes prevalence estimate for a geographical region?

PubMed

Chan, Wing Cheuk; Papaconstantinou, Dean; Lee, Mildred; Telfer, Kendra; Jo, Emmanuel; Drury, Paul L; Tobias, Martin

2018-05-01

To validate the New Zealand Ministry of Health (MoH) Virtual Diabetes Register (VDR) using longitudinal laboratory results and to develop an improved algorithm for estimating diabetes prevalence at a population level. The assigned diabetes status of individuals based on the 2014 version of the MoH VDR is compared to the diabetes status based on the laboratory results stored in the Auckland regional laboratory result repository (TestSafe) using the New Zealand diabetes diagnostic criteria. The existing VDR algorithm is refined by reviewing the sensitivity and positive predictive value of the each of the VDR algorithm rules individually and as a combination. The diabetes prevalence estimate based on the original 2014 MoH VDR was 17% higher (n = 108,505) than the corresponding TestSafe prevalence estimate (n = 92,707). Compared to the diabetes prevalence based on TestSafe, the original VDR has a sensitivity of 89%, specificity of 96%, positive predictive value of 76% and negative predictive value of 98%. The modified VDR algorithm has improved the positive predictive value by 6.1% and the specificity by 1.4% with modest reductions in sensitivity of 2.2% and negative predictive value of 0.3%. At an aggregated level the overall diabetes prevalence estimated by the modified VDR is 5.7% higher than the corresponding estimate based on TestSafe. The Ministry of Health Virtual Diabetes Register algorithm has been refined to provide a more accurate diabetes prevalence estimate at a population level. The comparison highlights the potential value of a national population long term condition register constructed from both laboratory results and administrative data. Copyright © 2018 Elsevier B.V. All rights reserved.

[Evaluation of T-SPOT.TB assay in the diagnosis of pulmonary tuberculosis within different age groups].

PubMed

Pan, Liping; Jia, Hongyan; Liu, Fei; Gao, Mengqiu; Sun, Huishan; Du, Boping; Sun, Qi; Xing, Aiying; Wei, Rongrong; Zhang, Zongde

2015-12-01

To evaluate the value of T-SPOT.TB assay in the diagnosis of pulmonary tuberculosis within different age groups. We analyzed 1 518 suspected pulmonary tuberculosis (PTB) patients who were admitted to the Beijing Chest Hospital from November 2012 to February 2014 and had valid T-SPOT.TB tests before anti-tuberculosis therapy. The 599 microbiologically and/or histopathologically-confirmed PTB patients (16-89 years old, 388 males and 211 females) and 235 non-TB patients (14-85 years old, 144 males and 91 females) were enrolled for the analysis of diagnostic performance of T-SPOT.TB, while patients with uncertain diagnosis or diagnosis based on clinical impression (n=684) were excluded from the analysis. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of the T-SPOT.TB were analyzed according to the final diagnosis. Furthermore, the diagnostic performance of T-SPOT.TB assay in the younger patients (14-59 years old) and elderly patients (60-89 years old) were also analyzed respectively. Categorical variables were compared by Pearson's Chi-square test, while continuous variables were compared by the Mann-Whitney U-test. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of the T-SPOT.TB in diagnosis of PTB were 90.1% (540/599), 65.5% (154/235), 86.9% (540/621), 72.3% (154/213), 2.61, and 0.15, respectively. The sensitivity and specificity of T-SPOT.TB assay were 92.6% (375/405) and 75.6% (99/131), respectively in the younger patients, and 85.0% (165/194), 52.9% (55/104) respectively in the elderly patients. The sensitivity and specificity of T-SPOT.TB assay in the younger patients were significantly higher than those in the elderly patients (P<0.01), and the spot forming cells in the younger PTB patients were significantly higher than in the elderly PTB patients [300 (126, 666)/10(6) PBMCs vs. 258 (79, 621)/10(6) PBMCs, P=0.037]. T-SPOT.TB is a promising test in the diagnosis of younger patients (14-59 years old) with suspected PTB, but the diagnostic performance in elderly patients (60-89 years old) is relatively reduced.

Serum Protein Electrophoresis in the Evaluation of Lytic Bone Lesions

PubMed Central

Nystrom, Lukas M.; Buckwalter, Joseph A.; Syrbu, Sergei; Miller, Benjamin J.

2013-01-01

Serum protein electrophoresis (SPEP) is often obtained at the initial evaluation of a radiolucent bone lesion of unknown etiology. The results are considered convincing evidence of the presence or absence of a plasma cell neoplasm. The sensitivity and specificity of the SPEP have not been reported in this clinical scenario. Our purpose is to assess the diagnostic value of the SPEP in the initial work-up of the radiolucent bone lesion. We identified 182 patients undergoing evaluation of a radiolucent bone lesion that included tissue biopsy and an SPEP value. We then calculated the sen-sitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SPEP as a diagnostic test for a plasma cell neo-plasm in this clinical scenario. Forty-six of 182 (25.3%) patients in our series were diagnosed with a plasma cell neo-plasm by histopathologic analysis. The sensitivity of SPEP was 71% and the specificity was 83%. PPV was 47% and NPV was 94%. When analyzing only those presenting with multiple lesions, the percentage of patients diag-nosed with multiple myeloma increased to 44.7% (34 of 76 patients). The SPEP, however, did not have a substantially increased diagnostic accuracy with sensitivity of 71%, specificity 79%, PPV 40% and NPV 93%. SPEP lacks sensitivity and positive predictive value to provide a definitive diagnosis of myeloma in radiolucent bone lesions, but has a high negative predictive value which may make it useful in ruling out the disease. We recommend that this test either be performed in conjunction with urine electrophoresis, immunofixation electro-phoresis and free light chain assay, or after biopsy confirming the diagnosis of myeloma. PMID:24027470

[Diagnostic value of integral scoring systems in assessing the severity of acute pancreatitis and patient's condition].

PubMed

Vinnik, Y S; Dunaevskaya, S S; Antufrieva, D A

2015-01-01

The aim of the study was to evaluate the diagnostic value of specific and nonspecific scoring systems Tolstoy-Krasnogorov score, Ranson, BISAP, Glasgow, MODS 2, APACHE II and CTSI, which used at urgent pancreatology for estimation the severity of acute pancreatitis and status of patient. 1550 case reports of patients which had inpatient surgical treatment at Road clinical hospital at the station Krasnoyarsk from 2009 till 2013 were analyzed. Diagnosis of severe acute pancreatitis and its complications were determined based on anamnestic data, physical exami- nation, clinical indexes, ultrasonic examination and computed tomography angiography. Specific and nonspecific scores (scoring system of estimation by Tolstoy-Krasnogorov, Ranson, Glasgow, BISAP, MODS 2, APACHE II, CTSI) were used for estimation the severity of acute pancreatitis and patient's general condition. Effectiveness of these scoring systems was determined based on some parameters: accuracy (Ac), sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Most valuables score for estimation of acute pancreatitis's severity is BISAP (Se--98.10%), for estimation of organ failure--MODS 2 (Sp--100%, PPV--100%) and APACHE II (Sp--100%, PPV--100%), for detection of pancreatonecrosis sings--CTSI (Sp--100%, NPV--100%), for estimation of need for intensive care--MODS 2 (Sp--100%, PPV--100%, NPV--96.29%) and APACHE II (Sp--100%, PPV--100%, NPV--97.21%), for prediction of lethality--MODS 2 (Se-- 100%, Sp--98.14%, NPV--100%) and APACHE II (Se--95.00%, NPV-.99.86%). Most effective scores for estimation of acute pancreatitis's severity are Score of estimation by Tolstoy-Krasnogorov, Ranson, Glasgow and BISAP Scoring systems MODS 2, APACHE I high specificity and positive predictive value allow using it at clinical practice.

cnvScan: a CNV screening and annotation tool to improve the clinical utility of computational CNV prediction from exome sequencing data.

PubMed

Samarakoon, Pubudu Saneth; Sorte, Hanne Sørmo; Stray-Pedersen, Asbjørg; Rødningen, Olaug Kristin; Rognes, Torbjørn; Lyle, Robert

2016-01-14

With advances in next generation sequencing technology and analysis methods, single nucleotide variants (SNVs) and indels can be detected with high sensitivity and specificity in exome sequencing data. Recent studies have demonstrated the ability to detect disease-causing copy number variants (CNVs) in exome sequencing data. However, exonic CNV prediction programs have shown high false positive CNV counts, which is the major limiting factor for the applicability of these programs in clinical studies. We have developed a tool (cnvScan) to improve the clinical utility of computational CNV prediction in exome data. cnvScan can accept input from any CNV prediction program. cnvScan consists of two steps: CNV screening and CNV annotation. CNV screening evaluates CNV prediction using quality scores and refines this using an in-house CNV database, which greatly reduces the false positive rate. The annotation step provides functionally and clinically relevant information using multiple source datasets. We assessed the performance of cnvScan on CNV predictions from five different prediction programs using 64 exomes from Primary Immunodeficiency (PIDD) patients, and identified PIDD-causing CNVs in three individuals from two different families. In summary, cnvScan reduces the time and effort required to detect disease-causing CNVs by reducing the false positive count and providing annotation. This improves the clinical utility of CNV detection in exome data.

Characterization of Focal Liver Lesions using CEUS and MRI with Liver-Specific Contrast Media: Experience of a Single Radiologic Center.

PubMed

Beyer, Lukas Philipp; Wassermann, Florian; Pregler, Benedikt; Michalik, Katharina; Rennert, Janine; Wiesinger, Isabel; Stroszczynski, Christian; Wiggermann, Philipp; Jung, Ernst Michael

2017-12-01

 The purpose of this study was to compare contrast-enhanced ultrasound (CEUS), magnetic resonance imaging (MRI) using liver-specific contrast agent and a combination of both for the characterization of focal liver lesions (FLL).  83 patients with both benign and malignant liver lesions were examined using CEUS and MRI after the intravenous administration of liver-specific contrast media. All patients had inconclusive results from prior imaging examinations. Histopathological specimens could be obtained in 53 patients. Ultrasound was performed using a multi-frequency curved probe (1 - 6 MHz) after the injection of 1 - 2.4 ml ultrasound contrast media. The sensitivity, specificity, positive predictive value and negative predictive value of CEUS, MRI and a combination of both (CEUS + MRI) were compared.  The sensitivity, specificity, positive and negative predictive values regarding lesion classification were 90.9 %, 70.6 %, 92.3 % and 66.6 %, respectively, for CEUS; 90.9 %, 82.4 %, 95.2 % and 70.0 %, respectively, for MRI; and 96.9 %, 70.6 %, 92.7 % and 85.7 % respectively, for CEUS + MRI. There were no statistically significant differences. 6 malignant lesions were missed using CEUS or MRI alone (false negatives). The use of both modalities combined reduced the false-negative results to 2.  CEUS and MRI with liver-specific contrast media are very reliable and of equal informative value in the characterization of focal liver lesions. The number of false-negative results can be decreased using a combination of the two methods. © Georg Thieme Verlag KG Stuttgart · New York.

Self-diagnosis of active head lice infestation by individuals from an impoverished community: high sensitivity and specificity.

PubMed

Pilger, Daniel; Khakban, Adak; Heukelbach, Jorg; Feldmeier, Hermann

2008-01-01

To compare sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of self-diagnosis for head lice infestation with visual inspection, we conducted a study in an urban slum in Brazil. Individuals were asked about active head lice infestation (self-diagnosis); we performed visual inspection and thereafter wet combing (gold standard). Of the 175 individuals included, 77 (44%) had an active head lice infestation. For self-diagnosis, sensitivity (80.5%), specificity (91.8%), PPV (88.6%) and NPV (85.7%) were high. Sensitivity of visual inspection was 35.1%. Public health professionals can use self-diagnosis as a diagnostic tool, to estimate accurately prevalence of pediculosis in a community, and to monitor ongoing intervention strategies.

When theory and biology differ: The relationship between reward prediction errors and expectancy.

PubMed

Williams, Chad C; Hassall, Cameron D; Trska, Robert; Holroyd, Clay B; Krigolson, Olave E

2017-10-01

Comparisons between expectations and outcomes are critical for learning. Termed prediction errors, the violations of expectancy that occur when outcomes differ from expectations are used to modify value and shape behaviour. In the present study, we examined how a wide range of expectancy violations impacted neural signals associated with feedback processing. Participants performed a time estimation task in which they had to guess the duration of one second while their electroencephalogram was recorded. In a key manipulation, we varied task difficulty across the experiment to create a range of different feedback expectancies - reward feedback was either very expected, expected, 50/50, unexpected, or very unexpected. As predicted, the amplitude of the reward positivity, a component of the human event-related brain potential associated with feedback processing, scaled inversely with expectancy (e.g., unexpected feedback yielded a larger reward positivity than expected feedback). Interestingly, the scaling of the reward positivity to outcome expectancy was not linear as would be predicted by some theoretical models. Specifically, we found that the amplitude of the reward positivity was about equivalent for very expected and expected feedback, and for very unexpected and unexpected feedback. As such, our results demonstrate a sigmoidal relationship between reward expectancy and the amplitude of the reward positivity, with interesting implications for theories of reinforcement learning. Copyright © 2017 Elsevier B.V. All rights reserved.

A New Weighted Injury Severity Scoring System: Better Predictive Power for Pediatric Trauma Mortality.

PubMed

Shi, Junxin; Shen, Jiabin; Caupp, Sarah; Wang, Angela; Nuss, Kathryn E; Kenney, Brian; Wheeler, Krista K; Lu, Bo; Xiang, Henry

2018-05-02

An accurate injury severity measurement is essential for the evaluation of pediatric trauma care and outcome research. The traditional Injury Severity Score (ISS) does not consider the differential risks of the Abbreviated Injury Scale (AIS) from different body regions nor is it pediatric specific. The objective of this study was to develop a weighted injury severity scoring (wISS) system for pediatric blunt trauma patients with better predictive power than ISS. Based on the association between mortality and AIS from each of the six ISS body regions, we generated different weights for the component AIS scores used in the calculation of ISS. The weights and wISS were generated using the National Trauma Data Bank (NTDB). The Nationwide Emergency Department Sample (NEDS) was used to validate our main results. Pediatric blunt trauma patients less than 16 years were included, and mortality was the outcome. Discrimination (areas under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, concordance) and calibration (Hosmer-Lemeshow statistic) were compared between the wISS and ISS. The areas under the receiver operating characteristic curves from the wISS and ISS are 0.88 vs. 0.86 in ISS=1-74 and 0.77 vs. 0.64 in ISS=25-74 (p<0.0001). The wISS showed higher specificity, positive predictive value, negative predictive value, and concordance when they were compared at similar levels of sensitivity. The wISS had better calibration (smaller Hosmer-Lemeshow statistic) than the ISS (11.6 versus 19.7 for ISS=1-74 and 10.9 versus 12.6 for ISS= 25-74). The wISS showed even better discrimination with the NEDS. By weighting the AIS from different body regions, the wISS had significantly better predictive power for mortality than the ISS, especially in critically injured children.Level of Evidence and study typeLevel IV Prognostic/Epidemiological.

Iodine concentration: a new, important characteristic of the spot sign that predicts haematoma expansion.

PubMed

Fu, Fan; Sun, Shengjun; Liu, Liping; Li, Jianying; Su, Yaping; Li, Yingying

2018-04-19

The computed tomography angiography (CTA) spot sign is a validated predictor of haematoma expansion (HE) in spontaneous intracerebral haemorrhage (SICH). We investigated whether defining the iodine concentration (IC) inside the spot sign and the haematoma on Gemstone spectral imaging (GSI) would improve its sensitivity and specificity for predicting HE. From 2014 to 2016, we prospectively enrolled 65 SICH patients who underwent single-phase spectral CTA within 6 h. Logistic regression was performed to assess the risk factors for HE. The predictive performance of individual spot sign characteristics was examined via receiver operating characteristic (ROC) analysis. The spot sign was detected in 46.1% (30/65) of patients. ROC analysis indicated that IC inside the spot sign had the greatest area under the ROC curve for HE (0.858; 95% confidence interval, 0.727-0.989; p = 0.003). Multivariate analysis found that spot sign with higher IC (i.e. IC > 7.82 100 μg/ml) was an independent predictor of HE (odds ratio = 34.27; 95% confidence interval, 5.608-209.41; p < 0.001) with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 0.81, 0.75, 0.90 and 0.60, respectively; while the spot sign showed sensitivity, specificity, PPV and NPV of 0.81, 0.79, 0.73 and 0.86. Logistic regression analysis indicated that the IC in haematomas was independently associated with HE (odds ratio = 1.525; 95% confidence interval, 1.041-2.235; p = 0.030). ICs in haematoma and in spot sign were all independently associated with HE. IC analysis in spectral imaging may help to identify SICH patients for targeted haemostatic therapy. • Iodine concentration in spot sign and haematoma can predict haematoma expansion • Spectral imaging could measure the IC inside the spot sign and haematoma • IC in spot sign improved the positive predictive value (PPV) cf. CTA.

Choosing a design to fit the situation: how to improve specificity and positive predictive values using Bayesian lot quality assurance sampling.

PubMed

Olives, Casey; Pagano, Marcello

2013-02-01

Lot Quality Assurance Sampling (LQAS) is a provably useful tool for monitoring health programmes. Although LQAS ensures acceptable Producer and Consumer risks, the literature alleges that the method suffers from poor specificity and positive predictive values (PPVs). We suggest that poor LQAS performance is due, in part, to variation in the true underlying distribution. However, until now the role of the underlying distribution in expected performance has not been adequately examined. We present Bayesian-LQAS (B-LQAS), an approach to incorporating prior information into the choice of the LQAS sample size and decision rule, and explore its properties through a numerical study. Additionally, we analyse vaccination coverage data from UNICEF's State of the World's Children in 1968-1989 and 2008 to exemplify the performance of LQAS and B-LQAS. Results of our numerical study show that the choice of LQAS sample size and decision rule is sensitive to the distribution of prior information, as well as to individual beliefs about the importance of correct classification. Application of the B-LQAS approach to the UNICEF data improves specificity and PPV in both time periods (1968-1989 and 2008) with minimal reductions in sensitivity and negative predictive value. LQAS is shown to be a robust tool that is not necessarily prone to poor specificity and PPV as previously alleged. In situations where prior or historical data are available, B-LQAS can lead to improvements in expected performance.

Combining peptide recognition specificity and context information for the prediction of the 14-3-3-mediated interactome in S. cerevisiae and H. sapiens.

PubMed

Panni, Simona; Montecchi-Palazzi, Luisa; Kiemer, Lars; Cabibbo, Andrea; Paoluzi, Serena; Santonico, Elena; Landgraf, Christiane; Volkmer-Engert, Rudolf; Bachi, Angela; Castagnoli, Luisa; Cesareni, Gianni

2011-01-01

Large-scale interaction studies contribute the largest fraction of protein interactions information in databases. However, co-purification of non-specific or indirect ligands, often results in data sets that are affected by a considerable number of false positives. For the fraction of interactions mediated by short linear peptides, we present here a combined experimental and computational strategy for ranking the reliability of the inferred partners. We apply this strategy to the family of 14-3-3 domains. We have first characterized the recognition specificity of this domain family, largely confirming the results of previous analyses, while revealing new features of the preferred sequence context of 14-3-3 phospho-peptide partners. Notably, a proline next to the carboxy side of the phospho-amino acid functions as a potent inhibitor of 14-3-3 binding. The position-specific information about residue preference was encoded in a scoring matrix and two regular expressions. The integration of these three features in a single predictive model outperforms publicly available prediction tools. Next we have combined, by a naïve Bayesian approach, these "peptide features" with "protein features", such as protein co-expression and co-localization. Our approach provides an orthogonal reliability assessment and maps with high confidence the 14-3-3 peptide target on the partner proteins. Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

The representation of order information in auditory-verbal short-term memory.

PubMed

Kalm, Kristjan; Norris, Dennis

2014-05-14

Here we investigate how order information is represented in auditory-verbal short-term memory (STM). We used fMRI and a serial recall task to dissociate neural activity patterns representing the phonological properties of the items stored in STM from the patterns representing their order. For this purpose, we analyzed fMRI activity patterns elicited by different item sets and different orderings of those items. These fMRI activity patterns were compared with the predictions made by positional and chaining models of serial order. The positional models encode associations between items and their positions in a sequence, whereas the chaining models encode associations between successive items and retain no position information. We show that a set of brain areas in the postero-dorsal stream of auditory processing store associations between items and order as predicted by a positional model. The chaining model of order representation generates a different pattern similarity prediction, which was shown to be inconsistent with the fMRI data. Our results thus favor a neural model of order representation that stores item codes, position codes, and the mapping between them. This study provides the first fMRI evidence for a specific model of order representation in the human brain. Copyright © 2014 the authors 0270-6474/14/346879-08$15.00/0.

The Collective Benefits of Feeling Good and Letting Go: Positive Emotion and (dis)Inhibition Interact to Predict Cooperative Behavior

PubMed Central

Rand, David G.; Kraft-Todd, Gordon; Gruber, June

2015-01-01

Cooperation is central to human existence, forming the bedrock of everyday social relationships and larger societal structures. Thus, understanding the psychological underpinnings of cooperation is of both scientific and practical importance. Recent work using a dual-process framework suggests that intuitive processing can promote cooperation while deliberative processing can undermine it. Here we add to this line of research by more specifically identifying deliberative and intuitive processes that affect cooperation. To do so, we applied automated text analysis using the Linguistic Inquiry and Word Count (LIWC) software to investigate the association between behavior in one-shot anonymous economic cooperation games and the presence inhibition (a deliberative process) and positive emotion (an intuitive process) in free-response narratives written after (Study 1, N = 4,218) or during (Study 2, N = 236) the decision-making process. Consistent with previous results, across both studies inhibition predicted reduced cooperation while positive emotion predicted increased cooperation (even when controlling for negative emotion). Importantly, there was a significant interaction between positive emotion and inhibition, such that the most cooperative individuals had high positive emotion and low inhibition. This suggests that inhibition (i.e., reflective or deliberative processing) may undermine cooperative behavior by suppressing the prosocial effects of positive emotion. PMID:25625722

The collective benefits of feeling good and letting go: positive emotion and (dis)inhibition interact to predict cooperative behavior.

PubMed

Rand, David G; Kraft-Todd, Gordon; Gruber, June

2015-01-01

Cooperation is central to human existence, forming the bedrock of everyday social relationships and larger societal structures. Thus, understanding the psychological underpinnings of cooperation is of both scientific and practical importance. Recent work using a dual-process framework suggests that intuitive processing can promote cooperation while deliberative processing can undermine it. Here we add to this line of research by more specifically identifying deliberative and intuitive processes that affect cooperation. To do so, we applied automated text analysis using the Linguistic Inquiry and Word Count (LIWC) software to investigate the association between behavior in one-shot anonymous economic cooperation games and the presence inhibition (a deliberative process) and positive emotion (an intuitive process) in free-response narratives written after (Study 1, N = 4,218) or during (Study 2, N = 236) the decision-making process. Consistent with previous results, across both studies inhibition predicted reduced cooperation while positive emotion predicted increased cooperation (even when controlling for negative emotion). Importantly, there was a significant interaction between positive emotion and inhibition, such that the most cooperative individuals had high positive emotion and low inhibition. This suggests that inhibition (i.e., reflective or deliberative processing) may undermine cooperative behavior by suppressing the prosocial effects of positive emotion.

Myositis-specific autoantibodies and their association with malignancy in Italian patients with polymyositis and dermatomyositis.

PubMed

Ceribelli, Angela; Isailovic, Natasa; De Santis, Maria; Generali, Elena; Fredi, Micaela; Cavazzana, Ilaria; Franceschini, Franco; Cantarini, Luca; Satoh, Minoru; Selmi, Carlo

2017-02-01

This study aims to characterize myositis-specific antibodies in a well-defined cohort of patients with idiopathic inflammatory myopathy and to determine their association with cancer. Sera from 40 patients with polymyositis, dermatomyositis, and controls were tested by protein and RNA immunoprecipitation to detect autoantibodies, and immunoprecipitation-Western blot was used for anti-MJ/NXP-2, anti-MDA5, and anti-TIF1γ/α identification. Medical records were re-evaluated with specific focus on cancer. Anti-MJ/NXP-2 and anti-TIF1γ/α were the most common antibodies in dermatomyositis. In six dermatomyositis cases, we found five solid forms of cancer and one Hodgkin's lymphoma in long-term remission. Among patients with cancer-associated dermatomyositis, three were positive for anti-TIF1γ/α, two for anti-Mi-2, and one for anti-MJ/NXP-2. The strongest positivity of anti-TIF1γ was seen in two active forms of cancer, and this antibody was either negative or positive at low titers in the absence of cancer or in the 7-year remission Hodgkin's lymphoma. Four out of twenty (20 %) patients with polymyositis had solid cancer, but no specific association with autoantibodies was identified; further, none of the four cases of antisynthetase syndrome had a history of cancer. No serum myositis-associated autoantibody was observed in control sera, resulting in positive predictive value 75 %, negative predictive value 78.5 %, sensitivity 50 %, specificity 92 %, and area under the ROC curve 0.7083 for the risk of paraneoplastic DM in anti-TIF1γ/α (+) patients. Myositis-specific autoantibodies can be identified thanks to the use of immunoprecipitation, and their association with cancer is particularly clear for anti-TIF1γ/α in dermatomyositis. This association should be evaluated in a prospective study by immunoprecipitation in clinical practice.

Direct detection of methicillin resistance in Staphylococcus aureus in blood culture broth by use of a penicillin binding protein 2a latex agglutination test.

PubMed

Qian, Qinfang; Venkataraman, Lata; Kirby, James E; Gold, Howard S; Yamazumi, Toshiaki

2010-04-01

We studied the utility of performing a penicillin binding protein 2a latex agglutination (PBP-LA) assay directly on Bactec blood culture broth samples containing Staphylococcus aureus to rapidly detect methicillin resistance. The sensitivity, specificity, positive predictive value, and negative predictive value of this method were 94.1%, 97.5%, 98%, and 92.9%, respectively.

Predators modify biogeographic constraints on species distributions in an insect metacommunity.

PubMed

Grainger, Tess Nahanni; Germain, Rachel M; Jones, Natalie T; Gilbert, Benjamin

2017-03-01

Theory describing the positive effects of patch size and connectivity on diversity in fragmented systems has stimulated a large body of empirical work, yet predicting when and how local species interactions mediate these responses remains challenging. We used insects that specialize on milkweed plants as a model metacommunity to investigate how local predation alters the effects of biogeographic constraints on species distributions. Species-specific dispersal ability and susceptibility to predation were used to predict when patch size and connectivity should shape species distributions, and when these should be modified by local predator densities. We surveyed specialist herbivores and their predators in milkweed patches in two matrix types, a forest and an old field. Predator-resistant species showed the predicted direct positive effects of patch size and connectivity on occupancy rates. For predator-susceptible species, predators consistently altered the impact of biogeographic constraints, rather than acting independently. Finally, differences between matrix types in species' responses and overall occupancy rates indicate a potential role of the inter-patch environment in mediating the joint effects of predators and spatial drivers. Together, these results highlight the importance of local top-down pressure in mediating classic biogeographic relationships, and demonstrate how species-specific responses to local and regional constraints can be used to predict these effects. © 2017 by the Ecological Society of America.

Diagnostic value of contrast-enhanced ultrasound in thyroid nodules with calcification.

PubMed

Jiang, Jue; Shang, Xu; Wang, Hua; Xu, Yong-Bo; Gao, Ya; Zhou, Qi

2015-03-01

The aim of this study was to investigate the diagnostic values of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in benign and malignant thyroid nodules with calcification. Conventional ultrasound and CEUS were performed in 122 patients with thyroid nodules with calcification. The thyroid nodules were characterized as benign or malignant by pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accordance rate of the two imaging methods were determined. The area under the receiver operating characteristics curve (AUC) was used to assess the diagnostic values of the two imaging methods. In 122 cases of thyroid nodules with calcification, 73 benign nodules and 49 malignant nodules were verified by pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accordance rate of conventional ultrasound were 50%, 77%, 59%, 69%, and 66%, respectively, and those of CEUS were 90%, 92%, 88%, 93%, and 91%, respectively. There were significant differences between the two imaging methods. AUCs of conventional ultrasound and CEUS were 0.628 ± 0.052 and 0.908 ± 0.031, suggesting low and high diagnostic values, respectively. CEUS has high diagnostic values, being significantly greater than those of conventional ultrasound, in differential diagnosis of benign and malignant thyroid nodules with calcification. Copyright © 2014. Published by Elsevier Taiwan.

Anthropometrics of Italian Senior Male Rugby Union Players: From Elite to Second Division.

PubMed

Fontana, Federico Y; Colosio, Alessandro; De Roia, Gabriela F; Da Lozzo, Giorgio; Pogliaghi, Silvia

2015-09-01

Anthropometric evaluation of athletes is necessary to optimize talent identification and player development. To provide a specific anthropometric reference database of senior male rugby players competing at different levels in the southern European region. Cross-sectional. In 362 professional players (25 ± 4 y; 138 Italian national team, 97 first-division, and 127 second-division national championships) the authors measured mass, stature, and percentage body fat (plicometry). Mean, SD, and coefficient of variation were calculated for forwards and backs and for positional subgroups. Binomial logistic regression and receiver-operating-characteristic curve were performed to assess which variables best predicted level assignment (international vs national level). For all competitive levels forwards were significantly heavier and taller and had a larger percentage body fat and fat-free mass than backs. The lower the competitive level, the higher the within-role variability observed; furthermore, players in a specific positional subgroup were lighter, shorter, and fatter and had less fat-free mass. Fatfree mass is the variable that best predicts the likelihood of being classified as an international or national player (cutoff value 79.54 kg). The data confirm the specificity in the physical requirements of rugby in individual playing positions at all competitive levels and document significant differences among elite and 1st- and 2nd-division players in the same positional role. These differences may reflect the variable technical abilities, selection, training practices, and requirements of the game among these categories.

Remembering everyday experience through the prism of self-esteem.

PubMed

Christensen, Tamlin Conner; Wood, Joanne V; Barrett, Lisa Feldman

2003-01-01

Two studies examined whether global self-esteem was associated with bias in memory for autobiographical experience. For 7 days, participants described specific events and made ratings of their experience (i.e., state self-esteem, positive and negative emotion, and perceived valence of the event) in response to each event. Later, participants were presented with their event descriptions and were asked to recall their experience ratings from memory. As hypothesized, higher global self-esteem predicted positive shifts in memory for experience, whereas lower global self-esteem predicted negative shifts in memory for experience. Patterns of bias were strongest for remembered state self-esteem, moderate for positive emotion, and minimal for event valence. Self-esteem did not predict bias for negative emotion. Mood at the time of recall (measured in Study 2) generally did not account for the patterns. These findings strengthen the view that self-esteem is a rich source of knowledge about the self that can influence memory for some kinds of autobiographical experience. Copyright 2003 Society for Personality and Social Psychology, Inc.

Muscle Weakness in the Empty and Full Can Tests Cannot Differentiate Rotator Cuff Tear from Cervical Spondylotic Amyotrophy: Pain Provocation is a Useful Finding.

PubMed

Iwata, Eiichiro; Shigematsu, Hideki; Inoue, Kazuya; Egawa, Takuya; Sakamoto, Yoshihiro; Tanaka, Yasuhito

2017-01-01

Rotator cuff tears and cervical spondylotic amyotrophy (CSA) are often confused as the main symptom in those with difficulty in shoulder elevation. Empty and full can tests are frequently used for the clinical diagnosis of rotator cuff tears. The aim of the present study was to investigate whether the empty and full can test results can help differentiate rotator cuff tears from CSA. Twenty-seven consecutive patients with rotator cuff tears and 25 with CSA were enrolled. We prospectively performed empty and full can tests in patients with rotator cuff tears and CSA. The following signs were considered positive: (a) muscle weakness during the empty can test, (b) muscle weakness during the full can test, (c) pain provocation during the empty can test, and (d) pain provocation during the full can test. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of rotator cuff tears for each positive finding. The sensitivity and specificity of each index were as follows (sensitivity, specificity, PPV, NPV): (a) 77.8%, 0%, 45.7%, 0%; (b) 66.7%, 4.0%, 42.9%, 10.0%; (c) 88.9%, 96.0%, 96.0%, 88.9%; and (d) 74.1%, 96.0%, 95.2%, 77.4%. There were significant differences for each index. Muscle weakness during the empty and full can tests was not useful in differentiating rotator cuff tears from CSA because of low specificity and PPV. However, pain provocation was useful in differentiating these two conditions because of high specificity and PPV.

Can 3'-Deoxy-3'-((18)F) Fluorothymidine Out Perform 2-Deoxy-2-((18)F) Fluoro-D-Glucose Positron Emission Tomography/Computed Tomography in the Diagnosis of Cervical Lymphadenopathy in Patients With Oral/Head and Neck Cancer?

PubMed

Schaefferkoetter, Joshua D; Carlson, Eric R; Heidel, Robert E

2015-07-01

The present study investigated the performance of cellular metabolism imaging with 2-deoxy-2-((18)F) fluoro-D-glucose (FDG) versus cellular proliferation imaging with 3'-deoxy-3'-((18)F) fluorothymidine (FLT) in the detection of cervical lymph node metastases in oral/head and neck cancer. We conducted a prospective cohort study to assess a head-to-head performance of FLT imaging and clinical FDG imaging for characterizing cervical lymph node metastases in patients with squamous cell carcinoma (SCC) of the oral/head and neck region. The primary predictor variable of the study was the presence of FDG or FLT avidity within the cervical lymph nodes. The primary outcome variable was the histologic presence of metastatic SCC in the cervical lymph nodes. The performance was reported in terms of the sensitivity, specificity, accuracy, and positive and negative predictive values. The overall accuracy for discriminating positive from negative lymph nodes was evaluated as a function of the positron emission tomography (PET) standardized uptake value (SUV). Receiver operating characteristic (ROC) analyses were performed for both tracers. Eleven patients undergoing surgical resection of SCC of the oral/head and neck region underwent preoperative FDG and FLT PET-computed tomography (CT) scans on separate days. The interpretation of the FDG PET-CT imaging resulted in sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 43.2, 99.5, 94.4, 88.9, and 94.7%, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for FLT PET-CT imaging was 75.7, 99.2, 97.1, 90.3, and 97.7%, respectively. The areas under the curve for the ROC curves were 0.9 and 0.84 for FDG and FLT, respectively. Poor correlation was observed between the SUV for FDG and FLT within the lymph nodes and tumors. FLT showed better overall performance for detecting lymphadenopathy on qualitative assessment within the total nodal population. This notwithstanding, FDG SUV performed better for pathologic discrimination within the visible lymph nodes. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure as a Screening Tool.

PubMed

Bastiaens, Leo; Galus, James

2018-03-01

The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure was developed to aid clinicians with a dimensional assessment of psychopathology; however, this measure resembles a screening tool for several symptomatic domains. The objective of the current study was to examine the basic parameters of sensitivity, specificity, positive and negative predictive power of the measure as a screening tool. One hundred and fifty patients in a correctional community center filled out the measure prior to a psychiatric evaluation, including the Mini International Neuropsychiatric Interview screen. The above parameters were calculated for the domains of depression, mania, anxiety, and psychosis. The results showed that the sensitivity and positive predictive power of the studied domains was poor because of a high rate of false positive answers on the measure. However, when the lowest threshold on the Cross-Cutting Symptom Measure was used, the sensitivity of the anxiety and psychosis domains and the negative predictive values for mania, anxiety and psychosis were good. In conclusion, while it is foreseeable that some clinicians may use the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure as a screening tool, it should not be relied on to identify positive findings. It functioned well in the negative prediction of mania, anxiety and psychosis symptoms.

Performance of diagnostic tests for bovine tuberculosis in North American furbearers and implications for surveillance.

PubMed

O'Brien, D J; Fierke, J S; Cooley, T M; Fitzgerald, S D; Cosgrove, M K; Schmitt, S M

2013-11-01

Risks of bovine tuberculosis (bTB) transmission from free-ranging wildlife to livestock remain a concern in the United States, in both known endemic areas and where spillover from recently-infected livestock herds occurs. Federal agriculture officials in the United States (US) have recommended surveillance of non-cervid furbearers to determine whether free-ranging wildlife in the vicinity of cattle herd breakdowns are bTB infected, yet the efficacy of common diagnostic tests in these species is largely unknown. We calculated the sensitivity, specificity, predictive values and positive likelihood ratios for bTB infection in carcasses of sixteen species of furbearers tested via: (i) the presence of gross lesions compatible with bTB; (ii) histopathology consistent with bTB; and (iii) the presence of acid-fast bacilli (AFB) on histopathology. The gold standard comparison test was mycobacterial culture of cranial ± visceral lymph nodes pooled for each animal. Forty-two animals distributed across six species cultured bTB positive from among 1522 furbearers tested over thirteen years. The sensitivity of all three tests was poor (10%, 22% and 24% for gross lesions, AFB and histopathology, respectively), while specificities (all ≥ 99%) and negative predictive values (all ≥ 97%) were high. Positive predictive values varied widely (31-75%). Likelihood ratios for culture positivity given a positive test result showed AFB on histopathology to be the most reliable test, and gross lesions the least, though confidence intervals were wide and overlapping. While non-cervid furbearers may prove useful in North American bTB surveillance, wildlife managers should be aware of factors that may abate their utility and complicate interpretation of surveillance. © 2013 Blackwell Verlag GmbH.

Diagnosing diabetic foot osteomyelitis: is the combination of probe-to-bone test and plain radiography sufficient for high-risk inpatients?

PubMed

Aragón-Sánchez, J; Lipsky, Benjamin A; Lázaro-Martínez, J L

2011-02-01

To investigate the accuracy of the sequential combination of the probe-to-bone test and plain X-rays for diagnosing osteomyelitis in the foot of patients with diabetes. We prospectively compiled data on a series of 338 patients with diabetes with 356 episodes of foot infection who were hospitalized in the Diabetic Foot Unit of La Paloma Hospital from 1 October 2002 to 31 April 2010. For each patient we did a probe-to-bone test at the time of the initial evaluation and then obtained plain X-rays of the involved foot. All patients with positive results on either the probe-to-bone test or plain X-ray underwent an appropriate surgical procedure, which included obtaining a bone specimen that was processed for histology and culture. We calculated the sensitivity, specificity, predictive values and likelihood ratios of the procedures, using the histopathological diagnosis of osteomyelitis as the criterion standard. Overall, 72.4% of patients had histologically proven osteomyelitis, 85.2% of whom had positive bone culture. The performance characteristics of both the probe-to-bone test and plain X-rays were excellent. The sequential diagnostic approach had a sensitivity of 0.97, specificity of 0.92, positive predictive value of 0.97, negative predictive value of 0.93, positive likelihood ratio of 12.8 and negative likelihood ratio of 0.02. Only 6.6% of patients with negative results on both diagnostic studies had osteomyelitis. Clinicians seeing patients in a setting similar to ours (specialized diabetic foot unit with a high prevalence of osteomyelitis) can confidently diagnose diabetic foot osteomyelitis when either the probe-to-bone test or a plain X-ray, or especially both, are positive. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Autonomy, Positive Relationships, and IL-6: Evidence for Gender-Specific Effects

PubMed Central

Eisenlohr-Moul, Tory A.; Segerstrom, Suzanne C.

2014-01-01

Objectives A body of evidence indicates that women value relationship-centered aspects of well-being more than men do, while men value autonomy-centered aspects of well-being more than women do. The current study examined whether gender moderates relations between autonomy and positive relationships and interleukin-6 (IL-6), a cytokine associated with inflammatory processes. Aspects of well-being consistent with gender-linked values were expected to be most health-protective such that positive relationships would predict lower IL-6 only or more strongly in women, and autonomy would predict lower IL-6 only or more strongly in men. Methods In the first study, a sample of 119 older adults (55% female) living in Kentucky were visited in their homes for interviews and blood draws. In the second study, a sample of 1,028 adults (45% female) living across the United States (U.S.) underwent a telephone interview followed by a visit to a research center for blood draws. Results In the Kentucky sample, autonomy was quadratically related to IL-6 such that average autonomy predicted higher IL-6; this effect was stronger in men, providing support for our hypothesis only at above average levels of IL-6. In the U.S. national sample, more positive relationships were associated with lower IL-6 in women only. When the national sample was restricted to match the Kentucky sample, higher autonomy was associated with lower IL-6 in men only. Conclusions Results provide preliminary evidence for gender-specific effects of positive relationships and autonomy on IL-6. Further work is needed to establish the generalizability of these effects to different ages, cultures, and health statuses. PMID:22908985

Early prediction of coma recovery after cardiac arrest with blinded pupillometry.

PubMed

Solari, Daria; Rossetti, Andrea O; Carteron, Laurent; Miroz, John-Paul; Novy, Jan; Eckert, Philippe; Oddo, Mauro

2017-06-01

Prognostication studies on comatose cardiac arrest (CA) patients are limited by lack of blinding, potentially causing overestimation of outcome predictors and self-fulfilling prophecy. Using a blinded approach, we analyzed the value of quantitative automated pupillometry to predict neurological recovery after CA. We examined a prospective cohort of 103 comatose adult patients who were unconscious 48 hours after CA and underwent repeated measurements of quantitative pupillary light reflex (PLR) using the Neurolight-Algiscan device. Clinical examination, electroencephalography (EEG), somatosensory evoked potentials (SSEP), and serum neuron-specific enolase were performed in parallel, as part of standard multimodal assessment. Automated pupillometry results were blinded to clinicians involved in patient care. Cerebral Performance Categories (CPC) at 1 year was the outcome endpoint. Survivors (n = 50 patients; 32 CPC 1, 16 CPC 2, 2 CPC 3) had higher quantitative PLR (median = 20 [range = 13-41] vs 11 [0-55] %, p < 0.0001) and constriction velocity (1.46 [0.85-4.63] vs 0.94 [0.16-4.97] mm/s, p < 0.0001) than nonsurvivors. At 48 hours, a quantitative PLR < 13% had 100% specificity and positive predictive value to predict poor recovery (0% false-positive rate), and provided equal performance to that of EEG and SSEP. Reduced quantitative PLR correlated with higher serum neuron-specific enolase (Spearman r = -0.52, p < 0.0001). Reduced quantitative PLR correlates with postanoxic brain injury and, when compared to standard multimodal assessment, is highly accurate in predicting long-term prognosis after CA. This is the first prognostication study to show the value of automated pupillometry using a blinded approach to minimize self-fulfilling prophecy. Ann Neurol 2017;81:804-810. © 2017 American Neurological Association.

Clinical Utility of Urinary Cytology to Detect BK Viral Nephropathy.

PubMed

Nankivell, Brian J; Renthawa, Jasveen; Jeoffreys, Neisha; Kable, Kathy; O'Connell, Philip J; Chapman, Jeremy R; Wong, Germaine; Sharma, Raghwa N

2015-08-01

Reactivation of BK polyoma virus can result in destructive viral allograft nephropathy (BKVAN) with limited treatment options. Screening programs using surrogate markers of viral replication are important preventive strategies, guiding immunosuppression reduction. We prospectively evaluated the diagnostic test performance of urinary decoy cells and urinary SV40T immunochemistry of exfoliated cells, to screen for BKVAN, (defined by reference histology with SV40 immunohistochemistry, n = 704 samples), compared with quantitative viremia, from 211 kidney and 141 kidney-pancreas transplant recipients. The disease prevalence of BKVAN was 2.6%. Decoy cells occurred in 95 of 704 (13.5%) samples, with a sensitivity of 66.7%, specificity of 88.6%, positive predictive value (PPV) of 11.7%, and negative predictive value of 98.5% to predict histologically proven BKVAN. Quantification of decoy cells improved the PPV to 32.1% (10 ≥ cells threshold). Immunohistochemical staining of urinary exfoliated cells for SV40T improved sensitivity to 85.7%, detecting atypical or degenerate infected cells (specificity of 92.3% and PPV of 33.3%), but was hampered by technical failures. Viremia occurred in 90 of 704 (12.8%) with sensitivity of 96.3%, specificity of 90.3%, PPV of 31.5%, and negative predictive value of 99.8%. The receiver-operator curve performance of quantitative viremia surpassed decoy cells (area under the curve of 0.95 and 0.79, respectively, P = 0.0018 for differences). Combining decoy cell and BK viremia in a diagnostic matrix improved prediction of BKVAN and diagnostic risk stratification, especially for high-level positive results. Although quantified decoy cells are acceptable surrogate markers of BK viral replication with unexceptional test performances, quantitative viremia displayed superior test characteristics and is suggested as the screening test of choice.

Protein interactions and ligand binding: from protein subfamilies to functional specificity.

PubMed

Rausell, Antonio; Juan, David; Pazos, Florencio; Valencia, Alfonso

2010-02-02

The divergence accumulated during the evolution of protein families translates into their internal organization as subfamilies, and it is directly reflected in the characteristic patterns of differentially conserved residues. These specifically conserved positions in protein subfamilies are known as "specificity determining positions" (SDPs). Previous studies have limited their analysis to the study of the relationship between these positions and ligand-binding specificity, demonstrating significant yet limited predictive capacity. We have systematically extended this observation to include the role of differential protein interactions in the segregation of protein subfamilies and explored in detail the structural distribution of SDPs at protein interfaces. Our results show the extensive influence of protein interactions in the evolution of protein families and the widespread association of SDPs with protein interfaces. The combined analysis of SDPs in interfaces and ligand-binding sites provides a more complete picture of the organization of protein families, constituting the necessary framework for a large scale analysis of the evolution of protein function.

[Predictive value of breast imaging report and database system (BIRADS) to detect cancer in a reference regional hospital].

PubMed

Bellolio, Enrique; Pineda, Viviana; Burgos, María Eugenia; Iriarte, M José; Becker, Renato; Araya, Juan Carlos; Villaseca, Miguel; Mardones, Noldy

2015-12-01

To validate the BIRADS in mammography, the calculation of its predictive value in each center is required, as recommended by the American College of Radiology. To determine the predictive value of the BIRADS system in our center. All ultrasound guided needle percutaneous biopsies, performed at our center between 2006 and 2010 were reviewed. Predictive value, sensitivity, specificity and diagnostic accuracy of BIRADS were calculated, with a confidence interval of 95%. Of 1,313 biopsies available, 1,058 met the inclusion criteria. Fifty eight percent of biopsies were performed to women with mammographies classified as BIRADS 4 or 5. The presence of cancer in mammographies classified as BIRADS 0 was 4%. The prevalence of cancer for mammographies BIRADS 1, 2, 3, 4 and 5 were 0, 3, 2.7, 17.7 and 72.4% respectively. The positive and negative predictive values of BIRADS classification were 55 and 92 % respectively. In our institution BIRADS classification 4 and 5 has a high positive predictive value for detecting cancer as in developed countries.

Development of a Pediatric Ebola Predictive Score, Sierra Leone1.

PubMed

Fitzgerald, Felicity; Wing, Kevin; Naveed, Asad; Gbessay, Musa; Ross, J C G; Checchi, Francesco; Youkee, Daniel; Jalloh, Mohamed Boie; Baion, David E; Mustapha, Ayeshatu; Jah, Hawanatu; Lako, Sandra; Oza, Shefali; Boufkhed, Sabah; Feury, Reynold; Bielicki, Julia; Williamson, Elizabeth; Gibb, Diana M; Klein, Nigel; Sahr, Foday; Yeung, Shunmay

2018-02-01

We compared children who were positive for Ebola virus disease (EVD) with those who were negative to derive a pediatric EVD predictor (PEP) score. We collected data on all children <13 years of age admitted to 11 Ebola holding units in Sierra Leone during August 2014-March 2015 and performed multivariable logistic regression. Among 1,054 children, 309 (29%) were EVD positive and 697 (66%) EVD negative, with 48 (5%) missing. Contact history, conjunctivitis, and age were the strongest positive predictors for EVD. The PEP score had an area under receiver operating characteristics curve of 0.80. A PEP score of 7/10 was 92% specific and 44% sensitive; 3/10 was 30% specific, 94% sensitive. The PEP score could correctly classify 79%-90% of children and could be used to facilitate triage into risk categories, depending on the sensitivity or specificity required.

Three year evaluation of Xpert MTB/RIF in a low prevalence tuberculosis setting: A Scottish perspective.

PubMed

Parcell, Benjamin J; Jarchow-MacDonald, Anna A; Seagar, Amie-Louise; Laurenson, Ian F; Prescott, Gordon J; Lockhart, Michael

2017-05-01

Xpert MTB/RIF (Cepheid) is a rapid molecular assay shown to be sensitive and specific for pulmonary tuberculosis (TB) diagnosis in highly endemic countries. We evaluated its diagnostic performance in a low TB prevalence setting, examined rifampicin resistance detection and quantitative capabilities predicting graded auramine microscopy and time to positivity (TTP) of culture. Xpert MTB/RIF was used to test respiratory samples over a 3 year period. Samples underwent graded auramine microscopy, solid/liquid culture, in-house IS6110 real-time PCR, and GenoType MTBDRplus (HAIN Lifescience) to determine rifampicin and/or isoniazid resistance. A total of 2103 Xpert MTB/RIF tests were performed. Compared to culture sensitivity was 95.8%, specificity 99.5%, positive predictive value (PPV) 82.1%, and negative predictive value (NPV) 99.9%. A positive correlation was found between auramine microscopy grade and Xpert MTB/RIF assay load. We found a clear reduction in the median TTP as Xpert MTB/RIF assay load increased. Rifampicin resistance was detected. Xpert MTB/RIF was rapid and accurate in diagnosing pulmonary TB in a low prevalence area. Rapid results will influence infection prevention and control and treatment measures. The excellent NPV obtained suggests further work should be carried out to assess its role in replacing microscopy. Copyright © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

[Is streptococcal pharyngitis diagnosis possible?].

PubMed

Marín Cañada, Jaime; Cubillo Serna, Ana; Gómez-Escalonilla Cruz, Nieves; Garzón de la Iglesia, Jesús; Benito Ortiz, Luis; Reyes Fernández, M Nieves

2007-07-01

To determine the validity of the Centor score (cervical adenopathy, tonsillar exudate, fever, and absence of catarrh symptoms) in diagnosing streptococcal pharyngitis (gold standard: throat swab). Descriptive study. San Fernando 2 Health Centre, Madrid (outer urban area), Spain. On hundred forty patients over 14 years old who had a "sore throat" as main symptom and attended clinic between 14 February and 12 May, 2005. Sensitivity, specificity, positive and negative predictive values, and the probability quotients of the Centor score were determined. Pharyngeal throat culture was used as the reference method. Thirty four patients had positive throat culture (24.3%; 95% CI, 17.6%-32.4%). Finding the 4 criteria in the Centor score had a positive predictive value (PPV) of 48.1% (95% CI, 30.7%-66.0%) and a negative predictive value (NPV) of 81.4% (95% CI, 73.3%-87.5%); although only fever (OR, 3.64; 95% CI, 1.40-9.49) and tonsillar exudate (OR, 6.18; 95% CI, 2.08-18.35) were linked to streptococcal aetiology. The high NPV and specificity of the clinical score makes the diagnosis of non-streptococcal pharyngitis very accurate. However, the PPV is low: a high Centor score (3 or 4 criteria) does not mean streptococcal pharyngitis with certainty. What approach to take with patients suspected of streptococcal pharyngitis is not yet resolved (microbiological test, early antibiotic, or postponed antibiotic).

Predicting failure of hematopoietic stem cell mobilization before it starts: the predicted poor mobilizer (pPM) score.

PubMed

Olivieri, Jacopo; Attolico, Immacolata; Nuccorini, Roberta; Pascale, Sara Pasquina; Chiarucci, Martina; Poiani, Monica; Corradini, Paolo; Farina, Lucia; Gaidano, Gianluca; Nassi, Luca; Sica, Simona; Piccirillo, Nicola; Pioltelli, Pietro Enrico; Martino, Massimo; Moscato, Tiziana; Pini, Massimo; Zallio, Francesco; Ciceri, Fabio; Marktel, Sarah; Mengarelli, Andrea; Musto, Pellegrino; Capria, Saveria; Merli, Francesco; Codeluppi, Katia; Mele, Giuseppe; Lanza, Francesco; Specchia, Giorgina; Pastore, Domenico; Milone, Giuseppe; Saraceni, Francesco; Di Nardo, Elvira; Perseghin, Paolo; Olivieri, Attilio

2018-04-01

Predicting mobilization failure before it starts may enable patient-tailored strategies. Although consensus criteria for predicted PM (pPM) are available, their predictive performance has never been measured on real data. We retrospectively collected and analyzed 1318 mobilization procedures performed for MM and lymphoma patients in the plerixafor era. In our sample, 180/1318 (13.7%) were PM. The score resulting from published pPM criteria had sufficient performance for predicting PM, as measured by AUC (0.67, 95%CI: 0.63-0.72). We developed a new prediction model from multivariate analysis whose score (pPM-score) resulted in better AUC (0.80, 95%CI: 0.76-0.84, p < 0001). pPM-score included as risk factors: increasing age, diagnosis of NHL, positive bone marrow biopsy or cytopenias before mobilization, previous mobilization failure, priming strategy with G-CSF alone, or without upfront plerixafor. A simplified version of pPM-score was categorized using a cut-off to maximize positive likelihood ratio (15.7, 95%CI: 9.9-24.8); specificity was 98% (95%CI: 97-98.7%), sensitivity 31.7% (95%CI: 24.9-39%); positive predictive value in our sample was 71.3% (95%CI: 60-80.8%). Simplified pPM-score can "rule in" patients at very high risk for PM before starting mobilization, allowing changes in clinical management, such as choice of alternative priming strategies, to avoid highly likely mobilization failure.

Identification and positional distribution analysis of transcription factor binding sites for genes from the wheat fl-cDNA sequences.

PubMed

Chen, Zhen-Yong; Guo, Xiao-Jiang; Chen, Zhong-Xu; Chen, Wei-Ying; Wang, Ji-Rui

2017-06-01

The binding sites of transcription factors (TFs) in upstream DNA regions are called transcription factor binding sites (TFBSs). TFBSs are important elements for regulating gene expression. To date, there have been few studies on the profiles of TFBSs in plants. In total, 4,873 sequences with 5' upstream regions from 8530 wheat fl-cDNA sequences were used to predict TFBSs. We found 4572 TFBSs for the MADS TF family, which was twice as many as for bHLH (1951), B3 (1951), HB superfamily (1914), ERF (1820), and AP2/ERF (1725) TFs, and was approximately four times higher than the remaining TFBS types. The percentage of TFBSs and TF members showed a distinct distribution in different tissues. Overall, the distribution of TFBSs in the upstream regions of wheat fl-cDNA sequences had significant difference. Meanwhile, high frequencies of some types of TFBSs were found in specific regions in the upstream sequences. Both TFs and fl-cDNA with TFBSs predicted in the same tissues exhibited specific distribution preferences for regulating gene expression. The tissue-specific analysis of TFs and fl-cDNA with TFBSs provides useful information for functional research, and can be used to identify relationships between tissue-specific TFs and fl-cDNA with TFBSs. Moreover, the positional distribution of TFBSs indicates that some types of wheat TFBS have different positional distribution preferences in the upstream regions of genes.

Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.

PubMed

Kumar, Gyanendra; Shahripour, Reza Bavarsad; Harrigan, Mark R

2016-05-01

OBJECT The impact of transcranial Doppler (TCD) ultrasonography evidence of vasospasm on patient-centered clinical outcomes following aneurysmal subarachnoid hemorrhage (aSAH) is unknown. Vasospasm is known to lead to delayed cerebral ischemia (DCI) and poor outcomes. This systematic review and meta-analysis evaluates the predictive value of vasospasm on DCI, as diagnosed on TCD. METHODS MEDLINE, Scopus, the Cochrane trial register, and clinicaltrials.gov were searched through September 2014 using key words and the terms "subarachnoid hemorrhage," "aneurysm," "aneurysmal," "cerebral vasospasm," "vasospasm," "transcranial Doppler," and "TCD." Sensitivities, specificities, and positive and negative predictive values were pooled by a DerSimonian and Laird random-effects model. RESULTS Seventeen studies (n = 2870 patients) met inclusion criteria. The amount of variance attributable to heterogeneity was significant (I(2) > 50%) for all syntheses. No studies reported the impact of TCD evidence of vasospasm on functional outcome or mortality. TCD evidence of vasospasm was found to be highly predictive of DCI. Pooled estimates for TCD diagnosis of vasospasm (for DCI) were sensitivity 90% (95% confidence interval [CI] 77%-96%), specificity 71% (95% CI 51%-84%), positive predictive value 57% (95% CI 38%-71%), and negative predictive value 92% (95% CI 83%-96%). CONCLUSIONS TCD evidence of vasospasm is predictive of DCI with high accuracy. Although high sensitivity and negative predictive value make TCD an ideal monitoring device, it is not a mandated standard of care in aSAH due to the paucity of evidence on clinically relevant outcomes, despite recommendation by national guidelines. High-quality randomized trials evaluating the impact of TCD monitoring on patient-centered and physician-relevant outcomes are needed.

Evolution and prognosis of long intensive care unit stay patients suffering a deterioration: A multicenter study.

PubMed

Hernández-Tejedor, Alberto; Cabré-Pericas, Lluís; Martín-Delgado, María Cruz; Leal-Micharet, Ana María; Algora-Weber, Alejandro

2015-06-01

The prognosis of a patient who deteriorates during a prolonged intensive care unit (ICU) stay is difficult to predict. We analyze the prognostic value of the serialized Sequential Organ Failure Assessment (SOFA) score and other variables in the early days after a complication and to build a new predictive score. EPIPUSE (Evolución y pronóstico de los pacientes con ingreso prolongado en UCI que sufren un empeoramiento, Evolution and prognosis of long intensive care unit stay patients suffering a deterioration) study is a prospective, observational study during a 3-month recruitment period in 75 Spanish ICUs. We focused on patients admitted in the ICU for 7 days or more with complications of adverse events that involve organ dysfunction impairment. Demographics, clinical variables, and serialized SOFA after a supervening clinical deterioration were recorded. Univariate and multivariate analyses were performed, and a predictive model was created with the most discriminating variables. We included 589 patients who experienced 777 cases of severe complication or adverse event. The entire sample was randomly divided into 2 subsamples, one for development purposes (528 cases) and the other for validation (249 cases). The predictive model maximizing specificity is calculated by minimum SOFA + 2 * cardiovascular risk factors + 2 * history of any oncologic disease or immunosuppressive treatment + 3 * dependence for basic activities of daily living. The area under the receiver operating characteristic curve is 0.82. A 14-point cutoff has a positive predictive value of 100% (92.7%-100%) and negative predictive value of 51% (46.4%-55.5%) for death. EPIPUSE model can predict mortality with a specificity and positive predictive value of 99% in some groups of patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Middle cerebral artery peak systolic velocity to predict fetal hemoglobin levels in twin anemia-polycythemia sequence.

PubMed

Slaghekke, F; Pasman, S; Veujoz, M; Middeldorp, J M; Lewi, L; Devlieger, R; Favre, R; Lopriore, E; Oepkes, D

2015-10-01

To evaluate the diagnostic accuracy of middle cerebral artery peak systolic velocity (MCA-PSV) Doppler measurements in prediction of hemoglobin levels in twin anemia-polycythemia sequence (TAPS). This study involved a consecutive cohort comprising monochorionic twin pregnancies complicated by TAPS managed at three European fetal medicine centers between 2005 and 2013. The accuracy of MCA-PSV, measured immediately prior to fetal hemoglobin (Hb) measurement by fetal or cord blood sampling, for prediction of anemia and polycythemia was assessed using 2 × 2 tables. A total of 116 measurements (74 recorded in donors and 42 in recipients) from 43 twin pregnancies complicated by TAPS were available for analysis. MCA-PSV multiples of the median (MoM) values correlated well with Hb levels (r = - 0.86; P < 0.001). The sensitivity of MCA-PSV ≥ 1.5 MoM to predict severe anemia (Hb deficit > 5 SD below the mean) in TAPS donors was 94% (95% CI, 85-98%); specificity was 74% (95% CI, 62-83%); positive and negative predictive values were 76% (95% CI, 65-85%) and 94% (95% CI, 83-98%), respectively. The sensitivity of MCA-PSV ≤ 1.0 MoM to predict polycythemia (Hb level > 5 SD above the mean) in TAPS recipients was 97% (95% CI, 87-99%); specificity was 96% (95% CI, 89-99%); positive and negative predictive values were 93% (95% CI, 81-97%) and 99% (95% CI, 93-100%), respectively. MCA-PSV measurement has high diagnostic accuracy for predicting abnormal Hb levels in fetuses with TAPS. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Joint Attention Initiation with and without Positive Affect: Risk Group Differences and Associations with ASD Symptoms

PubMed Central

Gangi, Devon N.; Ibañez, Lisa V.; Messinger, Daniel S.

2014-01-01

Infants at risk for Autism Spectrum Disorders (ASD) may have difficulty integrating smiles into initiating joint attention (IJA) bids. A specific IJA pattern, anticipatory smiling, may communicate preexisting positive affect when an infant smiles at an object and then turns the smile toward the social partner. We compared the development of anticipatory smiling at 8, 10, and 12 months in infant siblings of children with ASD (high-risk siblings) and without ASD (low-risk siblings). High-risk siblings produced less anticipatory smiling than low-risk siblings, suggesting early differences in communicating preexisting positive affect. While early anticipatory smiling distinguished the risk groups, IJA not accompanied by smiling best predicted later severity of ASD-related behavioral characteristics among high-risk siblings. High-risk infants appear to show lower levels of motivation to share positive affect with others. However, facility with initiating joint attention in the absence of a clear index of positive affective motivation appears to be central to the prediction of ASD symptoms. PMID:24281421

Controversy matters: Impacts of topic and solution controversy on the perceived credibility of a scientist who advocates.

PubMed

Beall, Lindsey; Myers, Teresa A; Kotcher, John E; Vraga, Emily K; Maibach, Edward W

2017-01-01

In this article, we focus on the potential influence of a scientist's advocacy position on the public's perceived credibility of scientists as a whole. Further, we examine how the scientist's solution position (information only, non-controversial, and controversial) affects the public's perception of the scientist's motivation for sharing information about specific issues (flu, marijuana, climate change, severe weather). Finally, we assess how perceived motivations mediate the relationship between solution position and credibility. Using data from a quota sample of American adults obtained by Qualtrics (n = 2,453), we found that in some conditions advocating for a solution positively predicted credibility, while in one condition, it negatively predicted scientist credibility. We also found that the influence of solution position on perceived credibility was mediated by several motivation perceptions; most notably through perception that the scientist was motivated to: (a) serve the public and (b) persuade the public. Further results and implications are discussed.

Controversy matters: Impacts of topic and solution controversy on the perceived credibility of a scientist who advocates

PubMed Central

Myers, Teresa A.; Kotcher, John E.; Vraga, Emily K.; Maibach, Edward W.

2017-01-01

In this article, we focus on the potential influence of a scientist’s advocacy position on the public’s perceived credibility of scientists as a whole. Further, we examine how the scientist’s solution position (information only, non-controversial, and controversial) affects the public’s perception of the scientist’s motivation for sharing information about specific issues (flu, marijuana, climate change, severe weather). Finally, we assess how perceived motivations mediate the relationship between solution position and credibility. Using data from a quota sample of American adults obtained by Qualtrics (n = 2,453), we found that in some conditions advocating for a solution positively predicted credibility, while in one condition, it negatively predicted scientist credibility. We also found that the influence of solution position on perceived credibility was mediated by several motivation perceptions; most notably through perception that the scientist was motivated to: (a) serve the public and (b) persuade the public. Further results and implications are discussed. PMID:29136643

Prospective evaluation of a screening protocol to exclude deep vein thrombosis on the basis of a combination of quantitative D-dimer testing and pretest clinical probability score.

PubMed

Yamaki, Takashi; Nozaki, Motohiro; Sakurai, Hiroyuki; Takeuchi, Masaki; Soejima, Kazutaka; Kono, Taro

2005-11-01

Clinical signs and symptoms such as swelling, pain, and redness are unreliable markers of deep vein thrombosis (DVT). Because of this venous duplex scanning (VDS) has been heavily used in DVT detection. The purpose of this study was to determine if a combination of D-dimer testing and pretest clinical score could reduce the use of VDS in symptomatic patients with suspected DVT. One hundred seventy-four consecutive patients with suspected DVT were prospectively evaluated using pretest clinical probability (PCP) score and D-dimer testing before VDS. After calculating clinical probability scores developed by Wells and associates, patients were divided into low risk (or=3 points) PCP. One hundred fifty-eight patients were enrolled. The prevalence of DVT in this study was 37%. Thirty-eight patients (24%) were classified as low risk, 64 (41%) as moderate risk, and 56 (35%) as high risk PCP. DVT was identified in only one patient (2.6%) with low risk PCP. In contrast, DVT was found in 22 (34%) with moderate risk, and 35 (63%) with high risk PCP. In the high and moderate risk PCP groups, positive scan patients had a markedly higher value of D-dimer assay than negative scan patients (p=0.0001 and p=0.0057, respectively). In the low risk PCP patients, D-dimer testing provided 100% sensitivity, 46% specificity, 4.8% positive predictive value, and 100% negative predictive value in the diagnosis of DVT. Similarly, in the moderate risk PCP, the D-dimer testing showed 100% sensitivity, 45% specificity, 49% positive predictive value, and 100% negative predictive value. In the high risk group, D-dimer testing achieved 100% sensitivity, 57% specificity, 80% positive predictive value, and 100% negative predictive value in the diagnosis of DVT. These results suggested that 36 of 158 patients who had a non-high PCP (low and moderate PCP) and a normal D-dimer concentration were considered to have no additional investigation, so VDS could have been reduced by 23% (36/158). A combination of D-dimer testing and clinical probability score may be effective in avoiding unnecessary VDS in suspected symptomatic DVT in the low and moderate PCP patients. The need for VDS could be reduced by 23% despite a relatively high prevalence of DVT.

Outcomes analysis of new entrant screening for active tuberculosis in Heathrow and Gatwick airports, United Kingdom 2009/2010.

PubMed

Severi, Ettore; Maguire, Helen; Ihekweazu, Chikwe; Bickler, Graham; Abubakar, Ibrahim

2016-04-22

In 2012, the United Kingdom (UK) Government announced that the new entrant screening for active tuberculosis (TB) in Heathrow and Gatwick airports would end. Our study objective was to estimate screening yield and diagnostic accuracy, and identify those at risk of active TB after entry. We designed a retrospective cohort study and linked new entrants screened from June 2009 to September 2010 through probabilistic matching with UK Enhanced TB Surveillance (ETS) data (June 2009 to December 2010). Yield was the proportion of cases reported to ETS within three months of airport screening in the screened population. To estimate screening diagnostic accuracy we assessed sensitivity, specificity, positive and negative predictive values. Through Poisson regression we identified groups at increased risk of TB diagnosis after entry. We identified 200,199 screened entrants, of these 59 had suspected TB at screening and were reported within 3 months to ETS (yield = 0.03 %). Sensitivity was 26 %; specificity was 99.7 %; positive predictive value was 13.2 %; negative predictive value was 99.9 %. Overall, 350 entrants were reported in ETS. Persons from countries with annual TB incidence higher than 150 cases per 100,000 population and refugees and asylum seekers were at increased risk of TB diagnosis after entry (population attributable risk 77 and 3 % respectively). Airport screening has very low screening yields, sensitivity and positive predictive value. New entrants coming from countries with annual TB incidence higher than 150 per 100,000 population, refugees and asylum seekers should be prioritised at pre- or post-entry screening.

Development of an evidence-based approach to external quality assurance for breast cancer hormone receptor immunohistochemistry: comparison of reference values.

PubMed

Makretsov, Nikita; Gilks, C Blake; Alaghehbandan, Reza; Garratt, John; Quenneville, Louise; Mercer, Joel; Palavdzic, Dragana; Torlakovic, Emina E

2011-07-01

External quality assurance and proficiency testing programs for breast cancer predictive biomarkers are based largely on traditional ad hoc design; at present there is no universal consensus on definition of a standard reference value for samples used in external quality assurance programs. To explore reference values for estrogen receptor and progesterone receptor immunohistochemistry in order to develop an evidence-based analytic platform for external quality assurance. There were 31 participating laboratories, 4 of which were previously designated as "expert" laboratories. Each participant tested a tissue microarray slide with 44 breast carcinomas for estrogen receptor and progesterone receptor and submitted it to the Canadian Immunohistochemistry Quality Control Program for analysis. Nuclear staining in 1% or more of the tumor cells was a positive score. Five methods for determining reference values were compared. All reference values showed 100% agreement for estrogen receptor and progesterone receptor scores, when indeterminate results were excluded. Individual laboratory performance (agreement rates, test sensitivity, test specificity, positive predictive value, negative predictive value, and κ value) was very similar for all reference values. Identification of suboptimal performance by all methods was identical for 30 of 31 laboratories. Estrogen receptor assessment of 1 laboratory was discordant: agreement was less than 90% for 3 of 5 reference values and greater than 90% with the use of 2 other reference values. Various reference values provide equivalent laboratory rating. In addition to descriptive feedback, our approach allows calculation of technical test sensitivity and specificity, positive and negative predictive values, agreement rates, and κ values to guide corrective actions.

Performance of Ultrasound in the Diagnosis of Gout in a Multi-Center Study: Comparison with Monosodium Urate Crystal Analysis as the Gold Standard

PubMed Central

Ogdie, Alexis; Taylor, William J; Neogi, Tuhina; Fransen, Jaap; Jansen, Tim L; Schumacher, H. Ralph; Louthrenoo, Worawit; Vazquez-Mellado, Janitzia; Eliseev, Maxim; McCarthy, Geraldine; Stamp, Lisa K.; Perez-Ruiz, Fernando; Sivera, Francisca; Ea, Hang-Korng; Gerritsen, Martijn; Cagnotto, Giovanni; Cavagna, Lorenzo; Lin, Chingtsai; Chou, Yin-Yi; Tausche, Anne-Kathrin; Ochtrop, Manuella Lima Gomes; Janssen, Matthijs; Chen, Jiunn-Horng; Slot, Ole; Lazovskis, Juris; White, Douglas; Cimmino, Marco A.; Uhlig, Till; Dalbeth, Nicola

2017-01-01

Objectives To examine the performance of ultrasound for the diagnosis of gout using presence of monosodium urate (MSU) crystals as the gold standard. Methods We analyzed data from the Study for Updated Gout Classification Criteria (SUGAR), a large, multi-center observational cross-sectional study of consecutive subjects with at least one swollen joint who conceivably may have gout. All subjects underwent arthrocentesis; cases were subjects with MSU crystal confirmation. Rheumatologists or radiologists, blinded to the results of the MSU crystal analysis, performed ultrasound on one or more clinically affected joints. Ultrasound findings of interest were: double contour sign (DCS), tophus, and ‘snowstorm’ appearance. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated. Multivariable logistic regression models were used to examine factors associated with positive ultrasound results among subjects with gout. Results Ultrasound was performed in 824 subjects (416 cases and 408 controls). The sensitivity, specificity, PPV and NPV for the presence of any one of the features were 76.9%, 84.3%, 83.3% and 78.1% respectively. Sensitivity was higher among subjects with disease ≥2 years duration and among subjects with subcutaneous nodules on exam (suspected tophus). Associations with a positive ultrasound finding included suspected clinical tophus (odds ratio 4.77; 95% CI 2.23–10.21), any abnormal plain film radiograph (4.68; 2.68–8.17) and serum urate (1.31; 1.06–1.62). Conclusions Ultrasound features of MSU crystal deposition had high specificity and high positive predictive value but more limited sensitivity for early gout. The specificity remained high in subjects with early disease and without clinical signs of tophi. PMID:27748084

Benefit of the basophil activation test in deciding when to reintroduce cow's milk in allergic children.

PubMed

Rubio, A; Vivinus-Nébot, M; Bourrier, T; Saggio, B; Albertini, M; Bernard, A

2011-01-01

Oral challenges are required to establish the persistence or resolution of IgE-mediated cow's milk allergy (CMA). Determining the appropriate timing for challenging is the main difficulty. The benefit of the basophil activation test (BAT) in predicting a child's reaction to the oral challenge was evaluated and compared to the specific IgE and skin prick tests' (SPT) results. One hundred and twelve consecutive children with CMA admitted for an oral challenge to reassess their allergy were included. Allergen-induced basophil activation was detected as a CD63-upregulation by flow cytometry. Thirty-six children (32%) had a positive oral challenge. The percentage of activated basophils in patients with a positive challenge (mean = 20.9; SD = 18.8) was significantly higher than that of patients with a negative challenge (mean = 3.9; SD = 9.8, P < 0.0001), and was well correlated with the eliciting dose of cow's milk (P < 0.0001). The BAT had an efficiency of 90%, a sensitivity of 91%, a specificity of 90%, and positive and negative predictive values of 81% and 96% in detecting persistently allergic patients. The area under the ROC curve was 0.866. These scores were higher than those obtained with SPT and IgE values, whichever positivity cut-point was chosen. Referring to a decisional algorithm combining BAT, specific IgE and SPT allowed the correct identification of 94% of patients as tolerant or persistently allergic to cow's milk proteins (CMP) in our cohort. The BAT could be a valuable tool in the management of paediatric CMA in addition to specific IgE quantification and SPT, by contributing in determining whether an oral challenge can safely be undertaken. © 2010 John Wiley & Sons A/S.

Asymptomatic bacteriuria in pregnant women attending Boo-Ali Hospital Tehran Iran: Urine analysis vs. urine culture

PubMed Central

Etminan-Bakhsh, Mina; Tadi, Sima; Darabi, Roksana

2017-01-01

Background Asymptomatic bacteriuria is one of the common problems in pregnancy. Asymptomatic bacteriuria is associated with pyelonephritis, preterm labor and low birth weight infants. The physiological and anatomical changes in pregnancy facilitate urinary tract infection (UTI) during pregnancy. Several tests are available for diagnosis of asymptomatic bacteriuria. The urine culture is a gold standard diagnostic test for asymptomatic bacteriuria but it is expensive and time-consuming. Screening methods may be useful in detecting high-risk pregnant women for asymptomatic bacteriuria. Objective The aim of the present study was to compare urine analysis as a rapid screening test to urine culture in diagnosis of asymptomatic bacteriuria. Methods A total of 123 pregnant women attending the obstetrics clinic of Boo-Ali hospital in Tehran, Iran from March 2013 to September 2014 were included in the present diagnostic cross-sectional study. One hundred twenty three mid-stream urine samples were inoculated into cultures and were processed by dipstick (nitrite test and leucocyte esterase test) and microscopic pus cell count. The sensitivity, specificity, positive predictive value and negative predictive value of nitrite test, leucocyte esterase test and microscopic pus cell count were compared with urine culture in diagnosis of asymptomatic bacteriuria by using SPSS version 19. Results Of 123 urine samples, significant asymptomatic bacteriuria (≥104 cfu/Ml) was detected in 8 (6.5%) subjects. The sensitivity and specificity of nitrite test were 37% and 100% respectively. The sensitivity of pus cell count alone and leucocyte esterase test alone were 100% but the specificity of them were 64% and 65% respectively. We found high negative predictive value by Pus cell count and the leucocyte esterase test (100%) and low positive predictive value by them (16% and 17% respectively). Conclusion Urine culture is the most useful test for diagnosis of asymptomatic bacteriuria. None of our screening tests had a sensitivity and specificity of 100%, whereas we can only refer the pregnant women with positive leucocyte esterase test and significant pyuria to the urine culture. PMID:29403616

Racing with friends: Resistance to peer influence, gist and specific risk beliefs.

PubMed

Mirman, Jessica H; Curry, Allison E

2016-11-01

Studies assessing young drivers' risk appraisals with their driving behavior have shown both positive and inverse associations, possibly due to differences in survey items that cue gist appraisals about risk (i.e., beliefs that are focused on meaning) or specific appraisals (i.e., beliefs that are focused on discrete instances). Prior research has indicated that gist-based reasoning is protective against engaging in risk behavior and that use of gist appraisals increases with development. Additionally, although much of adolescents' risk-taking occurs in groups, almost no research examines how adolescents' resistance to peer influence may relate to their specific and gist beliefs about socially-bound risk behavior, as well as their future engagement in such behavior. One hundred and thirty-two adolescent drivers participated in a prospective self-report study on racing behavior. Surveys measured specific and gist risk appraisals, resistance to peer influence, and racing behavior at two time points three months apart. We hypothesized that stronger specific appraisals would be associated with greater likelihood of racing, and stronger gist appraisals would be protective. Further, we hypothesized that resistance to peer influence would be positively associated with gist appraisals and negatively associated with specific risk appraisals; and would also be inversely associate with racing. Specific risk appraisals and gist appraisals were predictive of racing behavior as hypothesized. Resistance to peer influence did not predict racing, but was associated with each type of risk appraisal as predicted at Time 1, although the association between specific risk and resistance to peer influence was non-significant at the second time point. Gist beliefs and the ability to resist influence from friends might be indicative of an underlying strength of one's own beliefs about the self as a non-risk taking person who stands up for his or her beliefs, which is protective against engaging in risky behavior, such as racing with friends. Copyright © 2016 Elsevier Ltd. All rights reserved.

Interleukin-27 is a novel candidate diagnostic biomarker for bacterial infection in critically ill children

PubMed Central

2012-01-01

Introduction Differentiating between sterile inflammation and bacterial infection in critically ill patients with fever and other signs of the systemic inflammatory response syndrome (SIRS) remains a clinical challenge. The objective of our study was to mine an existing genome-wide expression database for the discovery of candidate diagnostic biomarkers to predict the presence of bacterial infection in critically ill children. Methods Genome-wide expression data were compared between patients with SIRS having negative bacterial cultures (n = 21) and patients with sepsis having positive bacterial cultures (n = 60). Differentially expressed genes were subjected to a leave-one-out cross-validation (LOOCV) procedure to predict SIRS or sepsis classes. Serum concentrations of interleukin-27 (IL-27) and procalcitonin (PCT) were compared between 101 patients with SIRS and 130 patients with sepsis. All data represent the first 24 hours of meeting criteria for either SIRS or sepsis. Results Two hundred twenty one gene probes were differentially regulated between patients with SIRS and patients with sepsis. The LOOCV procedure correctly predicted 86% of the SIRS and sepsis classes, and Epstein-Barr virus-induced gene 3 (EBI3) had the highest predictive strength. Computer-assisted image analyses of gene-expression mosaics were able to predict infection with a specificity of 90% and a positive predictive value of 94%. Because EBI3 is a subunit of the heterodimeric cytokine, IL-27, we tested the ability of serum IL-27 protein concentrations to predict infection. At a cut-point value of ≥5 ng/ml, serum IL-27 protein concentrations predicted infection with a specificity and a positive predictive value of >90%, and the overall performance of IL-27 was generally better than that of PCT. A decision tree combining IL-27 and PCT improved overall predictive capacity compared with that of either biomarker alone. Conclusions Genome-wide expression analysis has provided the foundation for the identification of IL-27 as a novel candidate diagnostic biomarker for predicting bacterial infection in critically ill children. Additional studies will be required to test further the diagnostic performance of IL-27. The microarray data reported in this article have been deposited in the Gene Expression Omnibus under accession number GSE4607. PMID:23107287

Electrophysiological evidence for preserved primacy of lexical prediction in aging.

PubMed

Dave, Shruti; Brothers, Trevor A; Traxler, Matthew J; Ferreira, Fernanda; Henderson, John M; Swaab, Tamara Y

2018-05-28

Young adults show consistent neural benefits of predictable contexts when processing upcoming words, but these benefits are less clear-cut in older adults. Here we disentangle the neural correlates of prediction accuracy and contextual support during word processing, in order to test current theories that suggest that neural mechanisms underlying predictive processing are specifically impaired in older adults. During a sentence comprehension task, older and younger readers were asked to predict passage-final words and report the accuracy of these predictions. Age-related reductions were observed for N250 and N400 effects of prediction accuracy, as well as for N400 effects of contextual support independent of prediction accuracy. Furthermore, temporal primacy of predictive processing (i.e., earlier facilitation for successful predictions) was preserved across the lifespan, suggesting that predictive mechanisms are unlikely to be uniquely impaired in older adults. In addition, older adults showed prediction effects on frontal post-N400 positivities (PNPs) that were similar in amplitude to PNPs in young adults. Previous research has shown correlations between verbal fluency and lexical prediction in older adult readers, suggesting that the production system may be linked to capacity for lexical prediction, especially in aging. The current study suggests that verbal fluency modulates PNP effects of contextual support, but not prediction accuracy. Taken together, our findings suggest that aging does not result in specific declines in lexical prediction. Copyright © 2018 Elsevier Ltd. All rights reserved.

The inclusion of N-terminal pro-brain natriuretic peptide in a sensitive screening strategy for systemic sclerosis-related pulmonary arterial hypertension: a cohort study

PubMed Central

2013-01-01

Introduction Pulmonary arterial hypertension (PAH) is a major cause of mortality in systemic sclerosis (SSc). Screening guidelines for PAH recommend multiple investigations, including annual echocardiography, which together have low specificity and may not be cost-effective. We sought to evaluate the predictive accuracy of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in combination with pulmonary function tests (PFT) (‘proposed’ algorithm) in a screening algorithm for SSc-PAH. Methods We evaluated our proposed algorithm (PFT with NT-proBNP) on 49 consecutive SSc patients with suspected pulmonary hypertension undergoing right heart catherisation (RHC). The predictive accuracy of the proposed algorithm was compared with existing screening recommendations, and is presented as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results Overall, 27 patients were found to have pulmonary hypertension (PH) at RHC, while 22 had no PH. The sensitivity, specificity, PPV and NPV of the proposed algorithm for PAH was 94.1%, 54.5%, 61.5% and 92.3%, respectively; current European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines achieved a sensitivity, specificity, PPV and NPV of 94.1%, 31.8%, 51.6% and 87.5%, respectively. In an alternate case scenario analysis, estimating a PAH prevalence of 10%, the proposed algorithm achieved a sensitivity, specificity, PPV and NPV for PAH of 94.1%, 54.5%, 18.7% and 98.8%, respectively. Conclusions The combination of NT-proBNP with PFT is a sensitive, yet simple and non-invasive, screening strategy for SSc-PAH. Patients with a positive screening result can be referred for echocardiography, and further confirmatory testing for PAH. In this way, it may be possible to shift the burden of routine screening away from echocardiography. The findings of this study should be confirmed in larger studies. PMID:24246100

Testing for amphetamine-type stimulant (ATS) use to ascertain validity of self-reported ATS use among young female sex workers in Cambodia.

PubMed

Kab, Vannda; Evans, Jennifer; Sansothy, Neth; Stein, Ellen; Claude-Couture, Marie; Maher, Lisa; Page, Kimberly

2012-06-28

To assess concordance between self-reported amphetamine-type stimulant (ATS) use and toxicology results among young female sex workers (FSW) in Phnom Penh, Cambodia. Cross-sectional data from the Young Women's Health Study-2 (YWHS-2), a prospective study of HIV and ATS use among young (15 to 29 years) FSW in Phnom Penh, Cambodia, was analyzed. The YWHS-2 assessed sociodemographic characteristics, HIV serology, HIV risk, and ATS use by self-report and urine toxicology testing at each quarterly visit, the second of which provided data for this assessment. Outcomes include sensitivity, specificity, positive- and negative predictive values (overall and stratified by age), sex-work setting, and HIV status. Among 200 women, prevalence of positive toxicology screening for ATS use was 14% (95% confidence interval [CI], 9.2, 18.9%) and concurrent prevalence of self-reported ATS was 15.5% (95% CI, 10.4, 20.6%). The sensitivity and specificity of self-reported ATS use compared to positive toxicology test results was 89.3% (25/28), and 96.5% (166/172), respectively. The positive predictive value of self-reported ATS use was 80.6% (25/31); the negative predictive value was 98.2% (166/169). Some differences in concordance between self-report and urine toxicology results were noted in analyses stratified by age group and sex-work setting but not by HIV status. Results indicate a high prevalence of ATS use among FSW in Phnom Penh, Cambodia, and high concordance between self-reported and toxicology-test confirmed ATS use.

Ankle stress test for predicting the need for surgical fixation of isolated fibular fractures.

PubMed

Egol, Kenneth A; Amirtharajah, Mohana; Amirtharage, Mohana; Tejwani, Nirmal C; Capla, Edward L; Koval, Kenneth J

2004-11-01

The purpose of this study was to confirm the prevalence of medial ankle widening among patients with an isolated fibular fracture and to determine the functional outcome of nonoperative treatment despite a diagnosis of a supination-external rotation stage-IV injury based on stress radiography. One hundred and one patients with evidence of an isolated fibular fracture and an intact mortise seen on a standard ankle trauma radiograph series were evaluated with stress radiographs. Clinical signs were recorded at the time of presentation. A positive stress test was defined as > or =4 mm of widening of the medial clear space. Patients with a negative stress test were treated nonoperatively, those with a positive stress test and clinical signs of medial injury were treated surgically, and those with a positive stress test and no signs of medial injury were treated according to the preference of the surgeon and patient. The patients were followed prospectively with radiographs and ankle outcome scores. Sixty-six (65%) of the 101 patients had a positive stress radiograph. Thirty-six of them had signs of medial injury, and thirty had no medial injury. With regard to predicting a positive stress radiograph, medial tenderness had a sensitivity of 56% and a specificity of 80%, swelling had a sensitivity of 55% and a specificity of 71%, and ecchymosis had a sensitivity of 26% and a specificity of 91%. Of the subset of patients without signs of medial injury, twenty were treated nonoperatively (group I) and ten were treated operatively (group II). Two of the twenty patients in group I had evidence of persistent widening of the medial clear space at the time of the latest follow-up (mean, 7.4 months); only one of those patients was symptomatic. The average American Orthopaedic Foot and Ankle Society (AOFAS) score was 94 points in group I and 93 points in group II. We found a high rate of positive stress radiographs for patients who presented with an isolated fibular fracture and an intact ankle mortise on the initial radiographs. Medial tenderness, swelling, and ecchymosis were not sensitive with regard to predicting widening of the medial clear space on stress radiographs. All of the patients with a positive stress radiograph and no clinical symptoms who were treated without surgery had a good or excellent clinical result.

[The prognostic value of gastric metaplasia in the duodenal mucosa in patients with Helicobacter pylori positive duodenal bulb ulcer].

PubMed

Marshalko, O V; Konorev, M R

2008-01-01

The predictive value of gastric metaplasia in the duodenal mucosa in patients Helicobacter pylori-positive patients with duodenal bulb ulcer (DBU) was investigated. One hundred and twenty four randomly selected patients with DBU were included in this prospective study. The detection of Helicobacter pylori (HP) in the stomach and duodenum was carried out with Giemsa (using standard visual analogue scale), rapid urease test (standard Jatrox-HP test, Rohm Pharma, Germany), and polymerase chain reaction (PCR) to detect the specific fragment of ureC HP gene (Helicopol II, Lytech, Russia). Regions of gastric metaplasia of the duodenum were confirmed by periodic acid-Schiff and alcian blue (Serva) staining (pH 1.0; 2.5) Duodenal ulcer (DU) complications were registered within 8 to 10 years. Estimation of the predictive factor (gastric metaplasia in the duodenum) was carried out in patients with non-complicated DU (Group 1; n = 73), and with such complications as bleeding, perforation, penetration, pyloroduodenal stenosis (Group 2; n = 51) which were revealed within the 8 to 10 years of observation. Gastric metaplasia in the duodenum was found in 64 or 87.7% of the 73 patients with non-complicated DU and in 5 or 9.8% of the 51 patients with complicated DU within 8 to 10 years of observation. The following facts about the predictive factor for the prognosis of DU complication were found: the sensitivity of 83.6%, the specificity of 92.8%, the predictive accuracy of 88.7%, the relative risk of the predicted outcome of 7.5, the relative risk of a different outcome of 0.11, the odds ration of 65.4. The study revealed a high and significant (p < 0.001) predictive value of gastric metaplasia in the duodenum as a marker of non-complicated clinical course of DU in HP-positive patients within an 8 to 10-year period.

Rapid detection of Mycobacterium tuberculosis and rifampicin resistance in extrapulmonary tuberculosis and sputum smear-negative pulmonary suspects using Xpert MTB/RIF.

PubMed

Ullah, Irfan; Javaid, Arshad; Masud, Haleema; Ali, Mazhar; Basit, Anila; Ahmad, Waqas; Younis, Faisal; Yasmin, Rehana; Khan, Afsar; Jabbar, Abdul; Husain, Masroor; Butt, Zahid Ahmad

2017-04-01

Tuberculosis (TB) is a serious public health problem in developing countries such as Pakistan. Rapid diagnosis of TB and detection of drug resistance are very important for timely and appropriate management of multidrug-resistant TB (MDR-TB). The purpose of this study was to determine the diagnostic efficacy of the Xpert MTB/RIF assay for rapid diagnosis of TB and detection of rifampicin (RIF) resistance in extrapulmonary and smear-negative pulmonary TB suspects. A total of 98 bronchoalveolar lavage fluid (BALF) and 168 extrapulmonary specimens were processed by Xpert MTB/RIF. Culture results are considered as the gold standard for diagnosis of TB, and drug susceptibility testing for detection of RIF resistance. Diagnostic efficacy was measured in terms of sensitivity, specificity and positive and negative predictive values. The Xpert MTB/RIF assay detected 40 (40.8 %) of 98 BALF of presumptive pulmonary TB and 60 (35.7 %) of 168 extrapulmonary specimens. Sensitivity and specificity of the Xpert MTB/RIF assay for detection of TB was 86 and 88.4 %, respectively. The positive predictive value was 71.5 % while negative predictive value was 95.1 %. The Xpert MTB/RIF assay is a rapid and simple technique with high sensitivity and specificity for diagnosing TB and detecting drug resistance in extrapulmonary and smear-negative TB cases.

Comparison of a Clinical Prediction Rule and a LAM Antigen-Detection Assay for the Rapid Diagnosis of TBM in a High HIV Prevalence Setting

PubMed Central

Patel, Vinod B.; Singh, Ravesh; Connolly, Cathy; Kasprowicz, Victoria; Zumla, Allimudin; Ndungu, Thumbi; Dheda, Keertan

2010-01-01

Background/Objective The diagnosis of tuberculous meningitis (TBM) in resource poor TB endemic environments is challenging. The accuracy of current tools for the rapid diagnosis of TBM is suboptimal. We sought to develop a clinical-prediction rule for the diagnosis of TBM in a high HIV prevalence setting, and to compare performance outcomes to conventional diagnostic modalities and a novel lipoarabinomannan (LAM) antigen detection test (Clearview-TB®) using cerebrospinal fluid (CSF). Methods Patients with suspected TBM were classified as definite-TBM (CSF culture or PCR positive), probable-TBM and non-TBM. Results Of the 150 patients, 84% were HIV-infected (median [IQR] CD4 count = 132 [54; 241] cells/µl). There were 39, 55 and 54 patients in the definite, probable and non-TBM groups, respectively. The LAM sensitivity and specificity (95%CI) was 31% (17;48) and 94% (85;99), respectively (cut-point ≥0.18). By contrast, smear-microscopy was 100% specific but detected none of the definite-TBM cases. LAM positivity was associated with HIV co-infection and low CD4 T cell count (CD4<200 vs. >200 cells/µl; p = 0.03). The sensitivity and specificity in those with a CD4<100 cells/µl was 50% (27;73) and 95% (74;99), respectively. A clinical-prediction rule ≥6 derived from multivariate analysis had a sensitivity and specificity (95%CI) of 47% (31;64) and 98% (90;100), respectively. When LAM was combined with the clinical-prediction-rule, the sensitivity increased significantly (p<0.001) to 63% (47;68) and specificity remained high at 93% (82;98). Conclusions Despite its modest sensitivity the LAM ELISA is an accurate rapid rule-in test for TBM that has incremental value over smear-microscopy. The rule-in value of LAM can be further increased by combination with a clinical-prediction rule, thus enhancing the rapid diagnosis of TBM in HIV-infected persons with advanced immunosuppression. PMID:21203513

Predictive and concurrent validity of the Braden scale in long-term care: a meta-analysis.

PubMed

Wilchesky, Machelle; Lungu, Ovidiu

2015-01-01

Pressure ulcer prevention is an important long-term care (LTC) quality indicator. While the Braden Scale is a recommended risk assessment tool, there is a paucity of information specifically pertaining to its validity within the LTC setting. We, therefore, undertook a systematic review and meta-analysis comparing Braden Scale predictive and concurrent validity within this context. We searched the Medline, EMBASE, PsychINFO and PubMed databases from 1985-2014 for studies containing the requisite information to analyze tool validity. Our initial search yielded 3,773 articles. Eleven datasets emanating from nine published studies describing 40,361 residents met all meta-analysis inclusion criteria and were analyzed using random effects models. Pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive values were 86%, 38%, 28%, and 93%, respectively. Specificity was poorer in concurrent samples as compared with predictive samples (38% vs. 72%), while PPV was low in both sample types (25 and 37%). Though random effects model results showed that the Scale had good overall predictive ability [RR, 4.33; 95% CI, 3.28-5.72], none of the concurrent samples were found to have "optimal" sensitivity and specificity. In conclusion, the appropriateness of the Braden Scale in LTC is questionable given its low specificity and PPV, in particular in concurrent validity studies. Future studies should further explore the extent to which the apparent low validity of the Scale in LTC is due to the choice of cutoff point and/or preventive strategies implemented by LTC staff as a matter of course. © 2015 by the Wound Healing Society.

Issues in the Development of the AIDMAN VISION SCREENER

DTIC Science & Technology

1990-12-01

relationship between the P-T ratio and disease prevalence . As indicated in the bottom portion of Figure 2, the predictive value of any screening test is...absence of disease/injury The Importance of Disease/Injury Prevalence Disease Prevalence - (TP + FN) / TOTAL The specificity and sensitivity The positive...and negative (and their corresponding inverses) predictive values of a given test of a given test are not affected by disease prevalence ! are affected

TargetMiner: microRNA target prediction with systematic identification of tissue-specific negative examples.

PubMed

Bandyopadhyay, Sanghamitra; Mitra, Ramkrishna

2009-10-15

Prediction of microRNA (miRNA) target mRNAs using machine learning approaches is an important area of research. However, most of the methods suffer from either high false positive or false negative rates. One reason for this is the marked deficiency of negative examples or miRNA non-target pairs. Systematic identification of non-target mRNAs is still not addressed properly, and therefore, current machine learning approaches are compelled to rely on artificially generated negative examples for training. In this article, we have identified approximately 300 tissue-specific negative examples using a novel approach that involves expression profiling of both miRNAs and mRNAs, miRNA-mRNA structural interactions and seed-site conservation. The newly generated negative examples are validated with pSILAC dataset, which elucidate the fact that the identified non-targets are indeed non-targets.These high-throughput tissue-specific negative examples and a set of experimentally verified positive examples are then used to build a system called TargetMiner, a support vector machine (SVM)-based classifier. In addition to assessing the prediction accuracy on cross-validation experiments, TargetMiner has been validated with a completely independent experimental test dataset. Our method outperforms 10 existing target prediction algorithms and provides a good balance between sensitivity and specificity that is not reflected in the existing methods. We achieve a significantly higher sensitivity and specificity of 69% and 67.8% based on a pool of 90 feature set and 76.5% and 66.1% using a set of 30 selected feature set on the completely independent test dataset. In order to establish the effectiveness of the systematically generated negative examples, the SVM is trained using a different set of negative data generated using the method in Yousef et al. A significantly higher false positive rate (70.6%) is observed when tested on the independent set, while all other factors are kept the same. Again, when an existing method (NBmiRTar) is executed with the our proposed negative data, we observe an improvement in its performance. These clearly establish the effectiveness of the proposed approach of selecting the negative examples systematically. TargetMiner is now available as an online tool at www.isical.ac.in/ approximately bioinfo_miu

The Role of Fine Needle Aspiration in the Diagnosis of Parotid Gland Tumors: Correlation With Preoperative Computerized Tomography Tumor Size.

PubMed

Ghantous, Yasmine; Naddaf, Raja; Barak, Michal; Abd-Elraziq, Murad; Abu Eln-Naaj, Imad

2016-03-01

The role of fine needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses is still controversial, regarding its sensitivity and specificity that vary between 41% and 100% and between 86% and 100% respectively.The aim of this study was to identify the specificity and sensitivity of FNAC of parotid gland tumors in relation to the tumor size as characterized preoperatively by computer tomography. The medical files of 79 patients whom were referred to the MaxilloFacila Surgery Department, Rambam medical center, over a 10.5-year period (2000-2010) were analyzed retrospectively.The extensity of the operation was determined by the location of the tumor as presented in computed tomography (CT) radiography, and preoperative FNAC examination.The majority of the masses were located in the superficial lobe (88.52%), and only 11.48% of the patients were located in the deep lobe (8:1 ratio). FNAC results were nondiagnostic in 7 patients (8.86%), 62 patients were diagnosed as inflammatory and benign lesion in (78.48%), malignant tumors were diagnosed in 10 patients (12.65%).The sensitivity in our study was 90%, the specificity was 98%, positive predictive value was 90%, negative predictive value was 98%, and diagnostic accuracy was 88%. The positive predictive value was 90%, the negative predictive value was 98%.Analyzing the effect of the preoperative CT size upon the accuracy of the FNAC diagnosis, we found that lesion with preoperative CT size greater than 24 mm has a more accurate FNAC result (P = 0.034).

Whole blood FPR1 mRNA expression predicts both non‐small cell and small cell lung cancer

PubMed Central

Vachani, Anil; Pass, Harvey I.; Rom, William N.; Ryden, Kirk; Weiss, Glen J.; Hogarth, D. K.; Runger, George; Richards, Donald; Shelton, Troy; Mallery, David W.

2018-01-01

While long‐term survival rates for early‐stage lung cancer are high, most cases are diagnosed in later stages that can negatively impact survival rates. We aim to design a simple, single biomarker blood test for early‐stage lung cancer that is robust to preclinical variables and can be readily implemented in the clinic. Whole blood was collected in PAXgene tubes from a training set of 29 patients, and a validation set of 260 patients, of which samples from 58 patients were prospectively collected in a clinical trial specifically for our study. After RNA was extracted, the expressions of FPR1 and a reference gene were quantified by an automated one‐step Taqman RT‐PCR assay. Elevated levels of FPR1 mRNA in whole blood predicted lung cancer status with a sensitivity of 55% and a specificity of 87% on all validation specimens. The prospectively collected specimens had a significantly higher 68% sensitivity and 89% specificity. Results from patients with benign nodules were similar to healthy volunteers. No meaningful correlation was present between our test results and any clinical characteristic other than lung cancer diagnosis. FPR1 mRNA levels in whole blood can predict the presence of lung cancer. Using this as a reflex test for positive lung cancer screening computed tomography scans has the potential to increase the positive predictive value. This marker can be easily measured in an automated process utilizing off‐the‐shelf equipment and reagents. Further work is justified to explain the source of this biomarker. PMID:29313979

Validation of the Hospital Anxiety and Depression Scale in patients with epilepsy.

PubMed

Wiglusz, Mariusz S; Landowski, Jerzy; Michalak, Lidia; Cubała, Wiesław J

2016-05-01

Despite the fact that depressive disorders are the most common comorbidities among patients with epilepsy (PWEs), they often go unrecognized and untreated. The availability of validated screening instruments to detect depression in PWEs is limited. The aim of the present study was to validate the Hospital Anxiety and Depression Scale (HADS) in adult PWEs. A consecutive group of 118 outpatient PWEs was invited to participate in the study. Ninety-six patients met inclusion criteria, completed HADS, and were examined by a trained psychiatrist using Structured Clinical Interview (SCID-I) for DSM-IV-TR. Receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores for the HADS depression subscale (HADS-D). Receiver operating characteristic analyses showed areas under the curve at approximately 84%. For diagnoses of MDD, the HADS-D demonstrated the best psychometric properties for a cutoff score ≥7 with sensitivity of 90.5%, specificity of 70.7%, positive predictive value of 46.3%, and negative predictive value of 96.4%. In the case of the group with 'any depressive disorder', the HADS-D optimum cutoff score was ≥6 with sensitivity of 82.5%, specificity of 73.2%, positive predictive value of 68.8%, and negative predictive value of 85.4%. The HADS-D proved to be a valid and reliable psychometric instrument in terms of screening for depressive disorders in PWEs. In the epilepsy setting, HADS-D maintains adequate sensitivity, acceptable specificity, and high NPV but low PPV for diagnosing MDD with an optimum cutoff score ≥7. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

Use of serologic tests to predict resistance to Canine distemper virus-induced disease in vaccinated dogs.

PubMed

Jensen, Wayne A; Totten, Janet S; Lappin, Michael R; Schultz, Ronald D

2015-09-01

The objective of the current study was to determine whether detection of Canine distemper virus (CDV)-specific serum antibodies correlates with resistance to challenge with virulent virus. Virus neutralization (VN) assay results were compared with resistance to viral challenge in 2 unvaccinated Beagle puppies, 9 unvaccinated Beagle dogs (4.4-7.2 years of age), and 9 vaccinated Beagle dogs (3.7-4.7 years of age). Eight of 9 (89%) unvaccinated adult dogs exhibited clinical signs after virus challenge, and 1 (13%) dog died. As compared to adult dogs, the 2 unvaccinated puppies developed more severe clinical signs and either died or were euthanized after challenge. In contrast, no clinical signs were detected after challenge of the 9 adult vaccinated dogs with post-vaccination intervals of up to 4.4 years. In vaccinated dogs, the positive and negative predictive values of VN assay results for resistance to challenge were 100% and 0%, respectively. Results indicate that dogs vaccinated with modified live CDV can be protected from challenge for ≤4.4 years postvaccination and that detection of virus-specific antibodies is predictive of whether dogs are resistant to challenge with virulent virus. Results also indicate that CDV infection in unvaccinated dogs results in age-dependent morbidity and mortality. Knowledge of age-dependent morbidity and mortality, duration of vaccine-induced immunity, and the positive and negative predictive values of detection of virus-specific serum antibodies are useful in development of rational booster vaccination intervals for the prevention of CDV-mediated disease in adult dogs. © 2015 The Author(s).

Clinician Suspicion of an Alcohol Problem: An Observational Study From the AAFP National Research Network

PubMed Central

Vinson, Daniel C.; Turner, Barbara J.; MSED; Manning, Brian K.; Galliher, James M.

2013-01-01

PURPOSE In clinical practice, detection of alcohol problems often relies on clinician suspicion instead of using a screening instrument. We assessed the sensitivity, specificity, and predictive values of clinician suspicion compared with screening-detected alcohol problems in patients. METHODS We undertook a cross-sectional study of 94 primary care clinicians’ office visits. Brief questionnaires were completed separately after a visit by both clinicians and eligible patients. The patient’s anonymous exit questionnaire screened for hazardous drinking based on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and for harmful drinking (alcohol abuse or dependence) based on 2 questions from the Diagnostic and Statistical Manual of Mental Disorders. After the visit, clinicians responded to the question, “Does this patient have problems with alcohol?” with answer options including “yes, hazardous drinking” and “yes, alcohol abuse or dependence.” Analyses assessed the associations between patients’ responses to screening questions and clinician’s suspicions. RESULTS Of 2,518 patients with an office visit, 2,173 were eligible, and 1,699 (78%) completed the exit questionnaire. One hundred seventy-one (10.1%) patients had a positive screening test for hazardous drinking (an AUDIT-C score of 5 or greater) and 64 (3.8%) for harmful drinking. Clinicians suspected alcohol problems in 81 patients (hazardous drinking in 37, harmful drinking in 40, and both in 4). The sensitivity of clinician suspicion of either hazardous or harmful drinking was 27% and the specificity was 98%. Positive and negative predictive values were 62% and 92%, respectively. CONCLUSION Clinician suspicion of alcohol problems had poor sensitivity but high specificity for identifying patients who had a positive screening test for alcohol problems. These data support the routine use of a screening tool to supplement clinicians’ suspicions, which already provide reasonable positive predictive value. PMID:23319506

Evaluation of Xpert MTB/RIF Versus AFB Smear and Culture to Identify Pulmonary Tuberculosis in Patients With Suspected Tuberculosis From Low and Higher Prevalence Settings

PubMed Central

Luetkemeyer, Anne F.; Firnhaber, Cynthia; Kendall, Michelle A.; Wu, Xingye; Mazurek, Gerald H.; Benator, Debra A.; Arduino, Roberto; Fernandez, Michel; Guy, Elizabeth; Johnson, Pamela; Metchock, Beverly; Sattler, Fred; Telzak, Edward; Wang, Yun F.; Weiner, Marc; Swindells, Susan; Sanne, Ian M.; Havlir, Diane V.; Grinsztejn, Beatriz; Alland, David

2016-01-01

Background. The Xpert MTB/RIF (Xpert) assay is a rapid nucleic acid amplification test widely used in settings of high tuberculosis prevalence to detect tuberculosis as well as rpoB mutations associated with rifampin resistance. Data are needed on the diagnostic performance of Xpert in lower-prevalence settings to inform appropriate use for both tuberculosis detection and the need for respiratory isolation. Methods. Xpert was compared to 2 sputum samples, each evaluated with acid-fast bacilli (AFB) smear and mycobacterial culture using liquid and solid culture media, from participants with suspected pulmonary tuberculosis from the United States, Brazil, and South Africa. Results. Of 992 participants enrolled with evaluable results, 22% had culture-confirmed tuberculosis. In 638 (64%) US participants, 1 Xpert result demonstrated sensitivity of 85.2% (96.7% in participants with AFB smear-positive [AFB+] sputum, 59.3% with AFB smear-negative [AFB–] sputum), specificity of 99.2%, negative predictive value (NPV) of 97.6%, and positive predictive value of 94.9%. Results did not differ between higher- and low-prevalence settings. A second Xpert assay increased overall sensitivity to 91.1% (100% if AFB+, 71.4% if AFB–), with specificity of 98.9%. In US participants, a single negative Xpert result predicted the absence of AFB+/culture-positive tuberculosis with an NPV of 99.7%; NPV of 2 Xpert assays was 100%, suggesting a role in removing patients from airborne infection isolation. Xpert detected tuberculosis DNA and mutations associated with rifampin resistance in 5 of 7 participants with rifampin-resistant, culture-positive tuberculosis. Specificity for rifampin resistance was 99.5% and NPV was 98.9%. Conclusions. In the United States, Xpert testing performed comparably to 2 higher-tuberculosis-prevalence settings. These data support the use of Xpert in the initial evaluation of tuberculosis suspects and in algorithms assessing need for respiratory isolation. PMID:26839383

Predicting Positive and Negative Relationships in Large Social Networks.

PubMed

Wang, Guan-Nan; Gao, Hui; Chen, Lian; Mensah, Dennis N A; Fu, Yan

2015-01-01

In a social network, users hold and express positive and negative attitudes (e.g. support/opposition) towards other users. Those attitudes exhibit some kind of binary relationships among the users, which play an important role in social network analysis. However, some of those binary relationships are likely to be latent as the scale of social network increases. The essence of predicting latent binary relationships have recently began to draw researchers' attention. In this paper, we propose a machine learning algorithm for predicting positive and negative relationships in social networks inspired by structural balance theory and social status theory. More specifically, we show that when two users in the network have fewer common neighbors, the prediction accuracy of the relationship between them deteriorates. Accordingly, in the training phase, we propose a segment-based training framework to divide the training data into two subsets according to the number of common neighbors between users, and build a prediction model for each subset based on support vector machine (SVM). Moreover, to deal with large-scale social network data, we employ a sampling strategy that selects small amount of training data while maintaining high accuracy of prediction. We compare our algorithm with traditional algorithms and adaptive boosting of them. Experimental results of typical data sets show that our algorithm can deal with large social networks and consistently outperforms other methods.

Validation of the cephalosporin intradermal skin test for predicting immediate hypersensitivity: a prospective study with drug challenge.

PubMed

Yoon, S-Y; Park, S Y; Kim, S; Lee, T; Lee, Y S; Kwon, H-S; Cho, Y S; Moon, H-B; Kim, T-B

2013-07-01

Cephalosporin is a major offending agent in terms of drug hypersensitivity along with penicillin. Cephalosporin intradermal skin tests (IDTs) have been widely used; however, their validity for predicting immediate hypersensitivity has not been studied. This study aimed to determine the predictive value of cephalosporin intradermal skin testing before administration of the drug. We prospectively conducted IDTs with four cephalosporins, one each of selected first-, second-, third-, or fourth-generation cephalosporins: ceftezol; cefotetan or cefamandole; ceftriaxone or cefotaxime; and flomoxef, respectively, as well as with penicillin G. After the skin test, whatever the result, one of the tested cephalosporins was administered intravenously and the patient was carefully observed. We recruited 1421 patients who required preoperative cephalosporins. Seventy-four patients (74/1421, 5.2%) were positive to at least one cephalosporin. However, none of responders had immediate hypersensitivity reactions after a challenge dose of the same or different cephalosporin, which were positive in the skin test. Four patients who suffered generalized urticaria and itching after challenge gave negative skin tests for the corresponding drug. The IDT for cephalosporin had a sensitivity of 0%, a specificity of 97.5%, a negative predictive value of 99.7%, and a positive predictive value (PPV) of 0%, when challenged with the same drugs that were positive in the skin test. Routine skin testing with a cephalosporin before its administration is not useful for predicting immediate hypersensitivity because of the extremely low sensitivity and PPV of the skin test (CRIS registration no. KCT0000455). © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Comparison of Selamectin and Imidacloprid plus Permethrin in Eliminating Leporacarus gibbus Infestation in Laboratory Rabbits (Oryctolagus cuniculus)

PubMed Central

Birke, Leslie L; Molina, Patricia E; Baker, David G; Leonard, Stuart T; Marrero, Luis J; Johnson, Merlin; Simkin, Jennifer

2009-01-01

A shipment of New Zealand white rabbits was infested with Leporacarus gibbus, a rabbit fur mite. This study compared the effectiveness of selamectin with that of imidocloprid plus permethrin in eliminating the mite infestation. Rabbits were divided into 2 groups, and either selamectin or imidocloprid plus permethrin was applied topically. Visual and microscopic examinations were performed on days 0, 1, 2, 3, 4, 5, 6, 13, and 27 for 5 sites (the left and right gluteal areas, neck, ventral tail, and abdomen). Mean percentage effectiveness for each treatment was calculated for each time point. Positive and negative predictive value, sensitivity, and specificity of visual examination were determined relative to microscopic assessment. In addition, location prevalence for the mites was determined. Both treatments were 100% effective by day 13, but selamectin was 100% effective by day 3. The positive predictive value of visual examination was 96%, its negative predictive value was 86%, sensitivity was 75%, and specificity was 98%. Parasite burden was most prevalent on the right and left gluteal areas. We conclude that although both imidocloprid plus permethrin and selamectin were effective against L. gibbus, treatment with selamectin more rapidly eliminated the infestation. PMID:19930824

Pharmacy Student Attitudes and Willingness to Engage in Care with People Living with HIV/AIDS

PubMed Central

Furtek, Kari J.; Malladi, Ruthvik; Ng, Eric; Zhou, Maria

2016-01-01

Objective. To describe the extent to which pharmacy students hold negative attitudes toward people living with HIV/AIDS (PLWHA) and to determine whether background variables, student knowledge, and professional attitudes may affect willingness to care for PLWHA. Methods. An online survey tool was developed and administered to 150 pharmacy students in their third professional year. Descriptive and stepwise multivariate regressions were performed. Results. While descriptive results showed a majority of respondents had favorable professional attitudes towards caring for PLWHA, most pharmacy students expressed discomfort with specific attitudes about being in close physical contact and receiving selected services from PLWHA. Multivariate results revealed that: (1) being a minority predicted greater knowledge; (2) having received prior HIV instruction and greater HIV knowledge predicted more positive professional attitudes caring for PLWHA; (3) being more socially liberal, having more positive professional attitudes caring for PLWHA, and having greater empathy towards PLWHA predicted student willingness to provide services. Conclusion. Future educational interventions specifically targeted toward socially conservative whites may impact greater student willingness to care for PLWHA. Additional research should also explore the generalizability of the present findings and modeling to pharmacy students in other regions of the country. PMID:27170816

White Students Reflecting on Whiteness: Understanding Emotional Responses

PubMed Central

Todd, Nathan R.; Spanierman, Lisa B.; Aber, Mark S.

2010-01-01

In the present investigation, the authors explored potential predictors of White students’ general emotional responses after they reflected on their Whiteness in a semi-structured interview (n = 88) or written reflection (n = 187). Specifically, the authors examined how color-blindness (i.e., awareness of White privilege) and racial affect (i.e., White empathy, White guilt, and White fear), assessed before the interview or written reflection, may predict positive and negative emotional responses, assessed immediately following the interview or written reflection. Furthermore, the authors considered whether affective costs of racism to Whites moderated the association between racial color-blindness and general positive and negative emotional responses of White students. Findings indicated that affective costs of racism moderated associations between racial color-blindness and general emotional responses. Specifically, White fear moderated associations for the written reflection group whereas White empathy moderated an association in the interview. White guilt did not moderate, but instead directly predicted a negative emotional response in the written reflection group. Findings suggest that the interaction between racial color-blindness and racial affect is important when predicting students’ emotional responses to reflecting on their Whiteness. Implications for educators and administrators are discussed. PMID:20657811

Validation of a Screening Questionnaire for Chronic Leg Ulcers.

PubMed

Zarchi, Kian; Theut Riis, Peter; Graversgaard, Christine; Miller, Iben M; Heidenheim, Michael; Jemec, Gregor B E

2016-12-01

The use of a validated screening questionnaire to identify individuals with chronic leg ulcers allows large-scale population-based studies to be conducted that measure and monitor the prevalence of the disease. The aim of this study was to design and validate such a screening questionnaire to identify patients with chronic leg ulcers. A simple 3-item questionnaire was developed at the Department of Dermatology, University Hospital of Zealand, Denmark. In total, 90 patients attending the department's outpatient clinic for dermatological diseases and chronic wounds were included in this study. All included participants completed the questionnaire and were subsequently examined by dermatologists. We found that the constructed 3-item questionnaire in this study had a sensitivity and specificity of 95% and 93% and a positive predictive value and negative predictive value of 78% and 95%, respectively. Moreover, we found that the use of the 3-item questionnaire, as compared with a single question, in which the participants were asked whether they currently have a leg ulcer, resulted in significantly higher positive predictive value (+11.6%, P = .035) and specificity (+5.6%, P = .046) of the diagnostic test. Future studies are merited to investigate the diagnostic accuracy of the questionnaire in other populations and settings.

The predictive value of MRI in detecting thyroid gland invasion in patients with advanced laryngeal or hypopharyngeal carcinoma.

PubMed

Lin, Peiliang; Huang, Xiaoming; Zheng, Chushan; Cai, Qian; Guan, Zhong; Liang, Faya; Zheng, Yiqing

2017-01-01

The aim of this study was to evaluate the predictive value of magnetic resonance imaging (MRI) in detecting thyroid gland invasion (TGI) in patients with advanced laryngeal or hypopharyngeal carcinoma. In a retrospective chart review, 41 patients with advanced laryngeal or hypopharyngeal carcinoma underwent MRI scan before total laryngectomy and ipsilateral or bilateral thyroidectomy during the past 5 years. The MRI findings were compared with the postoperative pathological results. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Among the 41 patients, 3 had thyroid gland invasion in postoperative pathological results. MRI correctly predicted the absence of TGI in 37 of 38 patients and TGI in all 3 patients. The sensitivity, specificity, PPV, and NPV of MRI were 100.0, 97.4, 75.0, and 100 %, respectively, with the diagnostic accuracy of 97.6 %. In consideration of the high negative predictive value of MRI, it may help surgeons selectively preserve thyroid gland in total laryngectomy and reduce the incidence of hypothyroidism and hypoparathyroidism postoperatively.

Prediction of multi-drug resistance transporters using a novel sequence analysis method [version 2; referees: 2 approved

DOE PAGES

McDermott, Jason E.; Bruillard, Paul; Overall, Christopher C.; ...

2015-03-09

There are many examples of groups of proteins that have similar function, but the determinants of functional specificity may be hidden by lack of sequencesimilarity, or by large groups of similar sequences with different functions. Transporters are one such protein group in that the general function, transport, can be easily inferred from the sequence, but the substrate specificity can be impossible to predict from sequence with current methods. In this paper we describe a linguistic-based approach to identify functional patterns from groups of unaligned protein sequences and its application to predict multi-drug resistance transporters (MDRs) from bacteria. We first showmore » that our method can recreate known patterns from PROSITE for several motifs from unaligned sequences. We then show that the method, MDRpred, can predict MDRs with greater accuracy and positive predictive value than a collection of currently available family-based models from the Pfam database. Finally, we apply MDRpred to a large collection of protein sequences from an environmental microbiome study to make novel predictions about drug resistance in a potential environmental reservoir.« less

Development and Initial Validation of the Pain Resilience Scale.

PubMed

Slepian, P Maxwell; Ankawi, Brett; Himawan, Lina K; France, Christopher R

2016-04-01

Over the past decade, the role of positive psychology in pain experience has gained increasing attention. One such positive factor, identified as resilience, has been defined as the ability to maintain positive emotional and physical functioning despite physical or psychological adversity. Although cross-situational measures of resilience have been shown to be related to pain, it was hypothesized that a pain-specific resilience measure would serve as a stronger predictor of acute pain experience. To test this hypothesis, we conducted a series of studies to develop and validate the Pain Resilience Scale. Study 1 described exploratory and confirmatory factor analyses that support a scale with 2 distinct factors, Cognitive/Affective Positivity and Behavioral Perseverance. Study 2 showed test-retest reliability and construct validity of this new scale, including moderate positive relationships with measures of positive psychological functioning and small to moderate negative relationships with vulnerability measures such as pain catastrophizing. Finally, consistent with our initial hypothesis, study 3 showed that the Pain Resilience Scale is more strongly related to ischemic pain responses than existing measures of general resilience. Together, these studies support the predictive utility of this new pain-specific measure of resilience in the context of acute experimental pain. The Pain Resilience Scale represents a novel measure of Cognitive/Affective Positivity and Behavioral Perseverance during exposure to noxious stimuli. Construct validity is supported by expected relationships with existing pain-coping measures, and predictive validity is shown by individual differences in response to acute experimental pain. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Evaluation of a commercial IgE ELISA in comparison with IgA and IgM ELISAs, IgG avidity assay and complement fixation for the diagnosis of acute toxoplasmosis.

PubMed

Kodym, P; Machala, L; Rohácová, H; Sirocká, B; Malý, M

2007-01-01

A panel of sera from patients with known case histories representative of acute toxoplasmosis (primarily lymphadenopathy, n = 106), latent toxoplasmosis (asymptomatic, n = 368) and negative samples (n = 54) was used to evaluate the capacity of five serological tests to differentiate among patients with acute or latent toxoplasmosis and non-infected individuals. Positive IgA, IgE and IgM ELISA results and low IgG avidity and complement fixation test (CFT) titres of >or=256 were considered to be indicative of acute toxoplasmosis. The most sensitive methods were IgM ELISA (98.1%) and CFT (97.1%), albeit with low specificity (65.0% and 64.5%, respectively) and positive predictive values (43.3% and 42.7%, respectively). IgG avidity assay and IgE ELISA had the highest specificity (97.7% and 91.7%, respectively) and the highest positive predictive values (89.4% and 75.6%, respectively). The best association between serological results and clinical findings was obtained with IgE ELISA (86%, as expressed via Youden's index). In a subset of 259 samples categorised by the period between the onset of clinical symptoms and sampling, >50% of patients had enlarged lymph nodes for <4 months, despite a broad range of differences. However, IgM remained positive for 12-18 months, IgA for 6-9 months and IgE for 4-6 months. IgG avidity remained low for a maximum of 4 months, after which avidity increased despite the persistence of enlarged lymph nodes and a positive IgE assay. Detection of IgE appears to be a highly specific test for confirming the acute nature of Toxoplasma infections that have been detected by other sensitive methods.

Unacceptably High Error Rates in Vitek 2 Testing of Cefepime Susceptibility in Extended-Spectrum-β-Lactamase-Producing Escherichia coli

PubMed Central

Rhodes, Nathaniel J.; Richardson, Chad L.; Heraty, Ryan; Liu, Jiajun; Malczynski, Michael; Qi, Chao

2014-01-01

While a lack of concordance is known between gold standard MIC determinations and Vitek 2, the magnitude of the discrepancy and its impact on treatment decisions for extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli are not. Clinical isolates of ESBL-producing E. coli were collected from blood, tissue, and body fluid samples from January 2003 to July 2009. Resistance genotypes were identified by PCR. Primary analyses evaluated the discordance between Vitek 2 and gold standard methods using cefepime susceptibility breakpoint cutoff values of 8, 4, and 2 μg/ml. The discrepancies in MICs between the methods were classified per convention as very major, major, and minor errors. Sensitivity, specificity, and positive and negative predictive values for susceptibility classifications were calculated. A total of 304 isolates were identified; 59% (179) of the isolates carried blaCTX-M, 47% (143) carried blaTEM, and 4% (12) carried blaSHV. At a breakpoint MIC of 8 μg/ml, Vitek 2 produced a categorical agreement of 66.8% and exhibited very major, major, and minor error rates of 23% (20/87 isolates), 5.1% (8/157 isolates), and 24% (73/304), respectively. The sensitivity, specificity, and positive and negative predictive values for a susceptibility breakpoint of 8 μg/ml were 94.9%, 61.2%, 72.3%, and 91.8%, respectively. The sensitivity, specificity, and positive and negative predictive values for a susceptibility breakpoint of 2 μg/ml were 83.8%, 65.3%, 41%, and 93.3%, respectively. Vitek 2 results in unacceptably high error rates for cefepime compared to those of agar dilution for ESBL-producing E. coli. Clinicians should be wary of making treatment decisions on the basis of Vitek 2 susceptibility results for ESBL-producing E. coli. PMID:24752253

Valuation of life in old and very old age: the role of sociodemographic, social, and health resources for positive adaptation.

PubMed

Jopp, Daniela; Rott, Christoph; Oswald, Frank

2008-10-01

Valuation of life (VOL) represents a construct capturing active attachment to life put forward by M. P. Lawton (e.g., 1999). As old and very old individuals may differ in terms of endorsement and with respect to what makes a life worth living, the present study investigated whether mean levels and the explanatory value of sociodemographic, social, and health predictors for VOL differ between young-old and old-old individuals. We presented a sample of 356 community-dwelling individuals aged 65 to 94 years with Lawton's Positive Valuation of Life Scale and established measures to assess predictors of VOL. Mean levels of VOL decreased from the third to the fourth age. Zero-order correlations showed significant relations between sociodemographic (i.e., age, gender, marital status, education), social (i.e., social contacts, phone calls, volunteering, contact with youth), and health (i.e., mobility, vision, hearing, activity restrictions, activity of daily living [ADL], instrumental ADL [IADL]) indicators. Regression analyses for the domain-specific predictors reduced the number of significant predictors to age, education, grandchildren, vision, and IADLs. When combining all sets of predictors, health explained twice as much variance in VOL compared to social indicators; sociodemographic indicators including age made no independent contribution. Separate analysis for young-old and old-old participants revealed age-differential prediction patterns. For the young-old, the role of health factors was especially strong, whereas specific social factors became more important in the old-old group. Age-differential predictive values of the resources seem to indicate positive adaptation to aging. Taking into account such prediction patterns may help to design specific interventions for young-old and old-old individuals.

Utility of Exercise Testing and Adenosine Response for Risk Assessment in Children with Wolff-Parkinson-White Syndrome.

PubMed

Ergul, Yakup; Ozturk, Erkut; Ozyilmaz, Isa; Unsal, Serkan; Carus, Hayat; Tola, Hasan Tahsin; Tanidir, Ibrahim Cansaran; Guzeltas, Alper

2015-01-01

We aimed to determine the correlation between noninvasive testing (exercise stress testing [EST] and adenosine responsiveness of accessory pathway [AP] ) and invasive electrophysiology study (EPS) for assessment antegrade conduction of the AP in Wolff-Parkinson-White syndrome. This prospective, observational study enrolled 40 children (58% male children, median age of 13 years, and median weight of 47.5 kg) with Wolff-Parkinson-White syndrome. Conduction through the AP to a cycle length of ≤250 ms was considered rapid or high-risk; otherwise, patients were nonrapid or low-risk. The sudden disappearance of the delta-wave was seen in 10 cases (25%) during EST. Accessory pathway was found to be high-risk in 13 cases (13/40, 32.5%) while the accessory path was identified as low-risk in 27 cases; however, six patients (15%) had blocked AP conduction with adenosine during EPS. Low-risk classification by EST alone to identify patients with nonrapid conduction in baseline EPS had a specificity of 93% and a positive predictive value of 90% (accuracy 54%). Blocked AP conduction with adenosine as a marker of nonrapid baseline AP conduction had a specificity of 93% and a positive predictive value of 84%. Finally, AP was adenosine nonresponsive in the majority of patients (28/30, 93%) with persistent delta-waves, 40% of those who had a sudden disappearance of delta-waves had an adenosine-responsive AP (P value: .028). Abrupt loss of preexcitation during EST and blocked AP conduction with adenosine had high specificity and positive predictive value for nonrapid and low-risk antegrade conduction during baseline invasive EPS. Successful risk stratification of pediatric patients with Wolff-Parkinson-White is possible through the use of EST and the adenosine responsiveness of AP. © 2015 Wiley Periodicals, Inc.

Diagnostic value of immunoglobulin G antibodies against Candida enolase and fructose-bisphosphate aldolase for candidemia

PubMed Central

2013-01-01

Background The yeast Candida is one of the most frequent pathogens isolated from bloodstream infections and is associated with significant morbidity and mortality. Problems with clinical and microbiological diagnosis of invasive candidiasis (IC) have prompted the development of non-culture-based laboratory methods. Previous reports suggest that serological detection of antibodies might be useful for diagnosing systemic candidiasis. Methods Diagnosis of IC using antibodies against recombinant Candida albicans enolase (Eno) and fructose-bisphosphate aldolase (Fba1) was evaluated. Using recombinant Eno and Fba1 as coating antigens, enzyme-linked immunosorbent assays (ELISAs) were used to analyze sera from patients with candidemia (n = 101), Candida colonization (n = 50), bacteremia (n = 84), invasive aspergillosis (n = 40); and from healthy controls (n = 200). Results The results demonstrated that ELISA detection of anti-Eno and anti-Fba1 IgG distinguished IC from other pathogenic infections in patients and healthy individuals. The sensitivity, specificity, and positive and negative predictive values were 72.3%, 94.7%, 78.5% and 93% for anti-Eno, and 87.1%, 92.8%, 76.5% and 96.4% for anti-Fba1 antibodies, respectively. Combining these two tests improved sensitivity up to 90.1% and negative predictive value up to 97.1%, with specificity and positive predictive values of 90.6% and 72.2%. The tests were specific to the Candida genus and antibody titers were higher for candidemia patients than for controls. Positive antibody tests were obtained before blood culture results for 42.2% of patients for anti-Eno and 51.1% for anti-Fba1. Conclusion These data suggest that tests that detect IgG antibodies against Candida enolase and fructose-bisphosphate aldolase, especially when used in combination, could be a powerful tool for diagnosing IC. PMID:23725337