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Sample records for adjusted d-dimer cut-off

  1. Age-adjusted D-dimer cut-off in the diagnostic strategy for deep vein thrombosis

    DEFF Research Database (Denmark)

    Nybo, Mads; Hvas, Anne-Mette

    2017-01-01

    Background. Studies have indicated that use of an age-adjusted D-dimer cut-off value for patients above 50 years increases utility of the diagnostic strategy for pulmonary embolism. Evidence for the same approach regarding diagnosis of deep vein thrombosis (DVT) is, however, unclear. Materials...

  2. Therapeutic significance of a D-dimer cut-off level of >3 μg/ml in colorectal cancer patients treated with standard chemotherapy plus bevacizumab

    International Nuclear Information System (INIS)

    Mochizuki, Satoshi; Yoshino, Takayuki; Kojima, Takashi

    2010-01-01

    The risk of venous thromboembolism has been reported to increase when receiving bevacizumab. Many cancer patients are reported to have elevated D-dimer levels. It is not clear what D-dimer level might indicate an increased risk of venous thromboembolism in the colorectal cancer patients treated with bevacizumab-containing chemotherapy. The D-dimer levels and any event concurrent with an elevated D-dimer level were evaluated in patients receiving bevacizumab. The D-dimer cut-off level was determined using the receiver-operating characteristic analysis. The selection criteria were as follows: histologically proven metastatic and unresectable colorectal adenocarcinoma; no prior chemotherapy containing bevacizumab; D-dimer test performed repetitively on the baseline and during bevacizumab administration; no venous thromboembolism identified at the baseline; and enhanced computed tomographic scan performed every 2 months. Sixty-nine patients were included. The chemotherapy regimens with bevacizumab included the regimen of 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX), the regimen of 5-fluorouracil, leucovorin and irinotecan (FOLFIRI), and leucovorin-modulated 5-fluorouracil. The median baseline D-dimer level was 1.2 μg/ml. The appropriate D-dimer cut-off level was 3 μg/ml with the negative predictive value of 98% and relative risk of 6.9. Twenty-one of 69 patients showed elevated D-dimer levels of >3 μg/ml, with 11 patients for unknown reasons, 6 with tumor progression, 3 with venous thromboembolism and 1 with sepsis. In the remaining 48 patients whose D-dimer levels were ≤3 μg/ml, only one patient developed a venous thromboembolism. A D-dimer cut-off level of 3 μg/ml might be a useful indicator level to exclude venous thromboembolism or show an increased risk for venous thromboembolism in colorectal cancer patients treated with bevacizumab-containing chemotherapy. (author)

  3. Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Does a Normal Age-Adjusted D-Dimer Rule Out PE?

    Directory of Open Access Journals (Sweden)

    Jacob Ortiz

    2017-01-01

    Full Text Available Risk assessment for pulmonary embolism (PE currently relies on physician judgment, clinical decision rules (CDR, and D-dimer testing. There is still controversy regarding the role of D-dimer testing in low or intermediate risk patients. The objective of the study was to define the role of clinical decision rules and D-dimer testing in patients suspected of having a PE. Records of 894 patients referred for computed tomography pulmonary angiography (CTPA at a University medical center were analyzed. The clinical decision rules overall had an ROC of approximately 0.70, while signs of DVT had the highest ROC (0.80. A low probability CDR coupled with a negative age-adjusted D-dimer largely excluded PE. The negative predictive value (NPV of an intermediate CDR was 86–89%, while the addition of a negative D-dimer resulted in NPVs of 94%. Thus, in patients suspected of having a PE, a low or intermediate CDR does not exclude PE; however, in patients with an intermediate CDR, a normal age-adjusted D-dimer increases the NPV.

  4. Age-adjusted high-sensitivity troponin T cut-off value for risk stratification of pulmonary embolism.

    Science.gov (United States)

    Kaeberich, Anja; Seeber, Valerie; Jiménez, David; Kostrubiec, Maciej; Dellas, Claudia; Hasenfuß, Gerd; Giannitsis, Evangelos; Pruszczyk, Piotr; Konstantinides, Stavros; Lankeit, Mareike

    2015-05-01

    High-sensitivity troponin T (hsTnT) helps in identifying pulmonary embolism patients at low risk of an adverse outcome. In 682 normotensive pulmonary embolism patients we investigate whether an optimised hsTnT cut-off value and adjustment for age improve the identification of patients at elevated risk. Overall, 25 (3.7%) patients had an adverse 30-day outcome. The established hsTnT cut-off value of 14 pg·mL(-1) retained its high prognostic value (OR (95% CI) 16.64 (2.24-123.74); p=0.006) compared with the cut-off value of 33 pg·mL(-1) calculated by receiver operating characteristic analysis (7.14 (2.64-19.26); pvalue of 45 pg·mL(-1) but not the established cut-off value of 14 pg·mL(-1) predicted an adverse outcome. An age-adjusted hsTnT cut-off value (≥14 pg·mL(-1) for patients aged risk (12.4% adverse outcome). Risk assessment of normotensive pulmonary embolism patients was improved by the introduction of an age-adjusted hsTnT cut-off value. A three-step approach helped identify patients at higher risk of an adverse outcome who might benefit from advanced therapy. Copyright ©ERS 2015.

  5. Adjust cut-off values of immunohistochemistry models to predict risk of distant recurrence in invasive breast carcinoma patients

    Directory of Open Access Journals (Sweden)

    Yen-Ying Chen

    2016-12-01

    Conclusion: It is necessary to adjust the cut-off values of IHC-based prognostic models to fit the purpose. If the estimated risk is clearly high or low, it may be reasonable to omit multigene assays when cost is a consideration.

  6. Age Adjusted D-Dimer for exclusion of Pulmonary Embolism: a retrospective cohort study.

    LENUS (Irish Health Repository)

    Monks, D

    2017-08-01

    D-Dimer (DD) will increase with age and recent studies have shown the upper limit of normal can be raised in those who are low risk and over 50. We studied age adjusted D-dimer (AADD) levels to assess whether pulmonary embolism (PE) could be safely excluded. This study analysed the Emergency Department (ED) Computed Tomographic Pulmonary Angiography (CTPA) requests. There were 756 requests. The parameters studied were; age, DD value, calculated AADD, CT result and Simplified Geneva Score (SGS). The primary outcome was the diagnostic performance of AADD. One hundred and eighty-five patients were included in the final cohort. Twenty-one patients had a negative DD after age adjustment. Of these one had a PE, corresponding to a failure rate of 4.76% (1 in 22). The sensitivity of AADD was 0.96 (95% CI 0.76 to 0.99) and its specificity was 0.12 (95% CI 0.08- 0.19). AADD demonstrated a reduction in false positives with one false negative, giving rise to a failure rate higher than that of other larger studies. Further study is indicated to accurately define the diagnostic characteristics for the Irish context.

  7. Phase- and size-adjusted CT cut-off for differentiating neoplastic lesions from normal colon in contrast-enhanced CT colonography

    International Nuclear Information System (INIS)

    Luboldt, W.; Kroll, M.; Wetter, A.; Vogl, T.J.; Toussaint, T.L.; Hoepffner, N.; Holzer, K.; Kluge, A.

    2004-01-01

    A computed tomography (CT) cut-off for differentiating neoplastic lesions (polyps/carcinoma) from normal colon in contrast-enhanced CT colonography (CTC) relating to the contrast phase and lesion size is determined. CT values of 64 colonic lesions (27 polyps 0 . The slope m was determined by linear regression in the correlation (lesion ∝[xA + (1 - x)V]//H) and the Y-intercept y 0 by the minimal shift of the line needed to maximize the accuracy of separating the colonic wall from the lesions. The CT value of the lesions correlated best with the intermediate phase: 0.4A+ 0.6V(r=0.8 for polyps ≥10 mm, r=0.6 for carcinomas, r=0.4 for polyps <10 mm). The accuracy in the differentiation between lesions and normal colonic wall increased with the height implemented as divisor, reached 91% and was obtained by the dynamic cut-off described by the formula: cut-off(A,V,H) = 1.1[0.4A + 0.6V]/H + 69.8. The CT value of colonic polyps or carcinomas can be increased extrinsically by scanning in the phase in which 0.4A + 0.6V reaches its maximum. Differentiating lesions from normal colon based on CT values is possible in contrast-enhanced CTC and improves when the cut-off is adjusted (normalized) to the contrast phase and lesion size. (orig.)

  8. Re-adjusting the cut-off score of the Korean version of the Childhood Autism Rating Scale for high-functioning individuals with autism spectrum disorder.

    Science.gov (United States)

    Kwon, Hyuk-Jin; Yoo, Hee-Jeong; Kim, Joo-Hyun; Noh, Dong-Hyun; Sunwoo, Hyun-Jung; Jeon, Ye Seul; Lee, Sang-Youn; Jo, Ye-Ul; Bong, Gui-Young

    2017-10-01

    The current cut-off score of the Korean version of the Childhood Autism Rating Scale (K-CARS) does not seem to be sensitive enough to precisely diagnose high-functioning autism. The aim of this study was to identify the optimal cut-off score of K-CARS for diagnosing high-functioning individuals with autism spectrum disorders (ASD). A total of 329 participants were assessed by the Korean versions of the Autism Diagnostic Interview - Revised (K-ADI-R), Autism Diagnostic Observation Schedule (K-ADOS), and K-CARS. IQ and Social Maturity Scale scores were also obtained. The true positive and false negative rates of K-CARS were 77.2% and 22.8%, respectively. Verbal IQ (VIQ) and Social Quotient (SQ) were significant predictors of misclassification. The false negative rate increased to 36.0% from 19.8% when VIQ was >69.5, and the rate increased to 44.1% for participants with VIQ > 69.5 and SQ > 75.5. In addition, if SQ was >83.5, the false negative rate increased to 46.7%, even if the participant's VIQ was ≤69.5. Optimal cut-off scores were 28.5 (for VIQ ≤ 69.5 and SQ ≤ 75.5), 24.25 (for VIQ > 69.5 and SQ > 75.5), and 24.5 (for SQ > 83.5), respectively. The likelihood of a false negative error increases when K-CARS is used to diagnose high-functioning autism and Asperger's syndrome. For subjects with ASD and substantial verbal ability, the cut-off score for K-CARS should be re-adjusted and/or supplementary diagnostic tools might be needed to enhance diagnostic accuracy for ASD. © 2017 The Authors. Psychiatry and Clinical Neurosciences © 2017 Japanese Society of Psychiatry and Neurology.

  9. Age- and sex-dependent reference intervals for D-dimer

    DEFF Research Database (Denmark)

    Haase, Christine; Joergensen, Maja; Ellervik, Christina

    2013-01-01

    A low D-dimer is commonly used to exclude venous thromboembolism in low risk patients. However, the reference intervals are poorly defined and D-dimer has been shown to increase by patient age. We aimed to establish age- and sex-dependent D-dimer reference intervals and to test the consequence of...... of different cut-off limits....

  10. Global emergency medicine journal club: a social media discussion about the Age-Adjusted D-Dimer Cutoff Levels To Rule Out Pulmonary Embolism trial.

    Science.gov (United States)

    Rezaie, Salim R; Swaminathan, Anand; Chan, Teresa; Shaikh, Sam; Lin, Michelle

    2015-05-01

    Annals of Emergency Medicine collaborated with an educational Web site, Academic Life in Emergency Medicine (ALiEM), to host an online discussion session featuring the 2014 Journal of the American Medical Association publication on the Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism (ADJUST-PE) trial by Righini et al. The objective is to describe a 14-day (August 25 to September 7, 2014) worldwide academic dialogue among clinicians in regard to 4 preselected questions about the age-adjusted D-dimer cutoff to detect pulmonary embolism. Five online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and Google Hangout. Comments across the social media platforms were curated for this report, as framed by the 4 preselected questions, and engagement was tracked through various Web analytic tools. Blog and Twitter comments, as well as video expert commentary involving the ADJUST-PE trial, are summarized. The dialogue resulted in 1,169 page views from 391 cities in 52 countries on the ALiEM Web site, 502,485 Twitter impressions, and 159 views of the video interview with experts. A postdiscussion summary on the Journal Jam podcast resulted in 3,962 downloads in its first week of publication during September 16 to 23, 2014. Common themes that arose in the multimodal discussions included the heterogeneity of practices, D-dimer assays, provider knowledge about these assays, and prevalence rates in different areas of the world. This educational approach using social media technologies demonstrates a free, asynchronous means to engage a worldwide audience in scholarly discourse. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  11. The diffuse cut-off

    International Nuclear Information System (INIS)

    2014-09-01

    After having recalled the interest of cut-off practices when consumption is higher than production (a cut-off operator turns out some sources of consumption), this publication more particularly addresses the practice of cut-off in the residential sector, also called diffused cut-off. This practice is based on a temporary reduction of electricity consumption in a great number of small sites (for example, a brief interruption of the electricity supply of radiators, hot water tanks, air conditioning devices in dwellings to reduce the total demand of an area). The three main modalities of valorisation of this cut-off power by the operator are presented. Advantages and drawbacks are discussed, and more particularly the impact of cut-off on thermal comfort

  12. Serum Potassium Levels Inversely Correlate with D-Dimer In Patients with Acute-Onset Atrial Fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Cervellin, Gianfranco, E-mail: gcervellin@ao.pr.it; Bonfanti, Laura; Picanza, Alessandra; Lippi, Giuseppe [1Academic Hospital of Parma (Italy)

    2015-03-15

    D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared to subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared with subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. The aim of this study was to investigate correlations between D-dimer and serum potassium in acute-onset AF (AAF). To investigate the potential correlation between the values of serum potassium and D-dimer in patients with AAF, we retrospectively reviewed clinical and laboratory data of all emergency department visits for AAF in 2013. Among 271 consecutive AAF patients with D-dimer assessments, those with hypokalemia (n = 98) had significantly higher D-dimer values than normokalemic patients (139 versus 114 ng/mL, p = 0.004). The rate of patients with D-dimer values exceeding the diagnostic cut-off was higher in the group of patients with hypokalemia than in those with normal serum potassium (26.5% versus 16.2%; p = 0.029). An inverse and highly significant correlation was found between serum potassium and D-dimer (r = −0.21; p < 0.001), even after adjustments for age and sex (beta coefficient −94.8; p = 0.001). The relative risk for a positive D-dimer value attributed to hypokalemia was 1.64 (95% CI, 1.02 to 2.63; p = 0.040). The correlation remained statistically significant in patients free from antihypertensive drugs (r = −0.25; p = 0.018), but not in those taking angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, or diuretics. The inverse correlation between values of potassium and D-dimer in patients with AAF provides important and complementary information about the thromboembolic risk of these patients.

  13. Fiber optic D dimer biosensor

    Science.gov (United States)

    Glass, Robert S.; Grant, Sheila A.

    1999-01-01

    A fiber optic sensor for D dimer (a fibrinolytic product) can be used in vivo (e.g., in catheter-based procedures) for the diagnosis and treatment of stroke-related conditions in humans. Stroke is the third leading cause of death in the United States. It has been estimated that strokes and stroke-related disorders cost Americans between $15-30 billion annually. Relatively recently, new medical procedures have been developed for the treatment of stroke. These endovascular procedures rely upon the use of microcatheters. These procedures could be facilitated with this sensor for D dimer integrated with a microcatheter for the diagnosis of clot type, and as an indicator of the effectiveness, or end-point of thrombolytic therapy.

  14. Effectiveness of d-dimer as a screening test for venous thromboembolism: an update.

    Science.gov (United States)

    Pulivarthi, Swaroopa; Gurram, Murali Krishna

    2014-10-01

    Venous thromboembolism (VTE) is the leading cause of morbidity and mortality among hospitalized patients. We searched the PubMed database and reviewed the articles published until June 2011. Articles related to the D-dimer and VTE were considered to write this paper. Many factors play a key role in changing the sensitivity and specificity of D-dimer testing, including the extent of thrombosis and fibrinolytic activity, duration of symptoms, anticoagulant therapy, comorbidity due to surgical or medical illnesses, inflammatory diseases, cancer, elderly age, pregnancy and the postpartum period, and previous VTE. Many previous studies have shown that the D-dimer test is highly sensitive (>95%) in acute deep venous thrombosis or pulmonary embolism, usually with a cut-off value of 500 μg FEU/l, which reasonably rules out acute VTE, particularly in patients with low clinical probability (LCP) or intermediate clinical probability. Patients with high D-dimer levels upon presentation may prompt a more intense diagnostic approach, irrespective of pretest probability. Studies performed after a negative D-dimer for 3 months proved the high negative predictive value (NPV) of D-dimer testing together with LCP in patients with suspected VTE. Among oncology patients, D-dimer testing has the highest sensitivity and NPV in excluding VTE. The new cutoff values of D-dimer testing were analyzed in a recent prospective study of pregnant women; they are 286 ng DDU/ml, 457 ng DDU/ml, and 644 ng DDU/ml for the first, second, and third trimesters, respectively.

  15. Age-related diagnostic value of D-dimer testing and the role of inflammation in patients with suspected deep vein thrombosis.

    Science.gov (United States)

    Prochaska, Jürgen H; Frank, Bernd; Nagler, Markus; Lamparter, Heidrun; Weißer, Gerhard; Schulz, Andreas; Eggebrecht, Lisa; Göbel, Sebastian; Arnold, Natalie; Panova-Noeva, Marina; Hermanns, Iris; Pinto, Antonio; Konstantinides, Stavros; Ten Cate, Hugo; Lackner, Karl J; Münzel, Thomas; Espinola-Klein, Christine; Wild, Philipp S

    2017-07-04

    Previous reports have investigated the impact of age on D-Dimer testing in elderly individuals with suspected deep vein thrombosis (DVT), but data on the age-related diagnostic value of D-dimer in a sample covering a broad age range are limited. The present study determined age-specifically the diagnostic accuracy of D-dimer and compared it to C-reactive protein (CRP), a marker of inflammation, in 500 patients with suspected DVT from the VTEval project (NCT02156401). Sensitivity of D-dimer was lower in patients  0.05). In conclusion, these data outline a clinically-relevant limitation of D-dimer testing among younger patients with suspected DVT indicating a necessity for age-adapted cut-off values. Further research is required to decrypt the role of inflammation in the pathophysiology and diagnosis of venous thrombosis.

  16. D-dimer for the diagnosis of upper extremity deep and superficial venous thrombosis.

    Science.gov (United States)

    Sartori, Michelangelo; Migliaccio, Ludovica; Favaretto, Elisabetta; Cini, Michela; Legnani, Cristina; Palareti, Gualtiero; Cosmi, Benilde

    2015-04-01

    D-dimer role is well established in the diagnostic work-up for lower limb deep vein thrombosis (DVT), however it has not been formally tested for clinically suspected upper extremity DVT and/or superficial vein thrombosis (SVT). To ascertain D-dimer diagnostic accuracy for upper extremity DVT and/or SVT. We performed a single centre management study in outpatients referred by emergency or primary care physicians for clinically suspected upper extremity DVT. All patients underwent D-dimer testing (cut-off value: ≤500 ng/mL), and a B-mode and color Doppler ultrasonography examination. In case of either technical problems or anatomical barriers, ultrasonography was repeated after 5-7 days. All patients were followed up for three months for the occurrence of symptomatic DVT and/or SVT and/or pulmonary embolism. We enrolled 239 patients (F: 63.6%; mean±SD age: 58.3±16.8). At the initial diagnostic work-up, DVT was detected in 24 (10%) patients while SVT in 35 (14.6%) patients. During follow-up, one upper extremity DVT was found. D-dimer levels were higher in patients with DVT than in those without. Sensitivity and specificity of D-dimer for DVT were 92% (95%CI: 73-99%) and 60% (95%CI: 52-67%) respectively, with a negative predictive value of 98% (95%CI: 93-100%), whereas for SVT they were 77% (95%CI: 59-89%) and 60% (95%CI: 52-67%) respectively, with a negative predictive value of 93% (95%CI: 86-97%). D-dimer has a negative predictive value ≥93% for excluding DVT in symptomatic outpatients and it can be a useful test in the diagnostic work-up of suspected upper extremity DVT. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Serum Potassium Levels Inversely Correlate with D-Dimer In Patients with Acute-Onset Atrial Fibrillation.

    Science.gov (United States)

    Cervellin, Gianfranco; Bonfanti, Laura; Picanza, Alessandra; Lippi, Giuseppe

    2014-12-09

    Background: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared to subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. Objective: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared with subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. The aim of this study was to investigate correlations between D-dimer and serum potassium in acute-onset AF (AAF). Methods: To investigate the potential correlation between the values of serum potassium and D-dimer in patients with AAF, we retrospectively reviewed clinical and laboratory data of all emergency department visits for AAF in 2013. Results: Among 271 consecutive AAF patients with D-dimer assessments, those with hypokalemia (n = 98) had significantly higher D-dimer values than normokalemic patients (139 versus 114 ng/mL, p = 0.004). The rate of patients with D-dimer values exceeding the diagnostic cut-off was higher in the group of patients with hypokalemia than in those with normal serum potassium (26.5% versus 16.2%; p = 0.029). An inverse and highly significant correlation was found between serum potassium and D-dimer (r = -0.21; p enzima conversora de angiotensina e diuréticos. Conclusões: A correlação inversa existente entre os níveis séricos de potássio e D-dímero em pacientes com FAA fornece informações importantes sobre o risco de tromboembolismo nestes pacientes.

  18. D-dimers (DD) in CVST.

    Science.gov (United States)

    Wang, Hui Fang; Pu, Chuan Qiang; Yin, Xi; Tian, Cheng Lin; Chen, Ting; Guo, Jun Hong; Shi, Qiang

    2017-06-01

    We were interested in further confirming whether D-dimers (DD) are indeed elevated in cerebral venous sinus thrombosis (CVST) as reported in those studies. CVST patients who had a plasma D-dimer test (139 cases) were included and divided into two groups: elevated D-dimer group (EDG) (>0.5 μg/mL; 65 cases) and normal D-dimer group (NDG) (≤0.5 μg/mL; 74 cases). The two groups were compared in terms of demographic data, clinical manifestation, laboratory and imaging data, using inferential statistical methods. The chi-squared and Fisher exact test showed that, compared to the NDG (74 cases), patients with elevated D-dimer levels were more likely to have a shorter symptom duration (SD) (30 ± 83.9 versus 90 ± 58.9 d, p = 0.003), more risk factors (75.4% versus 52.7%, p = 0.006), higher multiple venous sinus involvement (75.4% versus 59.5%, p = 0.037), increased fibrinogen (43.1% versus 18.9%, p = 0.037) and higher levels of blood glucose (18.3% versus 11%, p = 0.037). According to correlation analyses, D-dimer levels were positively correlated with number of venous sinuses involvement (NVS) (r = 0.321, p = 0.009) in the EDG. Multivariate logistic regression analysis showed that SD (OR, 0.025; 95% CI, 1.324-6.043; p = 0.000), NVS (OR, 1.573; 95% CI, 1.15-2.151; p = 0.005) and risk factors (OR, 3.321; 95% CI, 1.451-7.564; p = 0.004) were significantly different between the two groups. D-dimer is elevated in patients with acute/subacute CVST.

  19. The normative score and the cut-off value of the Oswestry Disability Index (ODI).

    Science.gov (United States)

    Tonosu, Juichi; Takeshita, Katsushi; Hara, Nobuhiro; Matsudaira, Ko; Kato, So; Masuda, Kazuhiro; Chikuda, Hirotaka

    2012-08-01

    The Oswestry Disability Index (ODI) is one of the most common scoring systems used for patients with low back pain (LBP). Although the normative score of the ODI was reported to be 10.19 in a review article, no study has calculated the normative score after adjusting the value based on the age distribution. In addition, none of the previous studies has estimated the cut-off value which separates LBP with disability from LBP without disability. The purpose of this study was to estimate the normative score by adjusting the data for age distribution in Japan, and to determine the cut-off value which separates LBP with disability from LBP without disability. We conducted an internet survey on LBP using the Japanese version of the ODQ. A total of 1,200 respondents, composed of 100 males and 100 females in each age group (from the 20s to 70s), participated in this study. We also asked them to provide information about their backgrounds. We estimated the normative score after correcting for the age distribution of Japan. We also estimated the ODI of those with or without disability, the factors associated with the ODI, and the cut-off value which separates LBP with disability from LBP without disability. The participants' backgrounds were similar to the national survey. The normative score of the ODI was estimated at 8.73. The ODI of the LBP with disability group was 22.07. Those with sciatica and obese subjects showed higher ODI than those without. The optimal cut-off value was estimated to be 12. We defined the normative score and the cut-off value of the ODI.

  20. The diagnostic value of ventilation-perfusion scintigraphy combined with plasma D-dimer assay in diagnosis of pulmonary embolism

    International Nuclear Information System (INIS)

    Wang Qian; Huang Lili; Qin Shuling; Yue Minggang; Wang Yu; Nie Yuxin; Liang Tiejun

    2005-01-01

    Objective: To investigate the clinical diagnostic value of ventilation-perfusion scintigraphy combined with plasma D-dimer assay in diagnosis of pulmonary embolism (PE). Methods: One hundred and four patients with clinically suspected PE underwent both pulmonary ventilation-perfusion scintigraphy and plasma D-dimer assay. According to the criteria of prospective investigation of the pulmonary embolism diagnosis (PIOPED), ventilation-perfusion scintigraphy was interpreted as normal, very low or low probability of PE, intermediate probability of PE and high probability of PE. High probability was considered as positive; normal and very low or low probability as negative and intermediate probability as non-diagnostic. Plasma D-dimer levels were measured using a quantitative immunoturbidimetric method, and a cut-off value of 500 mg/L was used in the diagnosis of PE. Clinical diagnostic value of ventilation-perfusion scintigraphy, D-dimer assay and combined use of ventilation-perfusion scintigraphy and D-dimer assay for diagnosing PE was evaluated, respectively, comparing with the final clinical diagnosis that was based on the clinical findings. Results: Among the 104 patients, 44 were diagnosed with PE and 60 were excluded. Ventilation-perfusion scintigraphy provided diagnostic interpretations for 86 (82.7%) patients, and non-diagnostic interpretations for 18 (17.3%) patients. For diagnosing PE, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ventilation-perfusion scintigraphy was 84.1%, 75.0%, 78.8%, 71.2% and 86.5%, respectively, and with D-dimer assay was 93.2%, 60.0%, 74.0%, 63.1% and 92.3%, respectively. If a plasma D-dimer level of < 500 mg/L was taken as a criterion to exclude PE for those intermediate probability of ventilation-perfusion scintigraphy, the diagnostic specificity and accuracy would be raised to 85.0% and 84.6%, respectively. Conclusions: When a non-diagnostic interpretation was occurred on

  1. Large D-Dimer Fluctuation in Normal Pregnancy

    DEFF Research Database (Denmark)

    Hedengran, Katrine K; Andersen, Malene R; Stender, Steen

    2016-01-01

    Introduction. D-dimer levels increase throughout pregnancy, hampering the usefulness of the conventional threshold for dismissing thromboembolism. This study investigates the biological fluctuation of D-dimer in normal pregnancy. Methods. A total of 801 healthy women with expected normal...... pregnancies were recruited. D-dimer was repeatedly measured during pregnancy, at active labor, and on the first and second postpartum days. Percentiles for each gestational week were calculated. Each individual D-dimer was normalized by transformation into percentiles for the relevant gestational age...... normal pregnancy, repeated D-dimer measurements are of no clinical use in the evaluation of thromboembolic events during pregnancy....

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

    Science.gov (United States)

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

    2017-11-09

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

  3. Cut-off wall system for subsurface liquid containment

    International Nuclear Information System (INIS)

    Carlson, R.; Khan, F.

    1997-01-01

    The subject of this paper is the use of a Cut-off Wall System (CWS) in conjunction with conventional soil bentonite slurry walls. The system is a vertical subsurface containment solution for isolating contaminated soils and groundwater in situ, thereby enhancing protection of the environment. The CWS is composed of geomembrane panels and specially designed connectors that form an interlocking subsurface vertical barrier wall. This system provides a cost effective, easily installed, positive cut-off for isolation of mixed and hazardous wastes, and wastes from uncontrolled releases. This application will address manufacturing, fabrication, installation, strength, QA/QC, chemical compatibility, and permeability

  4. A PROBLEM OF CUTTING OFF THE LAMINATED SEMIS TYPE PLATE

    Directory of Open Access Journals (Sweden)

    Florin Ciofu

    2012-11-01

    Full Text Available A problem often coped on many domains such as wood manufacturing, glass, plastics and metallic platework industry, is the shaping or cutting off a big plate in many pieces. With this purpose there are algorithms of optimizing for positioning the parts following to be cut off from a row plate. From mathematical point of view, in positioning the parts on a raw plate the number of solutions increase four times evrey time a new part is added, and in case of finding the best solution for about few hundreds of pieces or parts would require years of processing on the most performant computers nowadays – for an analogy remember the famous story with the rice beads which the King had to pay to the master teaching him the chess: twice more for each square of the chessboard; for the total quantity assessment, King ascertained that the crops in his whole life wouldn’t have been enough.

  5. Mol-Gastronomie: Dicke Saucen mit Cut-off

    Science.gov (United States)

    Vilgis, Thomas

    2006-01-01

    Schöne sämige und dennoch rustikale Saucen leben von einer besonderen Hydrostatik. Die Sämigkeit wird von der Physik der Emulsionen beigesteuert, die Rustikalität durch eine breite Verteilung der Gemüsepartikel. Allerdings mit einer maximalen Teilchengröße: Diesen oberen Cut-off stellt die Lochscheibe des Passiergeräts namens Flotte Lotte ein. Sie führt auch zur Physik der Stabilität von Dispersionen.

  6. Environmental sampling: Issues for the cut-off regime

    International Nuclear Information System (INIS)

    Fearey, B.L.

    1995-01-01

    The fissile material cut-off treaty (FMCT) initiative under the Conference on Disarmament mandate is envisioned to include certain aspects of environmental sampling and monitoring. One of the intents of this treaty is to bring certain non-NPT signatories (e.g., threshold states) under this treaty agreement along with the nuclear weapon states (NWSs). This paper provides a brief overview of some of the relevant issues that may be involved in the implementation and use of environmental monitoring for (1) verification of the cut-off regime declarations, (2) the detection of undeclared activities, and, (3) application in non-routine inspections. The intent is to provide backstopping information important for treaty negotiators. Specific issues addressed within this paper include signature sampling, differences in the proposed detection regime, potential signature integrators, specific examples and spoofing concerns. Many of these issues must be carefully considered and weighed in order to create a credibly verifiable inspection regime. Importantly, the cut-off treaty must enable nondiscriminatory implementation, while carefully assuring that nonproliferation treaty requirements are maintained (i.e., preventing unintentional release of critical weapons design information--potentially through environmental sampling and analysis)

  7. Genetic predictors of fibrin D-dimer levels in healthy adults

    Science.gov (United States)

    Smith, Nicholas L.; Huffman, Jennifer E.; Strachan, David P.; Huang, Jie; Dehghan, Abbas; Trompet, Stella; Lopez, Lorna M.; Shin, So-Youn; Baumert, Jens; Vitart, Veronique; Bis, Joshua C.; Wild, Sarah H.; Rumley, Ann; Yang, Qiong; Uitterlinden, Andre G; Stott, David. J.; Davies, Gail; Carter, Angela M.; Thorand, Barbara; Polašek, Ozren; McKnight, Barbara; Campbell, Harry; Rudnicka, Alicja R.; Chen, Ming-Huei; Buckley, Brendan M.; Harris, Sarah E.; Williams, Frances M. K.; Peters, Annette; Pulanic, Drazen; Lumley, Thomas; de Craen, Anton J.M.; Liewald, David C.; Gieger, Christian; Campbell, Susan; Ford, Ian; Gow, Alan J.; Luciano, Michelle; Porteous, David J.; Guo, Xiuqing; Sattar, Naveed; Tenesa, Albert; Cushman, Mary; Slagboom, P. Eline; Visscher, Peter M.; Spector, Tim D.; Illig, Thomas; Rudan, Igor; Bovill, Edwin G.; Wright, Alan F.; McArdle, Wendy L.; Tofler, Geoffrey; Hofman, Albert; Westendorp, Rudi G.J.; Starr, John M.; Grant, Peter J.; Karakas, Mahir; Hastie, Nicholas D.; Psaty, Bruce M.; Wilson, James F.; Lowe, Gordon D. O.; O’Donnell, Christopher J; Witteman, Jacqueline CM; Jukema, J. Wouter; Deary, Ian J.; Soranzo, Nicole; Koenig, Wolfgang; Hayward, Caroline

    2011-01-01

    Background Fibrin fragment D-dimer is one of several peptides produced when cross-linked fibrin is degraded by plasmin, and is the most widely-used clinical marker of activated blood coagulation. To identity genetic loci influencing D-dimer levels, we performed the first large-scale, genome-wide association search. Methods and Results A genome-wide investigation of the genomic correlates of plasma D-dimer levels was conducted among 21,052 European-ancestry adults. Plasma levels of D-dimer were measured independently in each of 13 cohorts. Each study analyzed the association between ~2.6 million genotyped and imputed variants across the 22 autosomal chromosomes and natural-log transformed D-dimer levels using linear regression in additive genetic models adjusted for age and sex. Among all variants, 74 exceeded the genome-wide significance threshold and marked 3 regions. At 1p22, rs12029080 (p-value 6.4×10−52) was 46.0 kb upstream from F3, coagulation factor III (tissue factor). At 1q24, rs6687813 (p-value 2.4×10−14) was 79.7 kb downstream of F5, coagulation factor V. At 4q32, rs13109457 (p-value 2.9×10−18) was located between 2 fibrinogen genes: 10.4 kb downstream from FGG and 3.0 kb upstream from FGA. Variants were associated with a 0.099, 0.096, and 0.061 unit difference, respectively, in natural-log transformed D-dimer and together accounted for 1.8% of the total variance. When adjusted for non-synonymous substitutions in F5 and FGA loci known to be associated with D-dimer levels, there was no evidence of an additional association at either locus. Conclusions Three genes were associated with fibrin D-dimer levels, of which the F3 association was the strongest and has not been previously reported. PMID:21502573

  8. Tentative Colistin Epidemiological Cut-Off Value for Salmonella spp

    DEFF Research Database (Denmark)

    Agersø, Yvonne; Torpdahl, Mia; Zachariasen, Camilla

    2012-01-01

    . Interestingly, Salmonella Dublin and Salmonella Enteritidis belong to the same O-group (O:1, 9,12), suggesting that surface lipopolysaccharides (LPS) of the cell (O-antigen) play a role in colistin susceptibility. The epidemiological cut-off value of >2 mg/L for colistin suggested by European Committee...... on Antimicrobial Susceptibility Testing (EUCAST) is placed inside the distribution for both Salmonella Dublin and Salmonella Enteritidis. All tested Salmonella Dublin isolates, regardless of MIC colistin value, had identical pmrA and pmrB sequences. Missense mutations were found only in pmrA in one Salmonella...

  9. Plasma d-Dimer and Incident Ischemic Stroke and Coronary Heart Disease: The Atherosclerosis Risk in Communities Study.

    Science.gov (United States)

    Folsom, Aaron R; Gottesman, Rebecca F; Appiah, Duke; Shahar, Eyal; Mosley, Thomas H

    2016-01-01

    Epidemiological studies have documented that plasma d-dimer, a fibrin degradation product, is a risk marker for coronary heart disease, but there is limited prospective evidence for stroke. Given that thrombosis is a key mechanism for many strokes, we studied whether d-dimer is a risk marker for ischemic stroke incidence in the Atherosclerosis Risk in Communities (ARIC) Study. We measured d-dimer in 11 415 ARIC participants free of stroke and coronary heart disease in 1992 to 1995. We followed them for stroke, stroke subtype, and coronary heart disease events through 2012. Over a median of 18 years of follow-up, 719 participants had incident strokes (628 ischemic and 91 hemorrhagic). d-dimer was associated positively with risk of total, ischemic, and cardioembolic strokes, with risk elevated primarily for the highest quintile of d-dimer. After adjustment for other cardiovascular risk factors, the hazard ratio for the highest versus lowest quintile of d-dimer was 1.30 (95% confidence interval, 1.02-1.67) for total stroke, 1.33 (95% confidence interval, 1.02-1.73) for ischemic stroke, and 1.79 (95% confidence interval, 1.08-2.95) for cardioembolic stroke. There was no association with hemorrhagic, lacunar, or nonlacunar stroke categories. d-dimer was positively but weakly associated with coronary heart disease incidence. A higher basal plasma d-dimer concentration in the general population is a risk marker for ischemic stroke, especially cardioembolic stroke. © 2015 American Heart Association, Inc.

  10. Explaining the use of attribute cut-off values in decision making by means of involvement

    DEFF Research Database (Denmark)

    Peschel, Anne O.; Grebitus, Carola; Colson, Gregory

    2016-01-01

    respondents’ attribute cut-off values and their validated Personal Involvement Inventory (PII). Evidence from the analysis indicates that consumers who are highly involved are more likely to exhibit attribute cut-off values and are less likely to violate their cut-off values. Further investigation using......In order to lower the cognitive burden of decision making, consumers may apply attribute cut-off values to simplify decision strategies. Products with attributes that do not pass the cut-off values are either not being considered by the individual or are greatly discounted. This study provides new...

  11. Association of D-dimer with microalbuminuria in patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Wakabayashi, Ichiro; Masuda, Hiroshi

    2009-01-01

    Microalbuminuria has been reported to be related to incidence of cardiovascular complications in diabetes. No consistent findings have been obtained on the relationships of microalbuminuria with blood coagulation and fibrinolysis. The purpose of this study was to determine whether microalbuminuria is associated with blood markers reflecting coagulation and fibrinolysis activities in patients with type 2 diabetes. The relationships of albumin excretion rate (AER) with atherosclerosis-related variables, including blood coagulation and fibrinolysis markers, were investigated in patients with type 2 diabetes who showed normoalbuminuria (AER: less than 20 microg/min) and microalbuminuria (AER: 20 microg/min or higher and less than 200 microg/min). AER was significantly correlated with body mass index (BMI), maximum intima-media thickness of common carotid arteries, blood HDL cholesterol, uric acid, creatinine and D-dimer. On the other hand, AER showed no significant correlation with blood platelets, fibrinogen, thrombin-antithrombin III complex, plasmin-alpha2 plasmin inhibitor complex and plasminogen activator inhibitor-1. In multiple regression analysis, using age, sex, BMI, pulse pressure, hemoglobin A1c, HDL cholesterol, uric acid, creatinine, D-dimer and history of anti-thrombotic therapy as explanatory variables, only D-dimer showed a significant correlation with AER. The mean level of log-converted D-dimer after adjustment for age and sex was significantly higher in subjects with microalbuminuria than in those with normoalbuminuria. D-dimer is associated with microalbuminuria in patients with diabetes and this suggests that glomerular dysfunction is in part mediated by hypercoagulability.

  12. International survey on D-dimer test reporting: a call for standardization.

    Science.gov (United States)

    Lippi, Giuseppe; Tripodi, Armando; Simundic, Ana-Maria; Favaloro, Emmanuel J

    2015-04-01

    D-dimer is the biochemical gold standard for diagnosing a variety of thrombotic disorders, but result reporting is heterogeneous in clinical laboratories. A specific five-item questionnaire was developed to gain a clear picture of the current standardization of D-dimer test results. The questionnaire was opened online (December 24, 2014-February 10, 2015) on the platform "Google Drive (Google Inc., Mountain View; CA)," and widely disseminated worldwide by newsletters and alerts. A total of 409 responses were obtained during the period of data capture, the largest of which were from Italy (136; 33%), Australia (55; 22%), Croatia (29; 7%), Serbia (26; 6%), and the United States (21; 5%). Most respondents belonged to laboratories in general hospitals (208; 51%), followed by laboratories in university hospitals (104; 26%), and the private sector (94; 23%). The majority of respondents (i.e., 246; 60%) indicated the use of fibrinogen equivalent unit for expressing D-dimer results, with significant heterogeneities across countries and health care settings. The highest prevalence of laboratories indicated they were using "ng/mL" (139; 34%), followed by "mg/L" (136; 33%), and "µg/L" (73; 18%), with significant heterogeneity across countries but not among different health care settings. Expectedly, the vast majority of laboratories (379; 93%) declared to be using a fixed cutoff rather than an age-adjusted threshold, with no significant heterogeneity across countries and health care settings. The results of this survey attest that at least 28 different combinations of measurement units are currently used to report D-dimer results worldwide, and this evidence underscores the urgent need for more effective international joined efforts aimed to promote a worldwide standardization of D-dimer results reporting. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  13. Physical and cut-off effects of heavy sea quarks

    CERN Document Server

    Knechtli, Francesco; Bruno, Mattia; Finkenrath, Jacob; Leder, Björn; Marinkovic, Marina; Sommer, Rainer

    2014-01-01

    We simulate a theory with two dynamical O($a$) improved Wilson quarks whose mass $M$ ranges from a factor eight up to a factor two below the charm quark mass and at three values of the lattice spacing ranging from 0.066 to 0.034 fm. This theory is a prototype to study the decoupling of heavy quarks. We measure the mass and cut-off dependence of ratios of gluonic observables defined from the Wilson flow or the static potential. The size of the 1/$M$ corrections can be determined and disentangled from the lattice artifacts. The difference with the pure gauge theory is at the percent level when two quarks with a mass of the charm quark are present.

  14. On the Cut-off Point for Combinatorial Group Testing

    DEFF Research Database (Denmark)

    Fischer, Paul; Klasner, N.; Wegener, I.

    1999-01-01

    The following problem is known as group testing problem for n objects. Each object can be essential (defective) or non-essential (intact). The problem is to determine the set of essential objects by asking queries adaptively. A query can be identified with a set Q of objects and the query Q...... group testing is equal to p* = 12(3 - 5), i.e., the strategy of testing each object individually minimizes the average number of queries iff p >= p* or n = 1. In the combinatorial setting the worst case number of queries is of interest. It has been conjectured that the cut-off point of combinatorial...... group testing is equal to alpha* = 13, i.e., the strategy of testing n - 1 objects individually minimizes the worst case number of queries iff k/n >= alpha* and k

  15. Polypharmacy Cut-Off for Gait and Cognitive Impairments.

    Science.gov (United States)

    Langeard, Antoine; Pothier, Kristell; Morello, Remy; Lelong-Boulouard, Véronique; Lescure, Pascale; Bocca, Marie-Laure; Marcelli, Christian; Descatoire, Pablo; Chavoix, Chantal

    2016-01-01

    Polypharmacy is a well-established risk factor for falls, and these are one of the major health problems that affect the quality of life as people age. However, the risk of mobility and cognitive impairments consecutive to polypharmacy has been little addressed, despite the association between these adverse outcomes and falls. Moreover, the rare polypharmacy cut-offs were all but one arbitrarily determined. Studying relationships between polypharmacy and both mobility and cognitive impairments, and statistically determining a cut-off point in the number of medicinal molecule beyond which polypharmacy has deleterious consequences with respect to mobility and cognitive impairment. We enrolled 113 community-dwelling adults aged 55 years and older with a fall history, with or without injury, in the previous year. We carefully collected information about daily medicinal molecules taken. We assessed basic mobility and global cognition with the Time-Up-and-Go and the Montreal Cognitive Assessment (MoCA) test, respectively (clinicaltrials.gov NCT02292316). Timed-Up and Go test and MoCA scores were both significantly correlated with the number of molecule, used. Receiver Operating Characteristic curves indicate, with high prediction (p risk for both impaired mobility and global cognition. These relationships were independent of the number of comorbidities and of the pharmacological class. Community-dwelling adults aged 55 years and older who take five or more daily medicinal molecules are at high risk for both mobility and cognitive impairments. Physicians and patients should be aware of these new findings, especially when there are multiple prescribers involved in the care of the patient.

  16. Serum D-dimer Levels Are Proportionally Associated with Left Atrial Enlargement in Patients with an Acute Ischemic Stroke due to Non-valvular Atrial Fibrillation.

    Science.gov (United States)

    Kim, Tae-Won; Song, In-Uk; Chung, Sung-Woo; Kim, Joong-Seok; Koo, Jaseong; Lee, Kwang-Soo

    2016-01-01

    Objective Left atrial enlargement (LAE) may predispose individuals to blood stasis in atrial fibrillation (AF), and thus play a crucial role in thrombogenesis. The D-dimer level is one of the surrogate markers for a hypercoagulable state and reflects thrombus formation in AF. Since the D-dimer level reflects hypercoagulability as well as thrombus and fibrin burdens, LAE could be associated with a D-dimer elevation. However, no studies have explored this association or which factors contribute to increases in the D-dimer levels in patients with AF. Therefore, we assessed whether the serum D-dimer levels are related to the left atrial volume index (LAVI) or other vascular risk factors and also evaluated the association between the D-dimer levels and the initial stroke severity. Methods Ninety-eight consecutive patients with an acute ischemic stroke and non-valvular AF (NVAF) who were anticoagulation-naïve were enrolled, and all patients were stratified into moderate-to-severe and mild neurologic deficit groups using the National Institutes of Health Stroke Scale on admission. The association between the initial serum D-dimer levels and the LAVI was evaluated in all enrolled patients, and the serum D-dimer levels were compared between the two groups. Results The patients were classified into two groups according to the severity of the neurologic deficit. In a partial correlation coefficient analysis adjusted for confounding factors, an increase in the initial serum D-dimer levels was significantly associated with LAVI (r=0.286; p=0.027). A linear regression analysis showed that a history of peripheral artery disease was the factor most strongly associated with the serum D-dimer level (t=3.90, pacute ischemic stroke and NVAF.

  17. Segmented Regression Based on Cut-off Polynomials

    Directory of Open Access Journals (Sweden)

    Miloš Kaňka

    2016-06-01

    Full Text Available In Statistika: Statistics and Economy Journal No. 4/2015 (pp. 39–58, author’s paper Segmented Regression Based on B-splines with Solved Examples was published. Use of B-spline basis functions has many advantages, the most important being a special form of matrix of system of normal equations suitable for quick solution of this system. The subject of this paper is to explain how that segmented regression can be mathematically developer in other way, which doesn’t require the knowledge of relatively complicated theory of B-spline basis functions, but is based on simpler apparatus of cut-off polynomials. The author considers a detailed calculation of matrix of system of normal equations elements and elaboration of so called polygonal method, as his contribution to issues of segmented regression. This method can be used to automatically obtain required values of nodal points. Author pays major attention to computing elements of matrix of systém of normal equations, which he also developed as computer program called TRIO.

  18. Emission Enhancement in a Plasmonic Waveguide at Cut-Off

    Directory of Open Access Journals (Sweden)

    Andrea Alù

    2011-01-01

    Full Text Available Enhancement of molecular emission is usually obtained by coupling small optical emitters with external resonant structures and systems, as first established by Purcell several decades ago, and verified in several recent investigations using molecules or quantum dots coupled with plasmonic nanoantennas. Here we theoretically investigate in detail a different mechanism for emission enhancement, based on our recent idea of a plasmonic nanolauncher [Phys. Rev. Lett. 2009, 103, 043902], i.e., a metamaterial-inspired ultranarrow waveguide channel operating near its cut-off frequency. Such system is not necessarily at resonance, but its peculiar operation may provide enhanced emission over a relatively broad physical area, which may allow enhancement of emission independent of the position of an individual or of a group of molecules along such plasmonic channel, and the possibility to bend and route the emitted energy with large flexibility. We present here extensive theoretical and numerical results that confirm this intuition and may envision a novel method for molecular emission enhancement at the nanoscale, with more flexibility than the conventional Purcell resonance techniques.

  19. Normal Limits of Electrocardiogram and Cut-Off Values for Left ...

    African Journals Online (AJOL)

    Gender difference exists in some cut-off values for LVH. This study defined the normal limits for electrocardiographic variables for young adult Nigerians. Racial factor should be taken into consideration in interpretation of ECG. Keywords: Normal limits, Electrocardiogram, Cut-off values, Left ventricular hypertrophy, Young ...

  20. Cut-off frequencies of circumferential horizontal shear waves in various functionally graded cylinder shells.

    Science.gov (United States)

    Shen, Xiaoqin; Ren, Dawei; Cao, Xiaoshan; Wang, Ji

    2018-03-01

    In this study, cut-off frequencies of the circumferential SH waves in functionally graded piezoelectric-piezomagnetic material (FGPPM) cylinder shells with traction free, electrical and magnetic open boundary conditions are investigated analytically. The Wentzel-Kramers-Brillouin (WKB) method is employed for solving differential equations with variable coefficients for general cases. For comparison, Bessel functions and Kummer functions are used for solving cut-off frequency problems in homogenous and ideal FGPPM cylinder shells. It is shown that the WKB solution for the cut-off frequencies has good precise. The set of cut-off frequencies is a series of approximate arithmetic progressions, for which the difference is a function of the density and the effective elastic parameter. The relationship between the difference and the gradient coefficient is described. These results provide theoretical guidance for the non-destructive evaluation of curved shells based on the cut-off frequencies. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Plasma D-dimer concentration in patients with systemic sclerosis

    Directory of Open Access Journals (Sweden)

    Montagnana Martina

    2006-01-01

    Full Text Available Abstract Background Systemic sclerosis (SSc is an autoimmune disorder of the connective tissue characterized by widespread vascular lesions and fibrosis. Little is known so far on the activation of the hemostatic and fibrinolytic systems in SSc, and most preliminary evidences are discordant. Methods To verify whether SSc patients might display a prothrombotic condition, plasma D-dimer was assessed in 28 consecutive SSc patients and in 33 control subjects, matched for age, sex and environmental habit. Results and discussion When compared to healthy controls, geometric mean and 95% confidence interval (IC95% of plasma D-dimer were significantly increased in SSc patients (362 ng/mL, IC 95%: 361–363 ng/mL vs 229 ng/mL, IC95%: 228–231 ng/mL, p = 0.005. After stratifying SSc patients according to disease subset, no significant differences were observed between those with limited cutaneous pattern and controls, whereas patients with diffuse cutaneous pattern displayed substantially increased values. No correlation was found between plasma D-dimer concentration and age, sex, autoantibody pattern, serum creatinine, erythrosedimentation rate, nailfold videocapillaroscopic pattern and pulmonary involvement. Conclusion We demonstrated that SSc patients with diffuse subset are characterized by increased plasma D-dimer values, reflecting a potential activation of both the hemostatic and fibrinolytic cascades, which might finally predispose these patients to thrombotic complications.

  2. Cut-off frequencies of Lamb waves in various functionally graded thin films

    Science.gov (United States)

    Cao, Xiaoshan; Shi, Junping; Jin, Feng

    2011-09-01

    An analytical study is carried out on the cut-off frequencies of Lamb waves in freestanding thin films made of various functionally graded elastic, piezoelectric, or piezoelectric-piezomagnetic materials. Results show that the set of cut-off frequencies is a union of two series of approximate arithmetic progression, in which the differences are inversely proportional to the definite integral of a function of the material parameters along thickness. Given the simple and universal relationship between cut-off frequencies and material parameters, this study provides theoretical guidance not only for nondestructive evaluation in engineering applications but for designing high-performance sensors based on Lamb waves.

  3. D-dimer and the Risk of Stroke and Coronary Heart Disease. The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

    Science.gov (United States)

    Zakai, Neil A; McClure, Leslie A; Judd, Suzanne E; Kissela, Brett; Howard, George; Safford, Monika; Cushman, Mary

    2017-02-28

    D-dimer, a biomarker of coagulation, is higher in blacks than in whites and has been associated with stroke and coronary heart disease (CHD). It was our objective to assess the association of higher D-dimer with stroke and CHD in blacks and whites. REGARDS recruited 30,239 black and white participants across the contiguous US and measured baseline D-dimer in stroke (n=646) and CHD (n=654) cases and a cohort random sample (n=1,104). Cox models adjusting for cardiovascular risk factors determined the hazard ratio (HR) for increasing D-dimer for cardiovascular disease with bootstrapping to assess the difference in HR for CHD versus stroke by race. D-dimer was higher with increasing age, female sex, diabetes, hypertension, pre-baseline cardiovascular disease and higher C-reactive protein (CRP). Accounting for cardiovascular risk factors, each doubling of D-dimer was associated with increased stroke (hazard ratio [HR] 1.15; 95 % confidence interval [CI] 1.01, 1.31) and CHD (HR 1.27; 95 % CI 1.11, 1.45) risk. The difference in the HR between CHD and stroke was 0.20 (95 % CI >0.00, 0.58) for blacks and 0.02 (95 % CI -0.30, 0.27) for whites. CRP mediated 22 % (95 % CI 5 %, 41 %) of the association between D-dimer and CHD and none of the association with stroke. Higher D-dimer increased the risk of stroke and CHD independent of cardiovascular risk factors and CRP, with perhaps a stronger association for CHD versus stroke in blacks than whites. These findings highlight potential different pathophysiology of vascular disease by disease site and race suggesting potential further studies targeting haemostasis in primary prevention of vascular disease.

  4. Human papillomavirus testing in primary cervical screening and the cut-off level for hybrid capture 2 tests

    DEFF Research Database (Denmark)

    Rebolj, Matejka; Bonde, Jesper; Njor, Sisse Helle

    2011-01-01

    To determine the trade-off between the sensitivity and the specificity for high grade cervical intraepithelial neoplasia at hybrid capture 2 cut-off values above the standard = 1 relative light units/cut-off level (rlu/co).......To determine the trade-off between the sensitivity and the specificity for high grade cervical intraepithelial neoplasia at hybrid capture 2 cut-off values above the standard = 1 relative light units/cut-off level (rlu/co)....

  5. The continuous cut-off method and the relativistic scattering of spin-1/2 particles

    International Nuclear Information System (INIS)

    Dolinszky, T.

    1979-07-01

    A high energy formula, obtained in the framework of the continuous cut-off approach, is shown to improve the correctness of the standard phase shift expression for Dirac scattering by two orders of magnitude in energy. (author)

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

    DEFF Research Database (Denmark)

    Smith, P.; Endris, R.; Kronvall, G.

    2016-01-01

    Epidemiological cut-off values were developed for application to antibiotic susceptibility data for Flavobacterium psychrophilum generated by standard CLSI test protocols. The MIC values for ten antibiotic agents against Flavobacterium psychrophilum were determined in two laboratories. For five a...

  7. Brug af D-dimer til at udelukke dyb venøs trombose i overekstremiteterne

    DEFF Research Database (Denmark)

    Ahler-Toftehøj, Hans-Ulrik; Mikkelsen, Peter

    2009-01-01

    D-dimer is often used to exclude deep venous thrombosis, primarily in the lower extremities. We describe a 38-year-old man who had deep venous thrombosis in the left vena subclavia in spite of a normal D-dimer. Only one inconclusive survey compares the value of D-dimer and upper extremity deep...

  8. Surface effect theory in binary alloys: surfaces with cut-off

    International Nuclear Information System (INIS)

    Kumar, V.; Silva, C.E.T.G. da; Moran-Lopez, J.L.

    1981-01-01

    A surface effect theory in binary alloys which ore ordered with surfaces with cut-off is presented. This theory is based in a model of pair interaction between first neighbours and includes long and short range effects. The (120) surface with sup(-) (110) monoatomic cut-off and terrace in the (110) planes of an alloy with body centered cubic structure is presented as example. Results for the concentrations in all the different surface sites are given. (L.C.) [pt

  9. Experimental research on the durability cutting tools for cutting-off steel profiles

    Directory of Open Access Journals (Sweden)

    Cristea Alexandru

    2017-01-01

    Full Text Available The production lines used for manufacturing U-shaped profiles are very complex and they must have high productivity. One of the most important stages of the fabrication process is the cutting-off. This paper presents the experimental research and analysis of the durability of the cutting tools used for cutting-off U-shaped metal steel profiles. The results of this work can be used to predict the durability of the cutting tools.

  10. Cut-off of electric consumption in France. Assessment of the cut-off potential by process modulation in industrial and tertiary sectors in metropolitan France. Final report + Synthesis

    International Nuclear Information System (INIS)

    Bertholon, Marion; Streiff, Frederic; Marchal, David; Bouchet, Alexandre; Foucher, Julie-Anne; Hoffer, Alexandre; Millet, Bruno; Sorlier, Pierre; Peron, Nicolas; Creon, Nicolas; Lenet, Sylvain; Guillet, Frederic; Mounier, Cyril; Charton, Franck; Duclos, Herve; Lenain, Yves; MADEC, Marc; Lepretre, Pascale; Vasseur, Olivier; Rigard-Cerison, Aude; Guedou, Benjamin; Houvenagel, Olivier; Epelbaum, David; Briant, Marie-Helene; Osmont, Robin; Elasri, Sofia; Barreyre, Gildas; Adam, Julien

    2017-09-01

    This study mainly aims at characterising and assessing the cut-off potential in the French industrial and tertiary sectors by providing qualitative as well as quantitative elements, and by highlighting the different mechanisms of valorisation of existing and currently developed cut-off. It also proposes a comparison of the French context with that of some foreign countries (notably United Kingdom, Japan, and some regions of the USA). Thus, it comprises an identification and analysis of cut-off mechanisms and practices, an assessment of technical and technical-economic cut-off sources in France, and a discussion of economic and organisational brakes and obstacles to cut-off developments

  11. Qualitative point-of-care D-dimer testing compared with quantitative D-dimer testing in excluding pulmonary embolism in primary care

    NARCIS (Netherlands)

    Lucassen, W. A. M.; Erkens, P. M. G.; Geersing, G. J.; Büller, H. R.; Moons, K. G. M.; Stoffers, H. E. J. H.; van Weert, H. C. P. M.

    2015-01-01

    General practitioners can safely exclude pulmonary embolism (PE) by using the Wells PE rule combined with D-dimer testing. To compare the accuracy of a strategy using the Wells rule combined with either a qualitative point-of-care (POC) D-dimer test performed in primary care or a quantitative

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

    Energy Technology Data Exchange (ETDEWEB)

    Baran, A.; Noszaly, Cs. [Faculty of Informatics, University of Debrecen, PO Box 12, Debrecen (Hungary); Salamon, P. [Hungarian Academy of Sciences (ATOMKI), Institute for Nuclear Research, PO Box 51, Debrecen (Hungary); Vertse, T. [Faculty of Informatics, University of Debrecen, PO Box 12, Debrecen (Hungary); Hungarian Academy of Sciences (ATOMKI), Institute for Nuclear Research, PO Box 51, Debrecen (Hungary)

    2015-07-15

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

  13. BANKRUPTCY PREDICTION MODEL WITH ZETAc OPTIMAL CUT-OFF SCORE TO CORRECT TYPE I ERRORS

    Directory of Open Access Journals (Sweden)

    Mohamad Iwan

    2005-06-01

    This research has successfully attained the following results: (1 type I error is in fact 59,83 times more costly compared to type II error, (2 22 ratios distinguish between bankrupt and non-bankrupt groups, (3 2 financial ratios proved to be effective in predicting bankruptcy, (4 prediction using ZETAc optimal cut-off score predicts more companies filing for bankruptcy within one year compared to prediction using Hair et al. optimum cutting score, (5 Although prediction using Hair et al. optimum cutting score is more accurate, prediction using ZETAc optimal cut-off score proved to be able to minimize cost incurred from classification errors.

  14. Secondary proton production at small atmospheric depths as a function of the geomagnetic cut-off

    Energy Technology Data Exchange (ETDEWEB)

    Papini, P. [Florence Univ. (Italy)]|[INFN, Florence (Italy); Grimani, C. [Perugia Univ. (Italy)]|[INFN, Perugia (Italy); Stephens, S.A. [Tata Institute of Fundamental Research, Bombay (International Commission on Radiation Units and Measurements)

    1995-09-01

    A detailed calculation of the energy spectrum of secondary protons in the atmosphere is being carried out in the energy range 20 MeV - 40 GeV. In this calculation, it is taken into account all processes leading to the production of secondary protons as a function of the atmospheric depth has been calculated using all relevant energy loss processes. In this paper, it is examine the effect of the geomagnetic cut-off on the spectral shape of secondary protons specially at energies below the geomagnetic cut-off for small atmospheric depths.

  15. Vertical cut-off walls for the containment of contaminated ground

    International Nuclear Information System (INIS)

    Jessberger, H.L.; Krubasik, K.; Beine, R.A.

    1997-01-01

    Vertical cut-off walls are widely used for the containment of contaminated sites, where a capping system is not sufficient for the protection of groundwater. Various types of cut-off walls are introduced and new developments are prescribed. Design and testing principles are outlined. Containment techniques are the appropriate measure for old landfills and abandoned industrial sites with contaminated ground and groundwater, too, since the shortage of financial resources in many countries classifies clean-up techniques as too cost intensive in most cases

  16. Relevance of Interleukin-6 and D-Dimer for Serious Non-AIDS Morbidity and Death among HIV-Positive Adults on Suppressive Antiretroviral Therapy.

    Directory of Open Access Journals (Sweden)

    Birgit Grund

    Full Text Available Despite effective antiretroviral treatment (ART, HIV-positive individuals are at increased risk of serious non-AIDS conditions (cardiovascular, liver and renal disease, and cancers, perhaps due in part to ongoing inflammation and/or coagulation. To estimate the potential risk reduction in serious non-AIDS conditions or death from any cause that might be achieved with treatments that reduce inflammation and/or coagulation, we examined associations of interleukin-6 (IL-6, D-dimer, and high-sensitivity C-reactive protein (hsCRP levels with serious non-AIDS conditions or death in 3 large cohorts.In HIV-positive adults on suppressive ART, associations of IL-6, D-dimer, and hsCRP levels at study entry with serious non-AIDS conditions or death were studied using Cox regression. Hazard ratios (HR adjusted for age, gender, study, and regression dilution bias (due to within-person biomarker variability were used to predict risk reductions in serious non-AIDS conditions or death associated with lower "usual" levels of IL-6 and D-dimer.Over 4.9 years of mean follow-up, 260 of the 3766 participants experienced serious non-AIDS conditions or death. IL-6, D-dimer and hsCRP were each individually associated with risk of serious non-AIDS conditions or death, HR = 1.45 (95% CI: 1.30 to 1.63, 1.28 (95% CI: 1.14 to 1.44, and 1.17 (95% CI: 1.09 to 1.26 per 2x higher biomarker levels, respectively. In joint models, IL-6 and D-dimer were independently associated with serious non-AIDS conditions or death, with consistent results across the 3 cohorts and across serious non-AIDS event types. The association of IL-6 and D-dimer with serious non-AIDS conditions or death was graded and persisted throughout follow-up. For 25% lower "usual" IL-6 and D-dimer levels, the joint biomarker model estimates a 37% reduction (95% CI: 28 to 46% in the risk of serious non-AIDS conditions or death if the relationship is causal.Both IL-6 and D-dimer are independently associated with

  17. Poverty and cutting off the power: Evaluation of the social contract of the Electricite de France

    International Nuclear Information System (INIS)

    Wodon, Q. T.

    2003-01-01

    Measures put in place by the French Electric Utility, Electricite de France (EDF) to assist those in default of payment of their electricity bills are evaluated. When introduced in 1996, it was expected that the new measures would reduce the necessity of cutting off power to the poor by one third. Notwithstanding these expectations and some progress in reducing the rate of power cut-off, the number of instances where service was denied, has risen. The evaluation is based on the annual survey of poor clients of the EDF undertaken by the Polling Institute Lavialle. The annual survey concerns itself chiefly with the attitude towards the service and the quality of dialogue between the Utility and its clients. The analysis resulted in three conclusions: (1) EDF appears to make progress in dealing with the problem based on evidence of higher client satisfaction and lower rate of cutting off power; (2) there is evidence of important beneficial changes in the policies of local EDF centres; and (3) there is noticeable evidence of improved coordination with social services agencies and higher quality of information made available; both these factors should contribute to higher client satisfaction. In general, EDF is to be congratulated for their efforts to date, for commissioning the survey and for participating in the evaluation. Nevertheless, in France the instances of cutting off electricity to poor households is still a fact of life, despite the commitment and the new measures put in place by EDF. 21 refs., 7 tabs., 1 fig

  18. Can semiquantitative measurements of SUVmax and cut-off values differentiate colorectal malignant from benign lessions?

    DEFF Research Database (Denmark)

    Nguyen, Tram; Hess, Søren; Petersen, Henrik

    2017-01-01

    OBJECTIVE: We investigated maximum standardized uptake value (SUVmax) and cut-off values for differentiation of malignant and benign lesions in colorectal cancer (CC) as multiple studies have questioned their validity. We also investigated more extended indices using common semi-quantification an......OBJECTIVE: We investigated maximum standardized uptake value (SUVmax) and cut-off values for differentiation of malignant and benign lesions in colorectal cancer (CC) as multiple studies have questioned their validity. We also investigated more extended indices using common semi......, which also precludes a clinically significant cut-off value. The same applies to SUVpeak and SUVmean while TLG measures may be more indicative. CONCLUSION: Semi-quantitative measurements of SUVmax and cut-off values proved inadequate for differentiating colorectal malignancies from benign findings......-quantification analysis in incidental colorectal findings (ICF). SUBJECTS AND METHODS: Fluorine-18-fluoro deoxy glucose positron emission tomography/computed tomography in 25 patients with a total of 30 focal ICF was retrospectively analysed using dedicated software. Method variability was tested through application...

  19. Establishing Streptomycin Epidemiological Cut-Off Values for Salmonella and Escherichia coli

    DEFF Research Database (Denmark)

    Migura, Lourdes Garcia; Sunde, Marianne; Karlsmose, Susanne

    2011-01-01

    This study was conducted to elucidate the accuracy of the current streptomycin epidemiological cut-off value (ECOFF) for Escherichia coli and Salmonella spp. A total of 236 Salmonella enterica and 208 E. coli isolates exhibiting MICs between 4 and 32 mg/L were selected from 12 countries. Isolates...

  20. Establishing streptomycin epidemiological cut-off values for Salmonella and Escherichia coli. Microbial Drug Resistance

    NARCIS (Netherlands)

    Garcia-Migura, L.; Sunde, M.; Karlsmose, S.; Veldman, K.T.; Schroeter, A.; Guerra, B.; Granier, S.A.; Perrin-Guyomard, A.; Gicquel-Bruneau, M.; Franco, A.; Englund, S.; Teale, C.; Heiska, H.; Clemente, L.; Boerlin, P.; Moreno, M.A.; Daignault, D.; Mevius, D.J.; Hendriksen, R.S.; Aarestrup, F.M.

    2012-01-01

    This study was conducted to elucidate the accuracy of the current streptomycin epidemiological cut-off value (ECOFF) for Escherichia coli and Salmonella spp. A total of 236 Salmonella enterica and 208 E. coli isolates exhibiting MICs between 4 and 32¿mg/L were selected from 12 countries. Isolates

  1. On the discovery of the Greisen–Zatzepin–Kuzmin cut-off

    Indian Academy of Sciences (India)

    Keywords. Statistical inference; Bayesian confidence level; cosmic rays. Abstract. The recent claim of the `5 sigma' observation of the Greisen–Zatzepin–Kuzmin cut-off by the HiRes group based on their nine years data is a significant step towards the eventual solution of one of the most intriguing questions in physics for ...

  2. Emission noise and high frequency cut-off of the Kondo effect in a quantum dot

    Science.gov (United States)

    Delagrange, R.; Basset, J.; Bouchiat, H.; Deblock, R.

    2018-01-01

    By coupling on chip via a resonant circuit a carbon nanotube to a quantum noise detector, a superconductor-insulator-superconductor junction we measure the emission noise of a carbon nanotube quantum dot in the Kondo regime. The signature of the Kondo effect in the current noise is measured for different ratios of the Kondo temperature over the measured frequency and for different asymmetries of the coupling to the contacts and compared to finite frequency quantum noise calculations. Our results point towards the existence of a high frequency cut-off of the electronic emission noise associated with the Kondo resonance. This cut-off frequency is on the order of a few times the Kondo temperature when the electronic system is close to equilibrium, which is the case for a strongly asymmetric coupling. On the other hand, this cut-off is shifted to lower frequencies in a symmetric coupling situation where the bias voltage drives the Kondo state out of equilibrium. We then attribute the low frequency cut-off to voltage-induced spin relaxation.

  3. Chronic kidney disease : Defining clinical cut-offs for albumin:creatinine ratio

    NARCIS (Netherlands)

    Bakker, Stephan J L

    2013-01-01

    Albuminuria is rapidly gaining recognition as a marker of the presence and of the progression of chronic kidney disease (CKD). In a new study, Naresh et al. attempt to define cut-off values for percentage change in urinary albumin:creatinine ratio that reflect changes in CKD status rather than

  4. Is the hymen a suitable cut-off point for clinically relevant pelvic organ prolapse?

    NARCIS (Netherlands)

    Wiegersma, Marian; Panman, Chantal M. C. R.; Kollen, Boudewijn J.; Berger, Marjolein Y.; Lisman-van Leeuwen, Yvonne; Dekker, Janny H.

    Objectives: The primary objective was to evaluate the ability of different anatomic cut-off points, as established in specialist urogynecology populations, to identify clinically relevant prolapse in a population of postmenopausal women with pelvic floor symptoms recruited from primary care. Study

  5. Prevalensi Sarkopenia pada Lansia di Komunitas (Community Dwelling berdasarkan Dua Nilai Cut-off Parameter Diagnosis

    Directory of Open Access Journals (Sweden)

    Vitriana

    2016-09-01

    Full Text Available Sarcopenia, aging muscle mass loss, and function syndromes can lead to decreased quality of life and increased elderly mortality. The availability of various screening methods and operational definitions in different studies has produced different findings of sarcopenia prevalence. The purpose of this study was to discover the prevalence of sarcopenia in Indonesian community-dwelling elderly based on muscle mass measured by bioimpedance analysis, handgrip strength using hand dynamometer, and physical performance based on six minutes walking test with two different cut-off point parameters of sarcopenia, i.e. the cut-off point recommended by Asian Working Group for Sarcopenia (AWGS and the cut-off point based on the reference used in Taiwan elderly population reference due to the lack of references for Indonesian elderly population. A cross-sectional study was conducted to 229 participants (71 men and 158 women from the community-dwelling elderly population between August and December 2014 in Bandung and Jatinangor. The results of the study showed that the sarcopenia prevalence in this study based on AWGS was 9.1% (7.4% in men and 1.7% in women while the prevalence based on the Taiwan reference revealed a prevalence of 40.6% (20.1% in men and 20.5% in women. This highly different prevalences shows the importance of defining a specific cut-off point for elderly population in community-dwelling Indonesia to get a more accurate sarcopenia prevalence.

  6. Normal Limits of Electrocardiogram and Cut-Off Values for Left ...

    African Journals Online (AJOL)

    olayemitoyin

    Summary: This study assessed healthy young adults to determine the normal limits for electrocardiographic variables and cut-off values for left ventricular hypertrophy. It was a cross sectional descriptive study in which the participants were evaluated clinically by standard 12-lead resting electrocardiogram (ECG) at 25mm/s ...

  7. Lactate clearance cut off for early mortality prediction in adult sepsis and septic shock patients

    Science.gov (United States)

    Sinto, R.; Widodo, D.; Pohan, H. T.

    2018-03-01

    Previous lactate clearance cut off for early mortality prediction in sepsis and septic shock patient was determined by consensus from small sample size-study. We investigated the best lactate clearance cut off and its ability to predict early mortality in sepsis and septic shock patients. This cohort study was conducted in Intensive Care Unit of CiptoMangunkusumo Hospital in 2013. Patients’ lactate clearance and eight other resuscitationendpoints were recorded, and theoutcome was observed during the first 120 hours. The clearance cut off was determined using receiver operating characteristic (ROC) analysis, and its ability was investigated with Cox’s proportional hazard regression analysis using other resuscitation endpoints as confounders. Total of 268 subjects was included, of whom 70 (26.11%) subjects died within the first 120 hours. The area under ROC of lactate clearance to predict early mortality was 0.78 (95% % confidence interval [CI] 0.71-0.84) with best cut off was sepsis and septic shock patients is 7.5%.

  8. Cut-off values of distal forearm bone density for the diagnosis of ...

    African Journals Online (AJOL)

    Background: The objective of this study was to establish a triage cut-off point or threshold for peripheral bone mineral density (BMD), applicable to black postmenopausal women, and that could be used as a screening method to differentiate between women with normal BMD, and those with possible central osteoporosis.

  9. Exploring cut-off values for large waist circumference in older adults : a new methodological approach

    NARCIS (Netherlands)

    Heim, N; Snijder, M B; Heymans, Martijn W; Deeg, D J H; Seidell, J C; Visser, M

    BACKGROUND: There is an ongoing debate about the applicability of current criteria for large waist circumference (WC) in older adults. OBJECTIVES: Our aim was to explore cut-off values for large WC in adults aged 70 years and older, using previously used and new methods. DESIGN: Prospective cohort

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

    Directory of Open Access Journals (Sweden)

    Stig Andersen

    2013-08-01

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

  11. Optimal cut-off of obesity indices to predict cardiovascular disease risk factors and metabolic syndrome among adults in Northeast China.

    Science.gov (United States)

    Yu, Jianxing; Tao, Yuchun; Tao, Yuhui; Yang, Sen; Yu, Yaqin; Li, Bo; Jin, Lina

    2016-10-13

    CVD risk factors (hypertension, dyslipidemia and diabetes) and MetS are closely related to obesity. The selection of an optimal cut-off for various obesity indices is particularly important to predict CVD risk factors and MetS. Sixteen thousand seven hundred sixty-six participants aged 18-79 were recruited in Jilin Province in 2012. Five obesity indices, including BMI, WC, WHR, WHtR and BAI were investigated. ROC analyses were used to evaluate the predictive ability and determine the optimal cut-off values of the obesity indices for CVD risk factors and MetS. BMI had the highest adjusted ORs, and the adjusted ORs for hypertension, dyslipidemia, diabetes and MetS were 1.19 (95 % CI, 1.17 to 1.20), 1.20 (95 % CI, 1.19 to 1.22), 1.12 (95 % CI, 1.10 to 1.13), and 1.40 (95 % CI, 1.38 to 1.41), respectively. However, BMI did not always have the largest adjusted AUROC. In general, the young age group (18 ~ 44) had higher ORs and AUROCs for CVD risk factors and MetS than those of the other age groups. In addition, the optimal cut-off values for WC and WHR in males were relatively higher than those in females, whereas the BAI in males was comparatively lower than that in females. The appropriate obesity index, with the corresponding optimal cut-off values, should be selected in different research studies and populations. Generally, the obesity indices and their optimal cut-off values are: BMI (24 kg/m 2 ), WC (male: 85 cm; female: 80 cm), WHR (male: 0.88; female: 0.85), WHtR (0.50), and BAI (male: 25 cm; female: 30 cm). Moreover, WC is superior to other obesity indices in predicting CVD risk factors and MetS in males, whereas, WHtR is superior to other obesity indices in predicting CVD risk factors and MetS in females.

  12. Waist circumference cut-off values to predict the incidence of hypertension: an estimation from a Brazilian population-based cohort.

    Science.gov (United States)

    Gus, M; Cichelero, F Tremea; Moreira, C Medaglia; Escobar, G Fortes; Moreira, L Beltrami; Wiehe, M; Fuchs, S Costa; Fuchs, F Danni

    2009-01-01

    Central obesity is a key component in the definition of the metabolic syndrome, but the cut-off values proposed to define abnormal values vary among different guidelines and are mostly based on cross-sectional studies. In this study, we identify the best cut-off values for waist circumference (WC) associated with the incidence of hypertension. Participants for this prospectively planned cohort study were 589 individuals who were free of hypertension and selected at random from the community of Porto Alegre, Brazil. Hypertension was defined by a blood pressure measurement >or= 140/90 mmHg or the use of blood pressure lowering drugs. A logistic regression model established the association between WC and the incidence of hypertension. A receiver operating characteristics (ROC) curve analysis was used to select the best WC cut-off point to predict the incidence of hypertension. During a mean follow-up of 5.5+/-0.9 years, 127 subjects developed hypertension. The hazard ratios for the development of hypertension, adjusted for age, baseline systolic blood pressure, alcohol consumption, gender and scholarship were 1.02 (95% CI; 1.00-1.04; P=0.02) for WC. The best cut-off WC values to predict hypertension were 87 cm in men and 80 cm in women, with an area under the curve of 0.56 (95% CI; 0.47-0.64; P=0.17) and 0.70 (95% CI; 0.63-0.77; Phypertension in individuals living in communities in Brazil, and this risk begins at lower values of WC that those recommended by some guidelines.

  13. Genetic predictors of fibrin D-dimer levels in healthy adults

    NARCIS (Netherlands)

    N.L. Smith (Nicholas); J.E. Huffman (Jennifer E.); D.P. Strachan (David); J. Huang (Jian); A. Dehghan (Abbas); S. Trompet (Stella); L.M. Lopez (Lorna M.); S.Y. Shin (So Youn); J. Baumert (Jens); V. Vitart (Veronique); J.C. Bis (Joshua); S.H. Wild (Sarah); A. Rumley (Ann); Q. Yang (Qiong Fang); A.G. Uitterlinden (André); D.J. Stott (David. J.); G. Davies (Gareth); A.M. Carter (Angela M.); B. Thorand (Barbara); O. Polašek (Ozren); B. McKnight (Barbara); H. Campbell (Harry); A.R. Rudnicka (Alicja); M.H. Chen (Min-hsin); B.M. Buckley (Brendan M.); S.E. Harris (Sarah); A. Peters (Annette); D. Pulanic (Drazen); T. Lumley (Thomas); A.J.M. de Craen (Anton J.M.); D.C. Liewald (David C.); C. Gieger (Christian); I. Ford (Ian); A.J. Gow (Alan J.); M. Luciano (Michelle); D.J. Porteous (David J.); X. Guo (Xiuqing); N. Sattar (Naveed); A. Tenesa (Albert); M. Cushman (Mary Ann); P.E. Slagboom (Eline); P.M. Visscher (Peter M.); T.D. Spector (Tim); T. Illig (Thomas); I. Rudan (Igor); E.G. Bovill (Edwin G.); A.F. Wright (Alan); W.L. McArdle (Wendy); G.H. Tofler (Geoffrey); A. Hofman (Albert); R.G.J. Westendorp (Rudi); J.M. Starr (John); P.J. Grant (Peter J.); M. Karakas (Mahir); N.D. Hastie (Nicholas D.); B.M. Psaty (Bruce); J.F. Wilson (James); G.D.O. Lowe (Gordon); C.J. O'Donnell (Christopher); J.C.M. Witteman (Jacqueline); J.W. Jukema (Jan Wouter); I.J. Deary (Ian); N. Soranzo (Nicole); W. Koenig (Wolfgang); C. Hayward (Caroline)

    2011-01-01

    textabstractBACKGROUND: Fibrin fragment D-dimer, one of several peptides produced when crosslinked fibrin is degraded by plasmin, is the most widely used clinical marker of activated blood coagulation. To identity genetic loci influencing D-dimer levels, we performed the first large-scale,

  14. Factors associated with D-dimer levels in HIV-infected individuals

    DEFF Research Database (Denmark)

    Borges, Alvaro H; O'Connor, Jemma L; Phillips, Andrew N

    2014-01-01

    than men, though a steeper increase of D-dimer with age occurred in men. Hepatitis B/C co-infection was the only co-morbidity associated with higher D-dimer levels. In this subgroup, the degree of hepatic fibrosis, as demonstrated by higher hyaluronic acid levels, but not viral load of hepatitis...

  15. The use of D-dimer in specific clinical conditions: a narrative review

    NARCIS (Netherlands)

    Bruinstroop, E.; van de Ree, M. A.; Huisman, M. V.

    2009-01-01

    The use of D-dimer in combination with a clinical decision rule has been widely investigated in pulmonary embolism and deep venous thrombosis. Although it has been shown to be safe in excluding venous thromboembolism, the clinician is often faced with specific situations in which the use of D-dimer

  16. D-Dimer assay as a non invasive test for the diagnosis of left atrial ...

    African Journals Online (AJOL)

    Background: Systemic embolism is a serious and sometime fatal complication of rheumatic MS. Objective: We assessed the predictive power of D-Dimer level to predict occurrence of left atrial (LA) thrombi in patients with rheumatic mitral stenosis (MS). Methods: D-dimer levels were analyzed for 24 patients with rheumatic ...

  17. Determination of a saliva cotinine cut-off to distinguish pregnant smokers from pregnant non-smokers

    DEFF Research Database (Denmark)

    Hegaard, Hanne K; Kjaergaard, Hanne; Møller, Lars F

    2007-01-01

    Objective validation of smoking status is necessary. Earlier studies have used saliva cotinine concentrations between 14.2 and 30 ng/ml as cut-off values to distinguish pregnant smokers from non-smokers. However, these cut-offs derive from studies including men and non-pregnant women. This consti...

  18. Changes in fibrin D-dimer, fibrinogen, and protein S during pregnancy

    DEFF Research Database (Denmark)

    Hansen, Anette Tarp; Andreasen, Birgitte Horst; Salvig, Jannie Dalby

    2010-01-01

    Background. Pregnancy is a hypercoagulable state with a 5- to 10- fold higher risk of venous thromboembolism. Existing reference intervals for fibrin D-dimer (D-dimer), functional fibrinogen (fibrinogen) and protein S, free antigen (protein S) are based on non-pregnant patients and reference...... intervals for pregnant patients are warranted. Objectives. The aim of the present study was to contribute to the establishment of reference intervals for D-dimer, fibrinogen and protein S during pregnancy and to discuss the use of the analyses during pregnancy. Methods. We included 55 healthy pregnant women...... in gestational week 11–17, with normal current pregnancy. Blood samples were collected in gestational weeks 11–17, 21–27 and 34–37. The three plasma parameters D-dimer, fibrinogen and protein S were analysed by STA-R Evolution®. Results. A significant rise in D-dimer was found from first to second trimester (p...

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

    Science.gov (United States)

    Looney, Marilyn A.; Gilbert, Jennie

    2012-01-01

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

  20. Cut-off point of body mass index for malnutrition screening in end stage lung disease

    Directory of Open Access Journals (Sweden)

    R. Sadegh

    2015-10-01

    Full Text Available Background: Malnutrition is one of the serious complications in end stage lung disease that affects quality of life, mortality rate and lung transplantation outcome. Objective: The aim of this was to determine the cut-off point of body mass index (BMI for malnutrition screening in end stage lung disease. Methods: This cross-sectional study was conducted in 86 patients referred to the lung transplant clinic of Masih Daneshvari Hospital from July 2012 to February 2013. Nutritional status was evaluated using anthropometric measurements including Mid-Arm Muscle Circumference (MAMC, Triceps Skinfold (TSF, BMI, and Fat-Free Mass Index (FFMI. With ROC curve analysis, the cut-off point of BMI for diagnosis of patients with MAMC and SFT<25% and FFMI<5% of normal range was determined. Data were analyzed using Chi-square test and T-test. Findings: Mean age was 36.7±13.73. Mean BMI was 21.1±5.12 kg/m2, mean TSF was 11.76±7.79 mm, mean MAMC was 21.41±3.93 cm2, and mean FFMI was 16.69±2.35 kg/m2. Twenty eight patients (32.6% had FFMI<5% and MAMC and SFT<25% of normal range. In ROC curve analysis, the cut-off point of BMI for malnutrition was 19.4 kg/m2 with sensitivity of 0.844, specificity of 0.842, Youden Index of 0.686 and Shortest distance from the point (0, 1 of 0.0493. Conclusion: With regards to the results, it seems that the cut-off point of BMI for malnutrition screening is 19.4 kg/m2 in patients with end stage lung disease.

  1. Flocking of the Motsch-Tadmor Model with a Cut-Off Interaction Function

    Science.gov (United States)

    Jin, Chunyin

    2018-04-01

    In this paper, we study the flocking behavior of the Motsch-Tadmor model with a cut-off interaction function. Our analysis shows that connectedness is important for flocking of this kind of model. Fortunately, we get a sufficient condition imposed only on the model parameters and initial data to guarantee the connectedness of the neighbor graph associated with the system. Then we present a theoretical analysis for flocking, and show that the system achieves consensus at an exponential rate.

  2. Influence of corium droplets cut-off diameter on steam explosion

    International Nuclear Information System (INIS)

    Leskovar, M.; Ursic, M.

    2007-01-01

    Steam explosion experiments have revealed that there are important differences of behaviour between simulant and prototypical melts (the efficiency of steam explosions with prototypical melts is about one order of magnitude lower than with alumina melts), and that also with prototypical melts the fuel coolant interactions (FCI) depend on the composition of corium (eutectic corium may explode spontaneously, whereas non-eutectic corium never did). To explore the ability of global FCI codes to adequately simulate the explosion phase if the premixture conditions at triggering would be known and to establish the influence of droplets freezing on the steam explosion, a number of explosion phase simulations of KROTOS experiment K-53 were performed with the code MC3D, starting from different predefined premixture and droplets conditions. In the performed parametric analysis the premixture radius and the corium droplets cut-off diameter were varied, assuming that corium droplets with a diameter smaller than the cut-off diameter can not participate in the explosion due to solidification. It was assumed that the phases in the premixture are distributed homogeneously. The phase fractions were determined based on experimental measurements of the average void fraction and the mass of released fuel. The analysis showed that there is an important influence of droplets freezing on the strength of the steam explosion, since already a small variation of the cut-off diameter significantly changed the calculated pressure impulses. Therefore the influence of droplets freezing on the steam explosion should be considered in global FCI codes. With the best-fit cut-off diameter and premixture radius a quite good agreement of simulation results with experimental measurements could be obtained. This is an indication that at least in principle the explosion phase can be reasonably well predicted if the premixture conditions at triggering are adequately determined and if we could judge based on

  3. Impalement oral injury: Ultrasonic scalpel is the best tool to cut off a toothbrush.

    Science.gov (United States)

    Yamaguchi, Yoshikazu; Miyashita, Tetsuya; Toki, Keiko; Takaki, Shunsuke; Goto, Takahisa

    2015-01-01

    Penetrating injuries to the oral cavity involving a toothbrush are relatively common among children. Sometimes general anesthesia is recommended. Although the handle prevents adequate mask ventilation in the induction of anesthesia, it is unknown what is the best tool to cut it preventing complications. The aim of this study was to evaluate the optimal tool to cut off the toothbrush handle. Six anesthesiologists participated in this study. We attached a triaxial acceleration sensor to the tip of the toothbrush to virtually measure force toward the wound. Each participant cut off the handle of the toothbrush using 3 tools: Gluck rib shears (GRS: cutting horizonal); Sklar Coryllos rib shears (SCRS: cutting vertical); and an ultrasonic scalpel (USS). Acceleration and time required to cut the toothbrush were measured. Each anesthesiologist evaluated the usability of each tool on a 5-point scale. The USS showed the longest mean time (GRS, 1.78 ± 1.01 s; SCRS, 7.30 ± 4.58 s; USS, 28.13 ± 13.41 s), lowest 3-dimensional acceleration (GRS, 2.15 ± 0.69 G; SCRS, 2.13 ± 0.57 G; USS, 1.01 ± 1.07 G), and highest mean score for usability. The USS appeared preferable to rib shears for cutting off toothbrush handles, even though it takes longer.

  4. ASEA 60/2 industrial robot project Bardons and Oliver cut-off lathe application

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, S.J.

    1988-01-25

    The scope of this document is to define a test plan for the testing of the ASEA 60/2 industrial robot at the Bardons and Oliver (B and O) cut-off lathe in Plant 6. This test plan describes the administrative procedures to be used and the general responsibilities of the Westinghouse Materials Company of Ohio (WMCO) organizations which are most involved in the preparation, coordination, and conduct of the installation, startup, and testing. Any deviations to this procedure will be approved by the test coordinator, Manager, Development, and Plant 6 Supervisor. The purpose of this test is to evaluate the ASEA 60/2 industrial robot to determine the feasibility of implementing a robot at the Bardons and Oliver cut-off lathe in Plant 6 for material handling purposes. This robot will be used as a developmental robot in that it will be installed temporarily at the B and O and then be relocated to another application. The robot will be used for training purposes to familiarize personnel with programming, computer usage, maintenance, and operation of the robot. Radiation exposure reduction of the machine tool operators in Plant 6 will also be determined. Success of the testing will be measured by the amount of radiation exposure reduction and determining the complexity of incorporating automated machinery with the B and O cut-off lathe utilizing a robot.

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

    Science.gov (United States)

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

    2017-10-01

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

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

    Science.gov (United States)

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

    2018-04-01

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

  7. Evaluation of novel large cut-off ultrafiltration membranes for adenovirus serotype 5 (Ad5 concentration.

    Directory of Open Access Journals (Sweden)

    Piergiuseppe Nestola

    Full Text Available The purification of virus particles and viral vectors for vaccine and gene therapy applications is gaining increasing importance in order to deliver a fast, efficient, and reliable production process. Ultrafiltration (UF is a widely employed unit operation in bioprocessing and its use is present in several steps of the downstream purification train of biopharmaceuticals. However, to date few studies have thoroughly investigated the performance of several membrane materials and cut-offs for virus concentration/diafiltration. The present study aimed at developing a novel class of UF cassettes for virus concentration/diafiltration. A detailed study was conducted to evaluate the effects of (i membrane materials, namely polyethersulfone (PES, regenerated cellulose (RC, and highly cross-linked RC (xRC, (ii nominal cut-off, and (iii UF device geometry at different production scales. The results indicate that the xRC cassettes with a cut-off of approximately 500 kDa are able to achieve a 10-fold concentration factor with 100% recovery of particles with a process time twice as fast as that of a commercially available hollow fiber. DNA and host cell protein clearances, as well as hydraulic permeability and fouling behavior, were also assessed.

  8. Correlation between Body Mass Index, Gender, and Skeletal Muscle Mass Cut off Point in Bandung

    Directory of Open Access Journals (Sweden)

    Richi Hendrik Wattimena

    2017-09-01

    Full Text Available Objective: To determine the average skeletal muscle mass (SMM value in young adults as a reference population; to analyze the correlation of gender, and body mass index to the cut off point; and to determine skeletal muscle mass cut off points of population in Bandung, Indonesia. Methods: This was a cross-sectional study involving 199 participants, 122 females and 77 males. The sampling technique used was the multistage random sampling. The participants were those who lived in four major regions in Bandung, Indonesia: Sukajadi, Cicadas, Buah Batu, and Cibaduyut. Results: The average appendicular skeletal mass index (ASMI in females and males based on body mass index (BMI were identified. The average ASMI values for normal BMI in females was 5.982±0.462 kg/m2 while the average ASMI values normal BMI for males was 7.581±0.744 kg/m2 Conclusions: A correlation between BMI and ASMI that was considered statistically significant was found in females (0.7712; p<0.05 and a very significant correlation was seen in males (0.870; p<0.05. The cut off points were defined by the normal BMI, which were 5.059 for females and 6.093 for males.

  9. Accuracy of D-Dimers to Rule Out Venous Thromboembolism Events across Age Categories

    Directory of Open Access Journals (Sweden)

    G. Der Sahakian

    2010-01-01

    Full Text Available Background. Strategies combining pretest clinical assessment and D-dimers measurement efficiently and safely rule out venous thromboembolism events (VTE in low- and intermediate-risk patients. Objectives. As process of ageing is associated with altered concentrations of coagulation markers including an increase in D-dimers levels, we investigated whether D-dimers could reliably rule out VTE across age categories. Method. We prospectively assessed the test performance in 1,004 patients visiting the emergency department during the 6-month period with low or intermediate risk of VTE who also received additional diagnostic procedures. Results. 67 patients had VTE with D-dimers levels above the threshold, and 3 patients displayed D-dimers levels below the threshold. We observed that specificity of D-dimers test decreased in an age-dependent manner. However, sensitivity and negative predictive value remained at very high level in each age category including older patients. Conclusion. We conclude that, even though D-dimers level could provide numerous false positive results in elderly patients, its high sensitivity could reliably help physicians to exclude the diagnosis of VTE in every low- and intermediate-risk patient.

  10. A review of the cut-off points for the diagnosis of vitamin B12 deficiency in the general population.

    Science.gov (United States)

    Aparicio-Ugarriza, Raquel; Palacios, Gonzalo; Alder, Monika; González-Gross, Marcela

    2015-07-01

    Vitamin B12 deficit is one of the most common vitamin deficiencies. However, there is no consensus on the cut-off points for vitamin B12 and its co-markers, such as folate, holotranscobalamin, methylmalonic acid and homocysteine. In order to establish the state of the art about cut-off points used to determine vitamin B12 deficiency in the last decades, the database MEDLINE was used for searching studies published in adults between December 1992 and May 2014 (69 articles), using search terms like 'vitamin B12', 'cobalamin', 'cut-off', 'deficiency' alone or in combinations. Broad ranges of cut-off points for vitamin B12 and its biomarkers were identified: vitamin B12 ranged between 100 pmol/L and 350 pmol/L, holotranscobalamin 20-50 pmol/L, methylmalonic acid 0.210-0.470 μmol/L, homocysteine 10-21.6 μmol/L, serum folate 3.7-15.9 nmol/L and red blood cell 124-397 nmol/L. For the majority of studies, the potential influence of age, analytical methods, gender and fortified food consumption was not taken in account when choosing cut-off values. This could explain the discrepancies between studies on vitamin B12 and folate deficiency prevalences. We conclude that there is inconsistency in the literature regarding vitamin B12 cut-offs. It would be necessary to establish different reference cut-offs according to age, considering the analytical methods used.

  11. A study of full width at half maximum (FWHM) according to the filter's cut off level in SPECT camera

    International Nuclear Information System (INIS)

    Park, Soung Ock; Kwon, Soo Il

    2003-01-01

    Filtering is necessary to reduce statistical noise and to increase image quality in SPECT images. Noises controlled by low-pass filter designed to suppress high spatial frequency in SPECT image. Most SPECT filter function control the degree of high frequency suppression by choosing a cut off frequency. The location of cut off frequency determines the affect image noise and spatial resolution. If select the low cut off frequency, its provide good noise suppression but insufficient image quantity and high cut off frequencies increase the image resolution but insufficient noise suppression. The purpose of this study was to determines the optimum cut off level with comparison of FWHM according to cut off level in each filters-Band-limited, Sheep-logan, Sheep-logan Hanning, Generalized Hamming, Low pass cosine, Parazen and Butterworth filter in SPECT camera. We recorded image along the X, Y, Z-axis with 99m TcO 4 point source and measured FWHM by use profile curve. We find averaged length is 9.16 mm ∼ 18.14 mm of FWHM in X, Y, and Z-axis, and Band-limited and Generalized Hamming filters measures 9.16 mm at 0.7 cycle/pixel cut off frequency

  12. Defining a BMI Cut-Off Point for the Iranian Population: The Shiraz Heart Study.

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Babai

    Full Text Available In this study we evaluated and redefined the optimum body mass index (BMI cut-off point for the Iranian population based on metabolic syndrome (MeS risk factors. We further evaluated BMI cut-off points with and without waist circumference (WC as a cofactor of risk and compared the differences. This study is part of the largest surveillance programs conducted in Shiraz, Iran, termed the Shiraz Heart study. Our study sample included subjects between the ages of 20 to 65 years old. After excluding pregnant women, those with missing data and those with comorbid disease, a total of 12283 made up the study population. The participants underwent a series of tests and evaluations by trained professionals in accordance with WHO recommendations. Hypertension, abnormal fasting blood sugar (FBS, triglyceride (TG and high density lipoprotein cholesterol (HDL (in the context of the definition of metabolic syndrome were prevalent among 32.4%, 27.6%, 42.1 and 44.2% of our participants, respectively. Women displayed higher rates of overall obesity compared to men (based on the definition by the WHO as higher than 30 kg/m2. Regarding MeS, 38.9% of our population had the all symptoms of MeS which was more prevalent among women (41.5% vs. 36%. When excluding WC in the definition of MeS, results showed that males tend to show a higher rate of metabolic risk factors (19.2% vs. 15.6%. Results of multivariate analysis showed that parallel to an increase in BMI, the odds ratio (OR for acquiring each component of the metabolic syndrome increased (OR = 1.178; CI: 1.166-1.190. By excluding WC, the previous OR decreased (OR = 1.105; CI: 1.093-1.118. Receiver Operating Characteristic (ROC curve analysis showed that the optimum BMI cut-off point for predicting metabolic syndrome was 26.1 kg/m2 and 26.2 kg/m2 [Accuracy (Acc = 69% and 61%, respectively] for males and females, respectively. The overall BMI cut-off for both sexes was 26.2 kg/m2 (Acc = 65% with sensitivity and

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

    Science.gov (United States)

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

    2017-09-21

    Obesity is defined by the World Health Organization (WHO) as a disease characterized by the excessive accumulation of body fat. Obesity is considered a public health problem, leading to serious social, psychological and physical problems. However, the appropriate cut-off point of body mass index (BMI) based on body fat percentage (BF%) for classifying an individual as obese in middle-aged adults living in Rio de Janeiro remains unclear. This was a prospective cross-sectional study comprising of 856 adults (413 men and 443 women) living in Rio de Janeiro, Brazil ranging from 30-59 years of age. The data were collected over a two year period (2010-2011), and all participants were underwent anthropometric evaluation. The gold standard was the percentage of body fat estimated by bioelectrical impedance analysis. The optimal sensitivity and specificity were attained by adjusting BMI cut-off values to predict obesity based on the WHO criteria: BF% >25% in men and >35% in women, according to the receiver operating characteristic curve (ROC) analysis adjusted for age and for the whole group. The BMI cut-offs for predicting BF% were 29.9 kg/m 2 in men and 24.9 kg/m 2 in women. The BMI that corresponded to a BF% previously defining obesity was similar to that of other Western populations for men but not for women. Furthermore, gender and age specific cut-off values are recommended in this population.

  14. Wentzel-Kramers-Brillouin solution of cut-off frequency for horizontal shear (SH) waves in various inhomogeneous thin films

    Science.gov (United States)

    Cao, Xiaoshan; Shi, Junping; Jin, Feng

    2013-01-01

    The Wentzel-Kramers-Brillouin method is employed to study the cut-off frequencies of the horizontal shear waves in a freestanding functionally graded piezoelectric-piezomagnetic material film with the electrically and magnetically open boundary conditions. An analytical solution, which could be used in analyzing the problems of various functionally graded materials, is proven to have high precision by analytical analysis and a numerical example. The results reveal that the set of cut-off frequencies is a series of approximate arithmetic progressions. A theoretical foundation based on the relationship between the cut-off frequencies and the materials' gradient property is established for nondestructive evaluation.

  15. Using D-Dimer to Diagnose Painless Acute Aortic Dissection: A Case Report

    Directory of Open Access Journals (Sweden)

    Caroline Barniol

    2011-01-01

    Case Presentation. We report the case of a 66-year-old Caucasian male who presented a syncope immediately followed by a left-arm weakness while driving his car. Clinical examination was normal, but bilateral jugular vein distension was noted. Electrocardiogram and chest radiography were unremarkable. Among blood tests performed, troponin I test result was negative, and D-dimer test concentration was >4000 ng/mL. Since D-dimer test result was positive, chest computer tomography angiogram was performed and found a thoracic aortic dissection. Conclusion. Our case report shows that acute aortic dissection diagnosis is difficult and must be associated with the interpretation of various clinical signs and D-dimer measurement. It could be helpful for the emergency physician to have a pretest probability D-dimer like in pulmonary embolism diagnosis.

  16. Defining Glaucomatous Optic Neuropathy from a Continuous Measure of Optic Nerve Damage - The Optimal Cut-off Point for Risk-factor Analysis in Population-based Epidemiology

    NARCIS (Netherlands)

    Ramdas, Wishal D.; Rizopoulos, Dimitris; Wolfs, Roger C. W.; Hofman, Albert; de Jong, Paulus T. V. M.; Vingerling, Johannes R.; Jansonius, Nomdo M.

    2011-01-01

    Purpose: Diseases characterized by a continuous trait can be defined by setting a cut-off point for the disease measure in question, accepting some misclassification. The 97.5th percentile is commonly used as a cut-off point. However, it is unclear whether this percentile is the optimal cut-off

  17. Enhanced trans-Himalaya pollution transport to the Tibetan Plateau by cut-off low systems

    Science.gov (United States)

    Zhang, Ruixiong; Wang, Yuhang; He, Qiusheng; Chen, Laiguo; Zhang, Yuzhong; Qu, Hang; Smeltzer, Charles; Li, Jianfeng; Alvarado, Leonardo M. A.; Vrekoussis, Mihalis; Richter, Andreas; Wittrock, Folkard; Burrows, John P.

    2017-02-01

    Long-range transport followed by deposition of black carbon on glaciers of Tibet is one of the key issues of climate research as it induces changes on radiative forcing and subsequently impacting the melting of glaciers. The transport mechanism, however, is not well understood. In this study, we use short-lived reactive aromatics as proxies to diagnose transport of pollutants to Tibet. In situ observations of short-lived reactive aromatics across the Tibetan Plateau are analyzed using a regional chemistry and transport model. The model performance using the current emission inventories over the region is poor due to problems in the inventories and model transport. Top-down emissions constrained by satellite observations of glyoxal are a factor of 2-6 higher than the a priori emissions over the industrialized Indo-Gangetic Plain. Using the top-down emissions, agreement between model simulations and surface observations of aromatics improves. We find enhancements of reactive aromatics over Tibet by a factor of 6 on average due to rapid transport from India and nearby regions during the presence of a high-altitude cut-off low system. Our results suggest that the cut-off low system is a major pathway for long-range transport of pollutants such as black carbon. The modeling analysis reveals that even the state-of-the-science high-resolution reanalysis cannot simulate this cut-off low system accurately, which probably explains in part the underestimation of black carbon deposition over Tibet in previous modeling studies. Another model deficiency of underestimating pollution transport from the south is due to the complexity of terrain, leading to enhanced transport. It is therefore challenging for coarse-resolution global climate models to properly represent the effects of long-range transport of pollutants on the Tibetan environment and the subsequent consequence for regional climate forcing.

  18. Child obesity cut-offs as derived from parental perceptions: cross-sectional questionnaire.

    Science.gov (United States)

    Black, James A; Park, MinHae; Gregson, John; Falconer, Catherine L; White, Billy; Kessel, Anthony S; Saxena, Sonia; Viner, Russell M; Kinra, Sanjay

    2015-04-01

    Overweight children are at an increased risk of premature mortality and disease in adulthood. Parental perceptions and clinical definitions of child obesity differ, which may lessen the effectiveness of interventions to address obesity in the home setting. The extent to which parental and objective weight status cut-offs diverge has not been documented. To compare parental perceived and objectively derived assessment of underweight, healthy weight, and overweight in English children, and to identify sociodemographic characteristics that predict parental under- or overestimation of a child's weight status. Cross-sectional questionnaire completed by parents linked with objective measurement of height and weight by school nurses, in English children from five regions aged 4-5 and 10-11 years old. Parental derived cut-offs for under- and overweight were derived from a multinomial model of parental classification of their own child's weight status against school nurse measured body mass index (BMI) centile. Measured BMI centile was matched with parent classification of weight status in 2976 children. Parents become more likely to classify their children as underweight when they are at the 0.8th centile or below, and overweight at the 99.7th centile or above. Parents were more likely to underestimate a child's weight if the child was black or South Asian, male, more deprived, or the child was older. These values differ greatly from the BMI centile cut-offs for underweight (2nd centile) and overweight (85th). Clinical and parental classifications of obesity are divergent at extremes of the weight spectrum. © British Journal of General Practice 2015.

  19. European quality assurance and quality control for cut-off walls and caps

    International Nuclear Information System (INIS)

    Jefferis, S.A.

    1997-01-01

    Cut-off walls and caps both may be seriously compromised by small areas of substandard materials or work. Quality assurance/quality control is therefore of crucial importance and the paper sets out the issues that need to be addressed when designing a quality plan for a containment. Consideration is given to the purpose of the containment, the parameters to be controlled, specifications and standards and tests on raw and manufactured materials and on the in-situ containment. It is not the purpose of the paper to give detailed test procedures but rather to identify the questions that must be answered to develop a quality plan

  20. Prospects for a fissile material cut-off: Achieving a successful NPT review process

    International Nuclear Information System (INIS)

    Kalinowski, M.

    1999-01-01

    Finding new and creative ways to overcome the current deadlock in progress in nuclear arms control became the most important question in the past year. For a long time it had been expected that after the conclusion of the Comprehensive Test Ban Treaty, the next step would be to ban production of fissile materials for weapon purposes. Three strategies are proposed for reaching relevant cut-off agreements. First suggests possible fore for achievement of relevant agreements, second is the proposal to begin with international register of inventories and production capabilities for all relevant nuclear materials, and the third one is ti identify equivalent steps obligatory for all the parties involved

  1. D-dimer assays - A help or hindrance in suspected pulmonary thromboembolism assessment?

    Directory of Open Access Journals (Sweden)

    H K Bayes

    2011-01-01

    Full Text Available Background : Suspected pulmonary thromboembolism (PTE is a common presentation to acute medical units and can cause diagnostic difficulty. National guidelines on PTE management highlight the need for clinical probability assessment and D-dimer assays to ensure appropriate use of diagnostic imaging. D-dimers are used widely in UK hospitals, yet concern exists regarding their misuse. Aims : In this study we aimed to assess the impact of the introduction of D-dimer assays, combined with clinical probability assessment, for evaluation of suspected PTE in our unit. Materials and Methods : This was a prospective audit of all patients presenting with suspected PTE over two 12-week periods, exactly 1 year apart. D-dimers were introduced into our unit between these two periods. We recorded the clinical probability score, potential causes of false-positive D-dimer assay, diagnostic imaging result, patient outcome, admission rates, and length of inpatient stay. Statistical Analysis : Categorical variables were compared using a 2 x 2 chi-square test or Fisher′s exact test. Groups were compared utilizing the two-sample t-test or Mann-Whitney U test. Results : A total of 190 patients were included in the study; 65% were female. PTE was confirmed in 8.4%. Patients in both audit periods were comparable with regard to suitability for D-dimer measurement. Following D-dimer introduction, 40 out of 110 patients in period 2 could be discharged directly from the emergency department. Of those admitted to hospital, the median length of stay was significantly reduced in period 2 (3 days in period 1 vs 1 day in period 2; P=0.0007. Use of diagnostic imaging was significantly reduced following the introduction of D-dimers (90% in period 1 vs 40% in period 2; P<0.0001. The positive diagnostic yield for PTE on CT pulmonary angiogram (CTPA increased significantly from 10% in period 1 to 23% in period 2 (P=0.039. Conclusion : D-dimers must be used judiciously in the

  2. Performance tests of an abrasive cut-off systems for the finishing of high-precision casts

    Directory of Open Access Journals (Sweden)

    A. Fedoryszyn

    2008-10-01

    Full Text Available The paper summarizes the performance data of a newly designed and engineered grinding and cut-off system. The machine is used forseparation of models manufactured by the investment casting method. The machine comprises the following units:- base supporting other assemblies and elements: abrasive disc holder and drives; this solution enables an easy replacement and access toholding elements while a belt transmission allows the disc rpm to be varied,- mechanism moving the spindle in the horizontal, hence the abrasive disc position with respect to the batch can be precisely controlled,depending on the cast position and their shape,- holding and positioning-control of the batch to enable the fore and aft movements and rotations,- guide systems ensuring the travel of the batch in the specified direction and adjusting the travel speed to the required cutting rate,- centering, control, exhaust system, housing.Extensive tests were performed, including the tests of operating parameters of abrasive discs depending on the cast material, cyclograms ofthe applied treatment are obtained accordingly.

  3. Projection systems with a cut-off line for automotive applications

    Science.gov (United States)

    Kloos, G.; Eichhorn, K.

    2005-08-01

    The lighting systems of a car provide a variety of challenges from the point of view of illumination science and technology. Engineering work in this field has to deal both with reflector and lens design as well as with opto-mechanical design and sensor technology. It has direct implications on traffic safety and the efficiency in which energy is used. Therefore, these systems are continuously improved and optimized. In this context, adaptive systems that we investigate for automotive applications gain increasing importance. The properties of the light distribution in the vicinity of the cut-off line are of key importance for the safe and efficient operation of automotive headlamps. An alternative approach is proposed to refine the description of these properties in an attempt to make it more quantitative. This description is intended to facilitate intercomparison between different systems and/or to study environmental influences on the cut-off line of a system under investigation. Designing projection systems it is necessary to take a delicate trade-off between efficiency, light-distribution characteristics, mechanical boundary conditions, and legal requirements into account. Considerations and results on optical properties of three-axial reflectors in dependence of layout parameters will be given. They can serve as a guideline for the optical workshop and for free-form optimization.

  4. Scanning tunnelling microscope light emission: Finite temperature current noise and over cut-off emission.

    Science.gov (United States)

    Kalathingal, Vijith; Dawson, Paul; Mitra, J

    2017-06-14

    The spectral distribution of light emitted from a scanning tunnelling microscope junction not only bears its intrinsic plasmonic signature but is also imprinted with the characteristics of optical frequency fluc- tuations of the tunnel current. Experimental spectra from gold-gold tunnel junctions are presented that show a strong bias (V b ) dependence, curiously with emission at energies higher than the quantum cut-off (eV b ); a component that decays monotonically with increasing bias. The spectral evolution is explained by developing a theoretical model for the power spectral density of tunnel current fluctuations, incorporating finite temperature contribution through consideration of the quantum transport in the system. Notably, the observed decay of the over cut-off emission is found to be critically associated with, and well explained in terms of the variation in junction conductance with V b . The investigation highlights the scope of plasmon-mediated light emission as a unique probe of high frequency fluctuations in electronic systems that are fundamental to the electrical generation and control of plasmons.

  5. Proceedings from the Fissile Material Cut-off seminar in Stockholm

    Energy Technology Data Exchange (ETDEWEB)

    Arbman, G. [ed.

    1998-07-01

    The Swedish Defence Research Establishment hosted an international expert seminar on the subject of verifying a prohibition of the production of fissile material for nuclear weapons purpose (cut-off) in Stockholm, June 3-5 1998. The objective of the seminar was to provide an opportunity for informal discussions among scientific and technical experts on various technical matters relating to the verification of a future Fissile Material Cut-off Treaty (FMCT). A stated aim of the seminar was to keep issues of scope to a minimum. Invited speakers and commentators were given an opportunity to present their views as written contributions. The present seminar proceedings are essentially the result of these views. In addition, short summaries of the discussions following each session are included. Although an attempt was made to be as complete and accurate as possible in reproducing these discussions, the editors apologise if some important points or statements have been omitted. If so, the main reason is that the documentation of the discussions were based on written notes, not taped recordings. Eight longer contributions have been separately indexed.

  6. Physical Activity Questionnaire for children and adolescents: English norms and cut-off points.

    Science.gov (United States)

    Voss, Christine; Ogunleye, Ayodele A; Sandercock, Gavin R H

    2013-08-01

    The Physical Activity Questionnaire for Children and Adolescents (PAQ-C/-A) provides general estimates of physical activity levels. Following recent expert recommendations for using the PAQ for population surveillance, the aim of this paper was twofold: first, to describe normative PAQ data for English youth; and second, to determine a criterion-referenced PAQ-score cut-off point. Participants (n = 7226, 53% boys, 10-15 years) completed an anglicized version of the PAQ. Peak oxygen uptake (VO2peak ) was predicted from PACER lap count according to latest FITNESSGRAM standards and categorized into "at-risk" and "no-risk" for metabolic syndrome. ROC curves were drawn for each age-sex group to identify PAQ scores, which categorized youth into "sufficiently active" versus "low-active" groups, using cardiorespiratory fitness as the criterion-referenced standard. PAQ scores were higher in boys than in girls and declined with age. Mean PAQ score was a significant, albeit relatively weak (area under the curve PAQ scores of ≥2.9 for boys and ≥2.7 for girls were identified as cut-off points, although it may be more appropriate to use lower, age-specific PAQ scores for girls of 13, 14 and 15 years (2.6, 2.4, 2.3, respectively). The normative and criterion-referenced PAQ values may be used to standardize and categorize PAQ scores in future youth population studies. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

  7. Cut-Off Values of Visceral Adiposity to Predict NAFLD in Brazilian Obese Adolescents

    Directory of Open Access Journals (Sweden)

    Ana Paula Grotti Clemente

    2013-01-01

    Full Text Available Objectives. The present study aimed at determining cut-off points of visceral fat to predict NAFLD and analyzed metabolic disorders of obese adolescents. Methods. Cross-sectional study involved 165 obese adolescents ranged in age from 15 to 19 years. Glycemia, hepatic transaminases, lipid profile, and insulin resistance were analyzed. Visceral and subcutaneous fat were measured by ultrasound and body composition by plesthysmography. Results. The NAFLD adolescents had significantly higher values for body mass, BMI-for-age, BMI, total fat, waist circumference, and visceral fat when compared with non-NAFLD obese adolescents in both genders. Moreover, there were significant positive correlations between visceral fat with the variables BMI-for-age (r=0.325,, TG (r=0.277, AST (r=0.509, ALT (r=0.519, WC (r=0.390, and visceral/subcutaneous ratio (r=0.790 for NAFLD group. Total fat, triglycerides, and visceral fat were the independent predictors to NAFLD. Analysis of the ROC curves revealed cut-off points of visceral fat of 4.47 cm for girls and 4.21 cm for boys. Conclusions. The results may suggest that abdominal ultrasonography procedure may be a safe alternative method of assessing visceral adiposity aiming to be considered to the development of preventive and treatment strategies in obese individuals. This clinial trial is registered with ClinicalTrial.gov (NCT01358773.

  8. Receiver Operating Characteristic (ROC to Determine Cut-Off Points of Biomarkers in Lung Cancer Patients

    Directory of Open Access Journals (Sweden)

    Heidi L. Weiss

    2004-01-01

    Full Text Available The role of biomarkers in disease prognosis continues to be an important investigation in many cancer studies. In order for these biomarkers to have practical application in clinical decision making regarding patient treatment and follow-up, it is common to dichotomize patients into those with low vs. high expression levels. In this study, receiver operating characteristic (ROC curves, area under the curve (AUC of the ROC, sensitivity, specificity, as well as likelihood ratios were calculated to determine levels of growth factor biomarkers that best differentiate lung cancer cases versus control subjects. Selected cut-off points for p185erbB-2 and EGFR membrane appear to have good discriminating power to differentiate control tissues versus uninvolved tissues from patients with lung cancer (AUC = 89% and 90%, respectively; while AUC increased to at least 90% for selected cut-off points for p185erbB-2 membrane, EGFR membrane, and FASE when comparing between control versus carcinoma tissues from lung cancer cases. Using data from control subjects compared to patients with lung cancer, we presented a simple and intuitive approach to determine dichotomized levels of biomarkers and validated the value of these biomarkers as surrogate endpoints for cancer outcome.

  9. Proceedings from the Fissile Material Cut-off seminar in Stockholm

    International Nuclear Information System (INIS)

    Arbman, G.

    1998-01-01

    The Swedish Defence Research Establishment hosted an international expert seminar on the subject of verifying a prohibition of the production of fissile material for nuclear weapons purpose (cut-off) in Stockholm, June 3-5 1998. The objective of the seminar was to provide an opportunity for informal discussions among scientific and technical experts on various technical matters relating to the verification of a future Fissile Material Cut-off Treaty (FMCT). A stated aim of the seminar was to keep issues of scope to a minimum. Invited speakers and commentators were given an opportunity to present their views as written contributions. The present seminar proceedings are essentially the result of these views. In addition, short summaries of the discussions following each session are included. Although an attempt was made to be as complete and accurate as possible in reproducing these discussions, the editors apologise if some important points or statements have been omitted. If so, the main reason is that the documentation of the discussions were based on written notes, not taped recordings. Eight longer contributions have been separately indexed

  10. Physical activity cut-offs and risk factors for preventing child obesity in Japan.

    Science.gov (United States)

    Minematsu, Kazuo; Kawabuchi, Ryosuke; Okazaki, Hiromi; Tomita, Hiroyuki; Tobina, Takuro; Tanigawa, Takeshi; Tsunawake, Noriaki

    2015-01-01

    There is no official recommendations for physical activity level or steps for preventing and improving child obesity in Japan. Three hundred and two Japanese children aged 9-12 years were recruited wore 3-D speed sensors. Subjects were divided into two groups using the criteria for child obesity in Japan. Body composition was measured on bioelectrical impedance analysis. Physical fitness test was done to evaluate physical strength. Twenty-four hour total steps, energy expenditure, and metabolic equivalents (MET) from Monday to Sunday were consecutively measured. The cut-offs for steps and physical activity level for preventing child obesity were evaluated on receiver operating characteristic curves. Daily life-related risk factors for child obesity were assessed on logistic regression analysis. In both sexes, body volume; bodyweight, body mass index, fat mass, and percentage body fat in the obese group was significantly higher than in the normal group, but age and height were not different (P obese group were inferior to those in the normal group (P child obesity. Additionally, >2 h TV viewing per day is a significant risk factor for child obesity (OR, 3.43; 95%CI: 1.27-9.31). Cut-offs for physical activity and potential risk factors for child obesity have been identified. Recommendations for changes to daily lifestyle for school-aged Japanese children are given. © 2014 Japan Pediatric Society.

  11. D-dimer to guide the intensity of anticoagulation in Chinese patients after mechanical heart valve replacement: a randomized controlled trial.

    Science.gov (United States)

    Zhang, L; Zheng, X; Long, Y; Wu, M; Chen, Y; Yang, J; Liu, Z; Zhang, Z

    2017-10-01

    Essentials Low anticoagulation intensity reduces bleeding but increases thrombosis during warfarin therapy. Elevated D-dimer level is associated with increased thrombosis events. D-dimer can be used to find potential thrombosis in those receiving low intensity therapy. D-dimer-guided therapy may be the optimal strategy for those with mechanical heart valve replacement. Background Controversies remain regarding the optimal anticoagulation intensity for Chinese patients after mechanical heart valve replacement despite guidelines having recommended a standard anticoagulation intensity. Objectives To investigate whether D-dimer could be used to determine the optimal anticoagulation intensity in Chinese patients after mechanical heart valve replacement. Patients/Methods This was a prospective, randomized controlled clinical study. A total of 748 patients following mechanical heart valve replacement in Wuhan Asia Heart Hospital were randomized to three groups at a ratio of 1 : 1 : 1. Patients in two control groups received warfarin therapy based on constant standard intensity (international normalized ratio [INR], 2.5-3.5; n = 250) and low intensity (INR, 1.8-2.6; n = 248), respectively. In the experimental group (n = 250), warfarin therapy was initiated at low intensity, then those with elevated D-dimer levels were adjusted to standard intensity. All patients were followed-up for 24 months until the occurrence of endpoints, including bleeding events, thrombotic events and all-cause mortality. Results A total of 718 patients were included in the analysis. Fifty-three events occurred during follow-up. There was less hemorrhage (3/240 vs. 16/241; hazard ratio [HR], 0.18; 95% confidence interval [CI], 0.07-0.45) and all-cause mortality (4/240 vs. 12/241; HR, 0.33; 95% CI, 0.12-0.87) observed in the D-dimer-guided group than in the standard-intensity group. A lower incidence of thrombotic events was also observed in the D-dimer-guided group when compared with the

  12. CT Findings of Disease with Elevated Serum D-Dimer Levels in an Emergency Room Setting

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ji Youn; Kwon, Woo Cheol; Kim, Young Ju [Dept. of Radiology, Wonju Christian Hospital, Yensei University Wonju College of Medicine, Wonju (Korea, Republic of)

    2012-01-15

    Pulmonary embolism and deep vein thrombosis are the leading causes of elevated serum D-dimer levels in the emergency room. Although D-dimer is a useful screening test because of its high sensitivity and negative predictive value, it has a low specificity. In addition, D-dimer can be elevated in various diseases. Therefore, information on the various diseases with elevated D-dimer levels and their radiologic findings may allow for accurate diagnosis and proper management. Herein, we report the CT findings of various diseases with elevated D-dimer levels in an emergency room setting, including an intravascular contrast filling defect with associated findings in a venous thromboembolism, fracture with soft tissue swelling and hematoma formation in a trauma patient, enlargement with contrast enhancement in the infected organ of a patient, coronary artery stenosis with a perfusion defect of the myocardium in a patient with acute myocardial infarction, high density of acute thrombus in a cerebral vessel with a low density of affected brain parenchyma in an acute cerebral infarction, intimal flap with two separated lumens in a case of aortic dissection, organ involvement of malignancy in a cancer patient, and atrophy of a liver with a dilated portal vein and associated findings.

  13. Third molar cut-off value in assessing the legal age of 18 in Saudi population.

    Science.gov (United States)

    AlQahtani, Sakher; Kawthar, Alemad; AlAraik, Ayman; AlShalan, Ahmad

    2017-03-01

    Teeth plays a major role in forensic sciences especially in age assessment of an individual, which can be used to aid in criminal or civil matters. The importance of teeth comes from their ability to survive inhumation well and because they are hardly affected by exogenous and endogenous factors. Third molars are the only teeth still developing after the age of 14 years and during the legal age of adulthood, which is 18 years. The consequences of criminal violation can strongly affect the individual's life, it is important to set different parameters to decide whether an individual is a minor or an adult in the absence of documents. Depending on the different legal requirement, such parameters can set above 90% probability for criminal matters and from 51% to civil matters. The aim of this research was to find the cut-off value of third molar development for the legal age of 18 amongst Saudi individuals using the third molar maturity index method by Cameriere et al. (2008) [17]. This was a cross sectional study on 300 archived orthopantomogram (OPG) of healthy Saudi patients between the ages 14 and 22 years attending the Dental Hospital at King Saud University, Riyadh, Saudi Arabia. All OPGs were taken by PLANMECA - ProMax machine and evaluated by the Romaxis software. The inclusion criteria were good quality OPGs taken during the course of treatment. All patients were healthy with no systemic diseases or disorders with the presence of third molars and clear root apex. The lower left mandibular third molar (LL3rdM) was assessed using third molar maturity index (I3m) to determine if the individual is younger or older than 18 years old. The cut-off value of I3m for the Saudi population was (I3mage of adulthood in Saudi population and the cut-off value of I3m is similar to other populations. Although dental age assessment by means of third molar development is useful, it still has its limitation because of its variation in position, morphology and development

  14. Appropriate body mass index cut-offs to determine thinness, overweight and obesity in South Asian children in the Netherlands.

    Directory of Open Access Journals (Sweden)

    Jeroen A de Wilde

    Full Text Available BACKGROUND: Asian populations have an increased risk of developing cardiometabolic disorders at a lower body mass index (BMI than other ethnic groups. Therefore, lower adult BMI cut-offs to determine overweight and obesity are recommended to assess the associated health risks for Asian (23 and 27.5 kg/m(2 respectively and Asian Indian (23, 25 kg/m(2 populations. The objective of this study was to develop BMI cut-offs for thinness, overweight, and obesity for South Asian children in the Netherlands, and to compare the BMI cut-offs and distribution with an Asian Indian reference, the WHO Child Growth Reference, and universal BMI cut-offs. METHODS: A reference cohort of 546 Surinamese South Asian boys and 521 girls, born between 1974-1976 (during the pre-obesity era with 3408 and 3267 BMI measurements respectively, was retrospectively analysed. BMI-for-age charts were created with the LMS method. BMI centile curves passing through the cut-off points of 15 (thinness, 23 (overweight, 25 and 27.5 kg/m(2 (obesity at 18y were drawn as cut-off levels. RESULTS: The BMI of Surinamese South Asian children had a similar distribution to the Asian Indian reference, apart from a lower mean and less variation. The BMI distribution differed considerably from the WHO reference and universal BMI criteria. The calculated BMI cut-offs corresponding to a BMI of 15, 23, 25, and 27.5 kg/m(2 at 18y were at the 7.1, 81.1, 89.8, and 95.5 percentile respectively in boys, and at the 2.7, 79.5, 89.2, and 95.2 percentile in girls. CONCLUSIONS: This is the first study proposing BMI cut-offs for South Asian children based on measurements from a prosperous population unaffected by the obesity epidemic. We recommend the use of these cut-offs in South Asian children in the Netherlands as these better reflect the health risks associated with thinness, overweight and obesity, and therefore may prevent the development of cardiometabolic disorders.

  15. A clinically based prognostic index for diffuse large B-cell lymphoma with a cut-off at 70 years of age significantly improves prognostic stratification

    DEFF Research Database (Denmark)

    Gang, Anne O.; Pedersen, Michael; d'Amore, Francesco

    2015-01-01

    The introduction of rituximab and generally improved health among elderly patients have increased the survival of patients with diffuse large B-cell lymphoma (DLBCL). The International Prognostic Index (IPI) from 1992 is based on pre-rituximab data from clinical trials including several lymphoma ...... dehydrogenase (LDH), stage and albumin level, and (2) a separate age-adjusted DLBCL-PI for patients 1 extranodal lesion, however excluding stage....... subtypes. We applied IPI factors to a population-based rituximab-treated cohort of 1990 patients diagnosed 2000-2010 and explored new factors and the optimal prognostic age cut-off for DLBCL. Multivariate-analyses (MVA) confirmed the prognostic value of all IPI factors except the presence of > 1 extranodal...... lesion. The optimal age cut-off was 70 years. In a MVA of albumin, lymphocyte count, sex, immunoglobulin G, bulky disease, hemoglobin and B-symptoms, only albumin was prognostic. We propose: (1) a modified DLBCL prognostic index (DLBCL-PI) including: age (70 years), performance status (PS), lactate...

  16. Association between Von Willebrand factor, disintegrin and metalloproteinase with thrombospondin type 1 motif member 13, d-Dimer and cystatin C levels with retinopathy in type 1 diabetes mellitus.

    Science.gov (United States)

    Domingueti, Caroline Pereira; Fuzatto, Jéssica A; Fóscolo, Rodrigo B; Reis, Janice S; Dusse, Luci M; Carvalho, Maria das Graças; Gomes, Karina B; Fernandes, Ana Paula

    2016-08-01

    We evaluated the association between plasma levels of VWF, ADAMTS13 and d-Dimer, which consist on endothelial dysfunction and hypercoagulability biomarkers, and cystatin C with retinopathy in type 1 diabetic patients. Patients were classified according to presence (n=55) or absence (n=70) of retinopathy. Plasma levels of VWF, ADAMTS13, d-Dimer and cystatin C were evaluated by ELISA and ADAMTS13 activity was evaluated by FRET. Plasma levels of VWF (p=0.033), ADAMTS13 activity (p=0.014), d-Dimer (p=0.002) and cystatin C (pdiabetic patients with retinopathy compared to those without this complication. The multivariate logistic regression analysis showed that ADAMTS13 activity (p=0.031) d-Dimer (p=0.015) and cystatin C (p=0.001) remained associated with retinopathy after adjustment for age, diabetes duration, use of statin, use of ACEi or angiotensin antagonist, use of acetylsalicylic acid and glomerular filtration rate. ADAMTS13 activity, d-Dimer and cystatin C are associated with retinopathy in type 1 diabetic patients and are promising biomarkers for the diagnosis and monitoring of diabetic retinopathy. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Influence of Different Cut-Off Values on the Diagnosis of Mild Cognitive Impairment in Parkinson's Disease

    Directory of Open Access Journals (Sweden)

    Inga Liepelt-Scarfone

    2011-01-01

    Full Text Available Comparable to Alzheimer's disease, mild cognitive impairment in Parkinson's disease (PD-MCI is associated with an increased risk for dementia. However different definitions of PD-MCI may have varying predictive accuracy for dementia. In a cohort of 101 nondemented Parkinson patients who underwent neuropsychological testing, the frequency of PD-MCI subjects and PD-MCI subtypes (i.e., amnestic/nonamnestic was determined by use of varying healthy population-based cut-off values. We also investigated the association between defined PD-MCI groups and ADL scales. Varying cut-off values for the definition of PD-MCI were found to affect frequency of PD-MCI subjects (9.9%–92.1% and, maybe more important, lead to a “shift” of proportion of detected PD-MCI subtypes especially within the amnestic single-domain subtype. Models using a strict cut-off value were significantly associated with lower ADL scores. Thus, the use of defined cut-off values for the definition of PD-MCI is highly relevant for comparison purposes. Strict cut-off values may have a higher predictive value for dementia.

  18. Determination of the upper cut-off values of serum alanine aminotransferase and aspartate aminotransferase in Chinese

    Science.gov (United States)

    Zhang, Peng; Wang, Chun-Yan; Li, Yu-Xiang; Pan, Yu; Niu, Jun-Qi; He, Shu-Mei

    2015-01-01

    AIM: To determine the upper cut-off values of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in a Northern Chinese population. METHODS: A total of 3769 subjects in Jilin Province Northeast China were stratified to determine the potential factors affecting serum ALT and AST levels. The upper cut-off values of serum ALT and AST in these subjects were determined using receiver operating characteristic analysis and their sensitivity and specificity were evaluated. RESULTS: Stratification analysis revealed that serum ALT and AST levels were associated with gender, alcohol consumption, serum cholesterol and triglyceride levels, and body mass index. The upper cut-off values of serum ALT and AST were 22.15 U/L and 25.35 U/L for healthy men and 22.40 U/L and 24.25 U/L for healthy women, respectively. The new cut-off values had a higher sensitivity, but a slightly lower specificity than the current standards. CONCLUSION: Our results indicate that the new upper cut-off values of serum ALT and AST are markedly lower than current standards and may be valuable for the evaluation of liver function. PMID:25741150

  19. ELISA validation and determination of cut-off level for chloramphenicol residues in honey

    Directory of Open Access Journals (Sweden)

    Biernacki Bogumił

    2015-09-01

    Full Text Available An analytical validation of a screening ELISA for detection of chloramphenicol (CAP in honey was conducted according to the Commission Decision 2002/657/EC and Guidelines for the Validation of Screening Methods for Residues of Veterinary Medicines. The analyte was extracted from honey with a water and ethyl acetate mixture, and CAP concentrations were measured photometrically at 450 nm. The recovery rate of the analyte from spiked samples was 79%. The cut-off level of CAP in honey as the minimum recovery (0.17 units was established. Detection capability (CCβ was fixed at 0.25 μg kg−1. No relevant interferences between matrix effects and structurally related substances including florfenicol and thiamphenicol were observed. The ELISA method should be useful for determination of CAP residues in honey monitoring.

  20. Determination of the stresses and displacements in the cut off curtain body executed by the > method

    International Nuclear Information System (INIS)

    Snisarenko, V.I.; Mel'nikov, A.I.

    1994-01-01

    Construction of the cut-off-curtain (COC) is analyzed as a possible variant to reduce the rate of radioactive horizontal migration. Such constructions can be executed by the > method. The theoretical analysis of the stress-strained state of the carried out using the methods of the theory of elasticity and of the limit equilibrium of the strewing medium. Theoretical dependences are obtained and formulas for practical calculations of the COC-body stress-strained state in the depth intervals which are of practical interest are suggested. The dependences obtained may be used to calculate the consolidation parameters and filtration coefficients, to choose materials for the COC body, geometrical size and film elements included

  1. Why did Van Gogh cut off his ear? The problem of alternative explanations in psychobiography.

    Science.gov (United States)

    Runyan, W M

    1981-06-01

    One of the tasks of personality psychology is to explain the behavior of individual human beings. Vincent Van Gogh, for example, cut off the lower half of his left ear and gave it to a prostitute. More than a dozen different explanations of his actions have been proposed. Is one of these explanations true, are all of them true, or, perhaps, are none of them true? And how can we know? This incident is examined in order to explore some of the problems in applying personality theories to the life of a single individual. A sequential procedure for generating and critically evaluating alternative explanatory conjectures is presented a a partial, although not a complete, solution to the problem of multiple interpretations.

  2. Percentile curves for body fatness and cut-offs to define malnutrition in Russians

    International Nuclear Information System (INIS)

    Nikolaev, D V; Eryukova, T A; Kolesnikov, V A; Rudnev, S G; Starunova, O A; Ponomareva, E G; Soboleva, N P; Sterlikov, S A

    2013-01-01

    Here, we report first results of the large-scale ongoing bioelectrical impedance body composition study in Russians. By the end of 2012, 216 out of 800 Russian Health Centres submitted raw bioimpedance data on 844,221 adults and children aged 5–80 years, representing nearly 0.6% of the Russian population, who were accessed cross-sectionally using the same type of bioimpedance meter, ABC-01 Medas. Estimates of overweight, obesity, and normal weight obesity prevalence in the general population, as well as characteristics of diagnostic sensitivity and specificity of the conventional WHO BMI-based criteria of obesity depending on age are obtained. The smoothed reference centile curves for percentage fat mass are constructed, and localized cut-offs for fatness and thinness are provided that can be used both at the individual and epidemiological levels.

  3. Refining Game Addiction Questionnairs: Evidence for a natural cut-off point?

    DEFF Research Database (Denmark)

    Nielsen, Rune Kristian

    2013-01-01

    This paper presents data from a pilot study, which was designed to illuminate critical flaws in the currently used instruments used to measure the prevalence of ‘computer game addiction’. The study found that the prevalence rate could be set anywhere between 23% and 0,6% depending on how the data......’ from ‘addicted gamers’ by making implicit assumptions about negative effects explicit will cause prevalence rates to drop even further. Unexpectedly, the data from this modified questionnaire provides preliminary evidence for a natural cut-off point that clearly separates addicted play from normal play...... is unique in the field of prevalence studies of computer game addiction both in its design and its findings. The findings and conclusions need to be addressed by future research in the area....

  4. From Newton's Law to the Linear Boltzmann Equation Without Cut-Off

    Science.gov (United States)

    Ayi, Nathalie

    2017-03-01

    We provide a rigorous derivation of the linear Boltzmann equation without cut-off starting from a system of particles interacting via a potential with infinite range as the number of particles N goes to infinity under the Boltzmann-Grad scaling. More particularly, we will describe the motion of a tagged particle in a gas close to global equilibrium. The main difficulty in our context is that, due to the infinite range of the potential, a non-integrable singularity appears in the angular collision kernel, making no longer valid the single-use of Lanford's strategy. Our proof relies then on a combination of Lanford's strategy, of tools developed recently by Bodineau, Gallagher and Saint-Raymond to study the collision process, and of new duality arguments to study the additional terms associated with the long-range interaction, leading to some explicit weak estimates.

  5. Optimal cut-off value for cardiac troponin I in ruling out Type 5 myocardial infarction

    DEFF Research Database (Denmark)

    Jørgensen, Peter Hartmund; Nybo, Mads; Jensen, Marianne Kjær

    2014-01-01

    The clinical classification of myocardial infarction (MI) into five types was introduced in 2007 as a component of the universal definition. A Type 5 MI was defined as a MI related to coronary artery bypass surgery. In a setting of patients undergoing elective coronary artery bypass grafting, we ...... set out (i) to describe the pattern of multiple serial cardiac troponin I (cTnI) measurements within 72 h postoperatively and (ii) to determine the optimal cardiac troponin I cut-off value in ruling in or ruling out a Type 5 MI.......The clinical classification of myocardial infarction (MI) into five types was introduced in 2007 as a component of the universal definition. A Type 5 MI was defined as a MI related to coronary artery bypass surgery. In a setting of patients undergoing elective coronary artery bypass grafting, we...

  6. Percentile curves for body fatness and cut-offs to define malnutrition in Russians

    Science.gov (United States)

    Nikolaev, D. V.; Rudnev, S. G.; Starunova, O. A.; Eryukova, T. A.; Kolesnikov, V. A.; Ponomareva, E. G.; Soboleva, N. P.; Sterlikov, S. A.

    2013-04-01

    Here, we report first results of the large-scale ongoing bioelectrical impedance body composition study in Russians. By the end of 2012, 216 out of 800 Russian Health Centres submitted raw bioimpedance data on 844,221 adults and children aged 5-80 years, representing nearly 0.6% of the Russian population, who were accessed cross-sectionally using the same type of bioimpedance meter, ABC-01 Medas. Estimates of overweight, obesity, and normal weight obesity prevalence in the general population, as well as characteristics of diagnostic sensitivity and specificity of the conventional WHO BMI-based criteria of obesity depending on age are obtained. The smoothed reference centile curves for percentage fat mass are constructed, and localized cut-offs for fatness and thinness are provided that can be used both at the individual and epidemiological levels.

  7. Flow rates through earthen, geomembrane ampersand composite cut-off walls

    International Nuclear Information System (INIS)

    Tachavises, C.; Benson, C.H.

    1997-01-01

    Flow rates through soil-bentonite (SIB), geomembrane (GM), and composite geomembrane-soil (CGS) cut-off walls were determined using a numerical model of ground water flow. Various geological and wall conditions were simulated. Results of the simulations show that flow rates past all wall types are affected by hydraulic conductivities of the aquifer and underlying confining layer. Flow rates past GM walls with perfect joints are very low, provided the confining layer has low hydraulic conductivity. However, if a small fraction of the joints are defective, GM walls can be ineffective in blocking flow. CGS walls with a low hydraulic conductivity shell are less sensitive to joint defects. CGS walls with good shells typically have lower flow rates than SB and GM walls, even if the CGS wall contains defective joints

  8. Verification arrangements for the proposed fissile material cut-off treaty

    International Nuclear Information System (INIS)

    Bragin, V.

    2001-01-01

    Since the mid-1950's, an agreement to terminate the production of fissile material for nuclear weapons has been on the agenda. On December 16, 1993, the UNGA adopted Resolution A/RES/48/75/L which recommends ''the negotiation in the most appropriate international forum of a non-discriminatory, multilateral and internationally and effectively verifiable treaty banning the production of fissile material for nuclear weapons and other nuclear explosive devices''. The proposed Fissile Material Cut-off Treaty (FMCT) is still one of the most important items on the multilateral disarmament and non-proliferation agenda. Successful achievement of the FMCT would be an important step towards the goal of eliminating nuclear weapons. (author)

  9. Elevation in D-dimer concentrations is positively correlated with gestation in normal uncomplicated pregnancy

    Directory of Open Access Journals (Sweden)

    Jeremiah ZA

    2012-08-01

    Full Text Available Zaccheaus A Jeremiah,1 Teddy C Adias,2 Margaret Opiah,3 Siyeoforiye P George,4 Osaro Mgbere,5 Ekere J Essien61Department of Medical Laboratory Sciences, Niger Delta University, Wilberforce Island, Nigeria; 2Bayelsa State College of Health Technology, Ogbia-Town, Nigeria; 3Department of Maternal and Child Health, Faculty of Nursing, Niger Delta University, Wilberforce Island, Nigeria; 4Postgraduate Hematology Unit, Rivers State University of Science and Technology, Port Harcourt, Nigeria; 5Houston Department of Health and Human Services, Houston, TX, USA; 6Institute of Community Health, University of Houston, Houston, TX, USABackground: D-dimer levels have been reported to increase progressively during pregnancy, but how this affects Nigerian women is not well known.Objective: This study aims to determine the D-dimer concentration and its relationship to other coagulation parameters among pregnant women in Port Harcourt, Nigeria.Method: In a cross-sectional observational study conducted in Port Harcourt, Nigeria, 120 pregnant women and 60 nonpregnant controls, drawn from a tertiary health institution in the Niger Delta, Nigeria, were assessed, using the standard procedures, for the following parameters: D-dimer concentration, prothrombin time, activated partial thromboplastin time, platelet count, hemoglobin, and packed cell volume.Results: The median D-dimer concentration of 153.1 ng/mL in the pregnant group was found to be significantly elevated when compared with the control value of 118.5 ng/mL (t = 2.348, P = 0.021. Conversely, there was a marked depression in the platelet count among pregnant women (193.5 × 109/L when compared with 229.0 × 109/L in the control group (t = 3.424; P = 0.001. There was no statistically significant difference in the values for the prothrombin time and the activated partial thromboplastin time between pregnant and nonpregnant women. D-dimer values correlated positively and significantly with gestation (r = 0

  10. Sucrose hydrolysis by invertase using a membrane reactor: effect of membrane cut-off on enzyme performance

    Directory of Open Access Journals (Sweden)

    Francesco Di Addezio

    2014-04-01

    Full Text Available Sucrose hydrolysis by invertase [EC.3.2.1.26] produces inverted sugar syrup, an ingredient mainly used in the food industry. To properly catalyze hydrolysis, the enzyme should be reused after this reaction. It is advisable to maintain constant activity over a considerable period. Thus, sucrose hydrolysis was performed in a membrane bioreactor - a continuously stirred tank reactor coupled with an ultrafiltration membrane (UFM which provides good diffusion and high activity per unit volume. Molecular weight cut-off for soluble invertase UFMs was up to 100kDa. This study focused on the role of UFM invertase cut-off as it is the main element in the process. We demonstrated that both the cut-off and chemical nature of the UFM affected specific invertase activity.

  11. ANP, BNP and D-dimer predict right ventricular dysfunction in patients with acute pulmonary embolism

    DEFF Research Database (Denmark)

    Borgwardt, Henrik Gutte; Mortensen, Jann; Jensen, Claus V

    2010-01-01

    The aim of this study was to predict right ventricular dysfunction (RVD) using plasma concentration of D-dimer, pro-atrial natriuretic peptide (pro-ANP), brain natriuretic peptide (BNP), endothelin-1 (ET-1) and cardiac troponin I (TNI) in patients with pulmonary embolism (PE).......The aim of this study was to predict right ventricular dysfunction (RVD) using plasma concentration of D-dimer, pro-atrial natriuretic peptide (pro-ANP), brain natriuretic peptide (BNP), endothelin-1 (ET-1) and cardiac troponin I (TNI) in patients with pulmonary embolism (PE)....

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

    Science.gov (United States)

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

    2017-01-01

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

  13. Establishing the cut-off score for remission and severity-ranges on the Psychotic Depression Assessment Scale (PDAS)

    DEFF Research Database (Denmark)

    Østergaard, Søren D; Rothschild, Anthony J; Flint, Alastair J

    2016-01-01

    BACKGROUND: The Psychotic Depression Assessment Scale (PDAS) is a rating scale dedicated to the measurement of severity in psychotic depression (PD). The aim of this study was to establish the PDAS cut-off for remission of PD as well as PDAS score-ranges for mild, moderate, and severe PD....... The secondary aim was to test how remission, as defined by the PDAS, would perform as outcome measure when applied to the data from a large randomized controlled trial (RCT) in PD. METHODS: The study was based on data from the Study of Pharmacotherapy in Psychotic Depression (STOP-PD). The cut-off for remission...

  14. Current MUAC Cut-Offs to Screen for Acute Malnutrition Need to Be Adapted to Gender and Age: The Example of Cambodia.

    Directory of Open Access Journals (Sweden)

    Marion Fiorentino

    Full Text Available Early identification of children 5 yrs. Therefore, this study aimed at defining gender and age-specific cut-offs to improve sensitivity of MUAC as an indicator of acute malnutrition.To establish new age and gender-specific MUAC cut-offs, pooled data was obtained for 14,173 children from 5 surveys in Cambodia (2011-2013. Sensitivity, false positive rates, and areas under receiver-operator characteristic curves (AUC were calculated using wasting for children 80% with the new cut-offs in comparison with the current WHO cut-offs.Gender and age specific MUAC cut-offs drastically increased sensitivity to identify children with WHZ-score <-2 z-scores. International reference of MUAC cut-offs by age group and gender should be established to screen for acute malnutrition at the community level.

  15. Optimal Cut-Off Points for the Short-Negative Act Questionnaire and Their Association with Depressive Symptoms and Diagnosis of Depression

    DEFF Research Database (Denmark)

    Conway, Paul Maurice; Høgh (Hogh), Annie; Nabe-Nielsen, Kirsten

    2018-01-01

    , the present study aimed to: (i) identify optimal cut-off points, reflecting a possible subjectively experienced exposure to occasional and frequent workplace bullying, for the 9-item Short Negative Act Questionnaire (S-NAQ), and (ii) examine the criterion validity of these cut-off points in relation...... and frequent workplace bullying. We employed receiver operating characteristic (ROC) curve analyses to derive the cut-off points for the S-NAQ. Based on these cut-off points, we created a new S-NAQ variable with three levels of exposure (i.e. ‘not exposed’, ‘first threshold’, and ‘second threshold’) and tested...... its criterion validity in relation to depressive symptoms (N = 4071) and diagnosis of depression (N = 4844). Results The S-NAQ cut-off points obtained were ≥12 and ≥16 when using occasional and frequent bullying as reference standards, respectively. Both cut-off points showed high classification...

  16. Impact of pretreatment plasma D-dimer levels and its perioperative change on prognosis in operable esophageal squamous cell carcinoma.

    Science.gov (United States)

    Li, Jianbo; Zheng, Zhifan; Fang, Min

    2017-10-03

    The aim of this study was to investigate the relationship between plasma D-dimer levels and its perioperative change and clinicopathological parameters in patients with operable esophageal squamous cell carcinoma (ESCC). We also analyzed their prognostic significance in ESCC patients. The data of 294 ESCC patients between December 2007 and December 2012 in Mingzhou hospital, Ningbo, China were analyzed retrospectively. Plasma D-dimer levels were measured one week before surgery and on the thirtieth postoperative day. The association between plasma D-dimer levels and clinicopathological parameters was evaluated. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate the effect of plasma D-dimer levels and its perioperative change on disease-free survival (DFS) and overall survival (OS). Plasma D-dimer levels were above 0.5 µg/mL in 148 patients (50.3%). Plasma D-dimer levels were significantly related with DFS ( P P D-dimer levels and DFS in patients with N 0 ( P P = 0.003). Multivariate analysis revealed that plasma D-dimer levels ( P P = 0.012), and T stage ( P = 0.033) were independent prognostic factors for DFS. Tumor length ( P = 0.018), T stage ( P = 0.008) and plasma D-dimer levels ( P = 0.001) qualified as independent prognostic factors for OS. Our study suggests that pretreatment plasma D-dimer levels is a powerful independent prognostic factor for operable ESCC. Further studies are needed to prospectively validate this prognostic model and investigate the mechanisms underlying the correlation between elevated plasma D-dimer levels and poor prognosis in operable ESCC.

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

    Directory of Open Access Journals (Sweden)

    Wollner Materko

    2017-09-01

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

  18. Serum D-dimer concentrations in nephrotic syndrome track with albuminuria, not estimated glomerular filtration rate.

    LENUS (Irish Health Repository)

    Sexton, D J

    2012-01-01

    The nephrotic syndrome is associated with an increased risk of venous and arterial thrombosis. There are little published data on the distribution, interpretation or determinants of serum D-dimer levels in patients with the nephrotic syndrome. We aimed to describe this relationship.

  19. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation

    DEFF Research Database (Denmark)

    Krarup, L-H; Sandset, E C; Sandset, P M

    2011-01-01

    Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background -  Patients with acute ischemic stroke and atrial fibrillation are at in......Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background -  Patients with acute ischemic stroke and atrial fibrillation.......96), and the combined endpoint of stroke progression, recurrent stroke, and death (D-dimer: 991 ng/ml vs 970 ng/ml, P = 0.91). Multivariable analyses did not alter the results. Conclusion -  D-dimer and other markers of hemostatic activation were not associated with stroke progression, recurrent stroke, or death...

  20. Point-of-care D-dimer testing in emergency departments.

    Science.gov (United States)

    Marquardt, Udo; Apau, Daniel

    2015-09-01

    Overcrowding and prolonged patient stays in emergency departments (EDs) affect patients' experiences and outcomes, and increase healthcare costs. One way of addressing these problems is through using point-of-care blood tests, laboratory testing undertaken near patient locations with rapidly available results. D-dimer tests are used to exclude venous thromboembolism (VTE), a common presentation in EDs, in low-risk patients. However, data on the effects of point-of-care D-dimer testing in EDs and other urgent care settings are scarce. This article reports the results of a literature review that examined the benefits to patients of point-of-care D-dimer testing in terms of reduced turnaround times (time to results), and time to diagnosis, discharge or referral. It also considers the benefits to organisations in relation to reduced ED crowding and increased cost effectiveness. The review concludes that undertaking point-of-care D-dimer tests, combined with pre-test probability scores, can be a quick and safe way of ruling out VTE and improving patients' experience.

  1. Observer and biological variation of a rapid whole blood D-dimer test

    NARCIS (Netherlands)

    Turkstra, F.; van Beek, E. J.; Büller, H. R.

    1998-01-01

    In consecutive patients with suspected venous thromboembolism the interobserver variability of the SimpliRED D-dimer test was evaluated by two observers who independently scored one plate, the between assay variation was performed simultaneously by a third independent observer, who assessed a second

  2. Establishing streptomycin epidemiological cut-off values for Salmonella and Escherichia coli.

    Science.gov (United States)

    Garcia-Migura, Lourdes; Sunde, Marianne; Karlsmose, Susanne; Veldman, Kees; Schroeter, Andreas; Guerra, Beatriz; Granier, Sophie A; Perrin-Guyomard, Agnès; Gicquel-Bruneau, Mireille; Franco, Alessia; Englund, Stina; Teale, Christopher; Heiska, Helmi; Clemente, Lurdes; Boerlin, Patrick; Moreno, Miguel A; Daignault, Danielle; Mevius, Dik; Hendriksen, Rene S; Aarestrup, Frank M

    2012-02-01

    This study was conducted to elucidate the accuracy of the current streptomycin epidemiological cut-off value (ECOFF) for Escherichia coli and Salmonella spp. A total of 236 Salmonella enterica and 208 E. coli isolates exhibiting MICs between 4 and 32 mg/L were selected from 12 countries. Isolates were investigated by polymerase chain reaction for aadA, strA, and strB streptomycin resistance genes. Out of 236 Salmonella isolates, 32 (13.5%) yielded amplicons for aadA (n = 23), strA (n = 9), and strB (n = 11). None of the 60 Salmonella isolates exhibiting MIC 4 mg/L harbored resistance genes. Of the Salmonella isolates exhibiting MICs 8 mg/L, 16 mg/L, and 32 mg/L, 1.6%, 15%, and 39%, respectively, tested positive for one or more genes. For most monitoring programs, the streptomycin ECOFF for Salmonella is wild type (WT) ≤32 or ≤16 mg/L. A cut-off value of WT ≤32 mg/L would have misclassified 13.5% of the strains as belonging to the WT population, since this proportion of strains harbored resistance genes and exhibited MICs ≤32 mg/L. Out of 208 E. coli strains, 80 (38.5%) tested positive for aadA (n = 69), strA (n = 18), and strB (n = 31). Of the E. coli isolates exhibiting MICs of 4 mg/L, 8 mg/L, 16 mg/L, and 32 mg/L, 3.6%, 17.6%, 53%, and 82.3%, respectively, harbored any of the three genes. Based on the European Committee on Antimicrobial Susceptibility Testing guidelines (ECOFF ≤16 mg/L), 25% of the E. coli strains presenting MIC ≤16 mg/L would have been incorrectly categorized as belonging to the WT population. The authors recommend an ECOFF value of WT ≤16 mg/L for Salmonella and WT ≤8 mg/L for E. coli.

  3. Appropriate body mass index cut-offs to determine thinness, overweight and obesity in South Asian children in The Netherlands

    NARCIS (Netherlands)

    Wilde, J.A. de; Dommelen, P. van; Middelkoop, B.J.C.

    2013-01-01

    Background: Asian populations have an increased risk of developing cardiometabolic disorders at a lower body mass index (BMI) than other ethnic groups. Therefore, lower adult BMI cut-offs to determine overweight and obesity are recommended to assess the associated health risks for Asian (23 and 27.5

  4. Long term performance of a slurry trench cut-off wall at Butnau Dam, Kettle Generating Station, Manitoba

    International Nuclear Information System (INIS)

    Halim, R.; Smith, N.J.; Gupta, R.C.; Osiowy, B.J.

    1998-01-01

    A 185 m long, 1.8 m wide slurry trench cut-off wall was constructed in 1971 through a portion of Manitoba Hydro's Butnau Dam located on the Nelson River in northern Manitoba. The performance of the dam has since been monitored as part of the maintenance and operation of the Kettle Generating Station. Piezometers, thermocouples, settlement gauges, marker pins and automated weir flow measurement systems were installed to monitor and ensure the safety of the dam, but none of the monitoring was related to the slurry trench cut-off wall which is now 26 years old. Recently, a review of the performance of the wall was conducted because of the severe climate in northern Manitoba and because of the lack of well documented performance histories for structures of this type. The review included contacts and discussions with experts and companies dealing with the construction of slurry trench cut-off walls in North America, and a literature search on the performance of similar walls. It was concluded that neither the review of the literature nor the instrumented and visual observations of the dam in the vicinity of the of the cut-off wall revealed any unusual readings or conditions that would warrant concern for the safety and performance of the dam. 7 refs., 4 figs

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

    Science.gov (United States)

    Bersabé, Rosa; Rivas, Teresa

    2010-05-01

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

  6. The Potential of Established Fitness Cut-off Points for Monitoring Women with Fibromyalgia : The al-Ándalus Project

    NARCIS (Netherlands)

    Castro-Piñero, José; Aparicio, Virginia A; Estévez-López, Fernando; Álvarez-Gallardo, Inmaculada C; Borges-Cosic, Milkana; Soriano-Maldonado, Alberto; Delgado-Fernández, Manuel; Segura-Jiménez, Víctor

    2017-01-01

    The aim of the present study was to determinate whether fitness cut-off points discriminate the severity of major fibromyalgia symptoms and health-related quality of life. Additionally, we investigated which American Colleague of Rheumatology (ACR) fibromyalgia criteria (1990 vs. modified 2010)

  7. Cut-off levels and diagnostic accuracy of infliximab trough levels and anti-infliximab antibodies in Crohn's disease

    DEFF Research Database (Denmark)

    Steenholdt, Casper; Bendtzen, Klaus; Brynskov, Jørn

    2011-01-01

    Reasons for infliximab failure in Crohn's disease and ulcerative colitis are debated. Serum levels of infliximab and anti-infliximab antibodies have been associated with loss of response. We aimed at determining cut-off levels for infliximab and anti-infliximab antibody concentrations associated...

  8. Anthropometric parameters’ cut-off points and predictive value for metabolic syndrome in women from Cartagena, Colombia

    Directory of Open Access Journals (Sweden)

    Gustavo José Mora-García

    2014-03-01

    Full Text Available Objective. To estimate anthropometric parameters’ (APs cut-off points and association for metabolic syndrome (MetS. Materials and methods. A cross-sectional study was carried out with a total of 434 adult women from Cartagena de Indias, Colombia, in 2012. APs measured were waist circumference (WC, body mass index (BMI, body adiposity index (BAI, waist-hip ratio (WHR and waist-height ratio (WHtR. Cut-off points were estimated by a receiver operating characteristic curve (ROC. Logistic regression was applied to estimate possible associations. Results. Cut-off points for WC, BMI, BAI, WHR and WHtR were 85 cm, 28 kg/m2, 39%, 0.80 and 56, respectively. Only WHtR was associated to MetS (OR=1.11, CI95% [1.07-1.15]. Conclusion. WC cut-off point was higher than those proposed for Latin-American women by the Joint Interim Statement (JIS. WHtR had a low predictive value for MetS.

  9. Screening for Internet Addiction: An Empirical Study on Cut-off Points for the Chen Internet Addiction Scale

    Directory of Open Access Journals (Sweden)

    Chih-Hung Ko

    2005-12-01

    Full Text Available The aim of this study was to establish the optimal cut-off points of the Chen Internet Addiction Scale (CIAS, to screen for and diagnose Internet addiction among adolescents in the community by using the well- established diagnostic criteria of Internet addiction. This survey of 454 adolescents used screening (57/58 and diagnostic (63/64 cut-off points of the CIAS, a self-reported instrument, based on the results of systematic diagnostic interviews by psychiatrists. The area under the curve of the receiver operating characteristic curve revealed that CIAS has good diagnostic accuracy (89.6%. The screening cut-off point had high sensitivity (85.6% and the diagnostic cut-off point had the highest diagnostic accuracy, classifying 87.6% of participants correctly. Accordingly, the screening point of the CIAS could provide a screening function in two-stage diagnosis, and the diagnostic point could serve as a diagnostic criterion in one-stage massive epidemiologic research.

  10. Setting up the cut-off level of a sensitive barcode lateral flow assay with magnetic nanoparticles.

    Science.gov (United States)

    Panferov, Vasily G; Safenkova, Irina V; Zherdev, Anatoly V; Dzantiev, Boris B

    2017-03-01

    A barcode lateral flow immunoassay (LFIA) based on magnetic nanoparticles with a controllable cut-off level was developed for the first time. The regulation of the cut-off levels was based on the changes in the position and concentration of three antibodies (two monoclonal and polyclonal) with different affinities (K D =4.22×10 -9 , 9.67×10 -9 , 1.05×10 -8 M), respectively. To obtain specific conjugates, monoclonal antibodies were covalently immobilized on the magnetic nanoparticles' surface. Potato virus X causing a reduction in the potato yield was used as a model polyvalent antigen. To detect potato virus X in the leaf extracts, a barcode LFIA with cut-off levels of 3, 30, and 150ng/mL was used for the analysis. The application of magnetic concentration leads to a six-fold reduction in the first cut-off level (0.5ng/mL) in comparison with magnetic LFIA without the concentration stage. Copyright © 2016. Published by Elsevier B.V.

  11. Interannual rainfall variability over the Cape south coast of South Africa linked to cut-off low associated rainfall

    CSIR Research Space (South Africa)

    Engelbrecht, CJ

    2014-10-01

    Full Text Available The influence of cut-off low (COL) associated rainfall on interannual rainfall variability over the Cape south coast region of South Africa for the period 1979-2011 is investigated. COLs are objectively identified and tracked on daily average 500 h...

  12. Cut-off points to identify sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP) definition.

    Science.gov (United States)

    Bahat, Gulistan; Tufan, Asli; Tufan, Fatih; Kilic, Cihan; Akpinar, Timur Selçuk; Kose, Murat; Erten, Nilgun; Karan, Mehmet Akif; Cruz-Jentoft, Alfonso J

    2016-12-01

    The reported prevalence of sarcopenia ranges widely depending on its definition criterion. European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria. This definition recommends using normative data of the study population rather than other reference populations. We aimed to define the reference cut-off values for muscle mass, muscle strength and calf circumference in Turkey in order to improve general applicability of EWGSOP criteria. Healthy young adults between 18 and 39 years of age with no known chronic disease or chronic drug usage were included in our study to serve as reference population for assessing muscle mass. Community-dwelling older outpatients were prospectively recruited from the geriatrics outpatient clinics of a university hospital for assessing hand grip strength and calf circumference. Body composition was assessed by bioimpedance analysis. Muscle strength was assessed measuring hand grip strength with a Jamar hand dynamometer. The cut-off thresholds for muscle mass were defined as the mean-2SD of the values of the young reference study population; for grip strength were calculated from ROC analyses using cut-off values that predicted gait speed young reference group included a total of 301 participants (187 male, 114 female; mean age: 26.5 ± 4.6 years). The cut-off thresholds for skeletal muscle mass indexes were 9.2 kg/m 2 and 7.4 kg/m 2 in males and females, respectively. The older community dwelling group included 406 subjects (123 male, 283 female, mean age: 76.6 ± 6.7 years). The cut-off thresholds for hand grip strength were 32 kg and 22 kg for males and females. The cut-off threshold for calf circumference was 33 cm for both males and females. The cut-off thresholds for muscle mass, grip strength and calf circumference were somewhat higher but comparable with other reference populations. Further worldwide studies from different nations and

  13. Ruling out clinically suspected pulmonary embolism by assessment of clinical probability and D-dimer levels: a management study

    NARCIS (Netherlands)

    Leclercq, Monique G. L.; Lutisan, Johan G.; van Marwijk Kooy, Marinus; Kuipers, Bart F.; Oostdijk, Ad H. J.; van der Leur, Jef J. C. M.; Büller, Harry R.

    2003-01-01

    D-dimer test combined with clinical probability assessment has been proposed as the first step in the diagnostic work-up of patients with suspected pulmonary embolism (PE). In a prospective management study we investigated the safety and efficiency of excluding PE by a normal D-dimer combined with a

  14. Verification of a Fissile Material Cut-off Treaty (FMCT): The Potential Role of the IAEA

    International Nuclear Information System (INIS)

    Chung, Jin Ho

    2016-01-01

    The objective of a future verification of a FMCT(Fissile Material Cut-off Treaty) is to deter and detect non-compliance with treaty obligations in a timely and non-discriminatory manner with regard to banning the production of fissile material for nuclear weapons or other nuclear devices. Since the International Atomic Energy Agency (IAEA) has already established the IAEA safeguards as a verification system mainly for Non -Nuclear Weapon States (NNWSs), it is expected that the IAEA's experience and expertise in this field will make a significant contribution to setting up a future treaty's verification regime. This paper is designed to explore the potential role of the IAEA in verifying the future treaty by analyzing verification abilities of the Agency in terms of treaty verification and expected challenges. Furthermore, the concept of multilateral verification that could be facilitated by the IAEA will be examined as a measure of providing a credible assurance of compliance with a future treaty. In this circumstance, it is necessary for the IAEA to be prepared for playing a leading role in FMCT verifications as a form of multilateral verification by taking advantage of its existing verification concepts, methods, and tools. Also, several challenges that the Agency faces today need to be overcome, including dealing with sensitive and proliferative information, attribution of fissile materials, lack of verification experience in military fuel cycle facilities, and different attitude and culture towards verification between NWSs and NNWSs

  15. Verification of a Fissile Material Cut-off Treaty (FMCT): The Potential Role of the IAEA

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Jin Ho [Korea Institute of Nuclear Nonproliferation and Control, Daejeon (Korea, Republic of)

    2016-05-15

    The objective of a future verification of a FMCT(Fissile Material Cut-off Treaty) is to deter and detect non-compliance with treaty obligations in a timely and non-discriminatory manner with regard to banning the production of fissile material for nuclear weapons or other nuclear devices. Since the International Atomic Energy Agency (IAEA) has already established the IAEA safeguards as a verification system mainly for Non -Nuclear Weapon States (NNWSs), it is expected that the IAEA's experience and expertise in this field will make a significant contribution to setting up a future treaty's verification regime. This paper is designed to explore the potential role of the IAEA in verifying the future treaty by analyzing verification abilities of the Agency in terms of treaty verification and expected challenges. Furthermore, the concept of multilateral verification that could be facilitated by the IAEA will be examined as a measure of providing a credible assurance of compliance with a future treaty. In this circumstance, it is necessary for the IAEA to be prepared for playing a leading role in FMCT verifications as a form of multilateral verification by taking advantage of its existing verification concepts, methods, and tools. Also, several challenges that the Agency faces today need to be overcome, including dealing with sensitive and proliferative information, attribution of fissile materials, lack of verification experience in military fuel cycle facilities, and different attitude and culture towards verification between NWSs and NNWSs.

  16. Solute removal capacity of high cut-off membrane plasma separators.

    Science.gov (United States)

    Ohkubo, Atsushi; Kurashima, Naoki; Nakamura, Ayako; Miyamoto, Satoko; Iimori, Soichiro; Rai, Tatemitsu

    2013-10-01

    In vitro blood filtration was performed by a closed circuit using high cut-off membrane plasma separators, EVACURE EC-2A10 (EC-2A) and EVACURE EC-4A10 (EC-4A). Samples were obtained from sampling sites before the plasma separator, after each plasma separator, and from the ultrafiltrate of each separator. The sieving coefficient (S.C.) of total protein (TP), albumin (Alb), IgG, interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), fibrinogen (Fib), antithrombin III (AT-III), and coagulation factor XIII (FXIII) were calculated. The S.C. of each solute using EC-2A and EC-A4 were as follows; TP: 0.25 and 0.56, Alb: 0.32 and 0.73, IgG: 0.16 and 0.50, IL-6:0.73 and 0.95, IL-8:0.85 and 0.82, TNF-α: 1.07 and 0.99, Fib: 0 and 0, FXIII: 0.07 and 0.17, respectively. When compared with the conventional type of membrane plasma separators, EVACURE could efficiently remove cytokines while retaining coagulation factors such as fibrinogen. Moreover, EC-2A prevented protein loss, whereas EC-4A could remove approximately 50% of IgG. © 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.

  17. Detection of cut-off point for rapid automized naming test in good readers and dyslexics

    Directory of Open Access Journals (Sweden)

    Zahra Soleymani

    2014-01-01

    Full Text Available Background and Aim: Rapid automized naming test is an appropriate tool to diagnose learning disability even before teaching reading. This study aimed to detect the cut-off point of this test for good readers and dyslexics.Methods: The test has 4 parts including: objects, colors, numbers and letters. 5 items are repeated on cards randomly for 10 times. Children were asked to name items rapidly. We studied 18 dyslexic students and 18 age-matched good readers between 7 and 8 years of age at second and third grades of elementary school; they were recruited by non-randomize sampling into 2 groups: children with developmental dyslexia from learning disabilities centers with mean age of 100 months, and normal children with mean age of 107 months from general schools in Tehran. Good readers selected from the same class of dyslexics.Results: The area under the receiver operating characteristic curve was 0.849 for letter naming, 0.892 for color naming, 0.971 for number naming, 0.887 for picture naming, and 0.965 totally. The overall sensitivity and specificity was 1 and was 0.79, respectively. The highest sensitivity and specificity were related to number naming (1 and 0.90, respectively.Conclusion: Findings showed that the rapid automized naming test could diagnose good readers from dyslexics appropriately.

  18. Accuracy of Cameriere's cut-off value for third molar in assessing 18 years of age.

    Science.gov (United States)

    De Luca, S; Biagi, R; Begnoni, G; Farronato, G; Cingolani, M; Merelli, V; Ferrante, L; Cameriere, R

    2014-02-01

    Due to increasingly numerous international migrations, estimating the age of unaccompanied minors is becoming of enormous significance for forensic professionals who are required to deliver expert opinions. The third molar tooth is one of the few anatomical sites available for estimating the age of individuals in late adolescence. This study verifies the accuracy of Cameriere's cut-off value of the third molar index (I3M) in assessing 18 years of age. For this purpose, a sample of orthopantomographs (OPTs) of 397 living subjects aged between 13 and 22 years (192 female and 205 male) was analyzed. Age distribution gradually decreases as I3M increases in both males and females. The results show that the sensitivity of the test was 86.6%, with a 95% confidence interval of (80.8%, 91.1%), and its specificity was 95.7%, with a 95% confidence interval of (92.1%, 98%). The proportion of correctly classified individuals was 91.4%. Estimated post-test probability, p was 95.6%, with a 95% confidence interval of (92%, 98%). Hence, the probability that a subject positive on the test (i.e., I3Mage or older was 95.6%. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  19. Azole susceptibility of Malassezia pachydermatis and Malassezia furfur and tentative epidemiological cut-off values.

    Science.gov (United States)

    Cafarchia, Claudia; Iatta, Roberta; Immediato, Davide; Puttilli, Maria Rita; Otranto, Domenico

    2015-09-01

    This study aims to determine the minimal inhibitory concentration (MIC) distribution and the epidemiological cut-off values (ECVs) of Malassezia pachydermatis and Malassezia furfur isolates for fluconazole (FLZ), itraconazole (ITZ), posaconazole (POS), and voriconazole (VOR). A total of 62 M. pachydermatis strains from dogs with dermatitis and 78 M. furfur strains from humans with bloodstream infections (BSI) were tested by a modified broth microdilution Clinical and Laboratory Standards Institute (CLSI) method. ITZ and POS displayed lower MICs than VOR and FLZ, regardless of the Malassezia species. The MIC data for azoles of M. pachydermatis were four two-fold dilutions lower than those of M. furfur. Based on the ECVs, about 94% of Malassezia strains might be categorized within susceptible population for all azoles, except for FLZ, and azole cross-resistance was detected in association with FLZ in M. pachydermatis but not in M. furfur.The study proposes, for the first time, tentative azole ECVs for M. pachydermatis and M. furfur for monitoring the emergence of isolates with decreased susceptibilities and shows that the azole MIC distribution varied according to the Malassezia species tested, thus suggesting the usefulness of determining the susceptibility profile for effective treatment of each species. © The Author 2015. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Efficacy of lower cut off value of serum prostate specific antigen in diagnosis of prostate cancer.

    Science.gov (United States)

    Rashid, M M; Alam, A K M K; Habib, A K M K; Rahman, H; Hossain, A K M S; Salam, M A; Rahman, S

    2012-12-01

    Indications of prostate biopsy are high serum prostate specific antigen (PSA) value and or abnormal digital rectal examination (DRE) findings. Although serum PSA value of 4 ng/ml is the most commonly used threshold for recommending prostate biopsy, significant proportion of men harbor prostate cancer even when their serum PSA values are less than 4.0 ng/ml. Therefore present study was designed to determine the performance status of serum PSA in lower cut-off values. This hospital based prospective study was conducted in the Department of Urology of Bangabandhu Sheikh Mujib Medical University (BSMMU) and Comfort Nursing Home Pvt. Ltd, Dhaka from July 2009 to October 2010. Two hundred six male patients aged over 50 years having lower urinary tract symptoms (LUTS) and serum PSA more than 2.5 ng/ml were prepared for prostate biopsy. Trans rectal ultrasound (TRUS) guided biopsy was done. The test statistics used to analyze the data were descriptive statistics, sensitivity, specificity, positive and negative predictive value, ROC curve. For all analytical tests, the level of significance was set at 0.05 and p indication for prostate biopsy.

  1. The Portuguese version of the Outcome Questionnaire (OQ-45): Normative data, reliability, and clinical significance cut-offs scores.

    Science.gov (United States)

    Machado, Paulo P P; Fassnacht, Daniel B

    2015-12-01

    The Outcome Questionnaire (OQ-45) is one of the most extensively used standardized self-report instruments to monitor psychotherapy outcomes. The questionnaire is designed specifically for the assessment of change during psychotherapy treatments. Therefore, it is crucial to provide norms and clinical cut-off values for clinicians and researchers. The current study aims at providing study provides norms, reliability indices, and clinical cut-off values for the Portuguese version of the scale. Data from two large non-clinical samples (high school/university, N = 1,669; community, N = 879) and one clinical sample (n = 201) were used to investigate psychometric properties and derive normative data for all OQ-45 subscales and the total score. Significant and substantial differences were found for all subscales between the clinical and non-clinical sample. The Portuguese version also showed adequate reliabilities (internal consistency, test-retest), which were comparable to the original version. To assess individual clinical change, clinical cut-off values and reliable change indices were calculated allowing clinicians and researchers to monitor and evaluate clients' individual change. The Portuguese version of the OQ-45 is a reliable instrument with comparable Portuguese norms and cut-off scores to those from the original version. This allows clinicians and researchers to use this instrument for evaluating change and outcome in psychotherapy. This study provides norms for non-clinical and clinical Portuguese samples and investigates the reliability (internal consistency and test-retest) of the OQ-45. Cut-off values and reliable change index are provided allowing clinicians to evaluate clinical change and clients' response to treatment, monitoring the quality of mental health care services. These can be used, in routine clinical practice, as benchmarks for treatment progress and to empirically base clinical decisions such as continuation of treatment or considering

  2. Detection of the high-energy cut-off from the Seyfert 1.5 galaxy NGC 5273

    Science.gov (United States)

    Pahari, Mayukh; McHardy, I. M.; Mallick, Labani; Dewangan, G. C.; Misra, R.

    2017-09-01

    We perform the NuSTAR and Swift/XRT joint energy spectral fitting of simultaneous observations from the broad-line Seyfert 1.5 galaxy NGC 5273. When fitted with the combination of an exponential cut-off power law and a reflection model, a high-energy cut-off is detected at 143^{+96}_{-40} keV with 2σ significance. Existence of such cut-off is also consistent with the observed Comptonizing electron temperature when fitted with a Comptonization model independently. We observe a moderate hard X-ray variability of the source over the time-scale of ∼12 yr using INTEGRAL/ISGRI observations in the energy range of 20-100 keV. When the hard-band count rate (6-20 keV) is plotted against the soft-band count rate (3-6 keV), a hard offset is observed. Our results indicate that the cut-off energy may not correlate with the coronal X-ray luminosity in a simple manner. Similarities in parameters that describe coronal properties indicate that the coronal structure of NGC 5273 may be similar to that of the broad-line radio galaxy 3C 390.3 and another galaxy MCG-5-23-16, where the coronal plasma is dominated by electrons, rather than electron-positron pairs. Therefore, the coronal cooling is equally efficient to the heating mechanism keeping the cut-off energy at low even at the low accretion rate.

  3. ELISA Cut-off Point for the Diagnosis of Human Brucellosis; a Comparison with Serum Agglutination Test

    Directory of Open Access Journals (Sweden)

    Anahita Sanaei Dashti

    2012-03-01

    Full Text Available Background: Brucellosis is a world-wide disease, which has a diverse clinical manifestation, and its diagnosis has to be proven by laboratory data. Serum agglutination test (SAT is the most-widely used test for diagnosing brucellosis. The enzyme linked immunosorbent assay (ELISA can also determine specific antibody classes against brucella. It is a sensitive, simple and rapid test, which could be an acceptable alternative to SAT with fewer limitations, however, like any other new test it should be further evaluated and standardized for various populations. This study was planned to determine an optimal cut-off point, for ELISA which would offer maximum sensitivity and specificity for the test when compared to SAT.Methods: Four hundred and seven patients with fever and other compatible symptoms of brucellosis were enrolled in the study. Serum agglutination test, 2-Mercaptoethanol test, and ELISA were performed on their sera. Results: The cut-off point of 53 IU/ml of ELISA-IgG yielded the maximal sensitivity and specificity comparing to the other levels of ELISA-IgG, and was considered the best cut off-point of ELISA-IgG to diagnose acute brucellosis. At this cut-off, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were 84.09%, 85.38%, 62.20, 94.90, 5.75, 0.18, respectively.Conclusion: The best cut-off point of ELISA-IgG is 53 IU/ml, which yields the maximal sensitivity and specificity to diagnose acute brucellosis.

  4. The Objective Borderline Method (OBM): A Probability-Based Model for Setting up an Objective Pass/Fail Cut-Off Score in Medical Programme Assessments

    Science.gov (United States)

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

    2013-01-01

    The decision to pass or fail a medical student is a "high stakes" one. The aim of this study is to introduce and demonstrate the feasibility and practicality of a new objective standard-setting method for determining the pass/fail cut-off score from borderline grades. Three methods for setting up pass/fail cut-off scores were compared: the…

  5. Linezolid extracorporeal removal during haemodialysis with high cut-off membrane in critically ill patients.

    Science.gov (United States)

    Villa, Gianluca; Cassetta, Maria Iris; Tofani, Lorenzo; Valente, Serafina; Chelazzi, Cosimo; Falsini, Silvia; De Gaudio, Angelo Raffaele; Novelli, Andrea; Ronco, Claudio; Adembri, Chiara

    2015-10-01

    Continuous venovenous haemodialysis with high cut-off membrane (HCO-CVVHD) is often used in critically ill septic patients with acute kidney injury (AKI) to sustain renal function and to remove circulating inflammatory mediators. The aim of this study was to analyse the extracorporeal removal of linezolid and related alterations in pharmacokinetic/pharmacodynamic (PK/PD) parameters during HCO-CVVHD. Three critically ill septic patients with AKI, treated with linezolid and HCO-CVVHD, were prospectively observed. To calculate the extracorporeal clearance of linezolid and the PK parameters, effluent, pre-filter and post-filter samples were contemporaneously collected before linezolid infusion, just after 1-h infusion (maximum serum concentration; C(max)), at 3 h and 6 h after dosing, and before the next dose (trough serum concentration; C(min)). Linezolid C(max) and C(min) (pre-filter) ranged from 10.4-23.5 mg/L and from 2.9-10.3 mg/L. The dialysate saturation coefficient was 0.66-0.85 and the extracorporeal clearance with a diffusive dose of 35 m L/kg/h ranged from 2.1-2.5 L/h. Total linezolid clearance was between 1.7 L/h and 6.3 L/h. The total area under the plasma concentration-time curve (AUC0-∞) ranged from 95.1 mgh/L to 352.9 mgh/L, in accordance with the different clinical conditions. AUCfree/MIC ratios were always clearance may affect linezolid total clearance, the clinical features of critically ill septic patients appear to be mainly responsible for the high variability of linezolid serum concentrations. Copyright © 2015. Published by Elsevier B.V.

  6. High cut-off hemofiltration versus standard hemofiltration: effect on plasma cytokines.

    Science.gov (United States)

    Atan, Rafidah; Peck, Leah; Visvanathan, Kumar; Skinner, Narelle; Eastwood, Glenn; Bellomo, Rinaldo; Storr, Markus; Goehl, Hermann

    2016-11-11

    To study the effects of continuous veno-venous hemofiltration (CVVH) with high cut-off filters (CVVH-HCO) on plasma cytokine levels, sieving coefficient and clearance compared to CVVH using standard filters (CVVH-Std) in a nested cohort within a double-blind randomized controlled trial in severe acute kidney injury (AKI) patients. We measured plasma and post-filter levels of IL-6, TNF-alpha, IL-8, IL-1 beta, RANTES, IL-10, IFN-gamma and IFN-alpha in both study groups. We also measured cytokine levels in the ultrafiltrate and calculated sieving coefficients and clearances. By 72 hours of treatment, IL-6 had decreased during both treatments (p = 0.009 and 0.005 respectively). In contrast, IL-10 had decreased with CVVH-Std (p = 0.03) but not CVVH-HCO (p = 0.135). None of the other cytokines showed changes over time. There were also no significant between group differences in plasma levels for each cytokine over the 72-hour treatment period. For all cytokines combined, however, the median sieving coefficient was higher for CVVH-HCO (0.31 vs. 0.16; p = 0.042) as was the mass removal rate by ultrafiltration (p = 0.027). While overall combined cytokine levels had fallen to 62.2% of baseline at 72 hours for CVVH-HCO (p<0.0001) and to 75.9% of baseline with CVVH-Std (p = 0.008) there were no between group differences. CVVH-HCO achieved greater combined sieving coefficient and mass removal rate by ultrafiltration for a group of key cytokines than CVVH-Std. However, this effect did not differentially lower their plasma level over the first 72 hours. Our study does not support the use of CVVH-HCO to lower cytokines in critically ill patients with AKI.

  7. Metabolic syndrome in adolescents: definition based on regression of IDF adult cut-off points.

    Science.gov (United States)

    Benmohammed, K; Valensi, P; Balkau, B; Lezzar, A

    2016-12-01

    The objective of this study was to derive a sex- and age-specific definition of the metabolic syndrome (MetS) and its abnormalities for adolescents. This is a cross-sectional study. A total of 1100 adolescent students, aged 12-18 y, were randomly selected from schools and classrooms in the city of Constantine, Algeria; all had anthropometric measurements taken, and 989 had blood tests. Gender-specific growth curves for components of the MetS were derived, using the LMS (lambda-mu-sigma) method, and the percentiles corresponding to the thresholds of the MetS components proposed for adults by the International Diabetes Federation (IDF) were identified. The prevalence of the MetS using this new definition was 4.3% for boys and 3.7% for girls (P = 0.64). Overall, a high waist circumference was the most frequent of the syndrome components, but the frequency was much higher in girls than that in boys, 33.6% and 6.9%, respectively. In contrast, a high systolic blood pressure was seen in 26.8% of the boys and only 11.4% of the girls. The prevalence of the MetS was higher among adolescents with a body mass index (BMI) ≥95th percentile of the study population, 28.8%, against 9.8% in adolescents with a BMI between the 95th and 85th percentile and 1.8% in those with a BMI definition. For clinical practice, we propose a simplified definition for boys and girls based on regression of IDF adult cut-off points. This definition should be tested in further studies with other adolescent populations. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  8. Thirteen treated of acute renal failure secondary to multiple myeloma with high cut off filters.

    Science.gov (United States)

    Berni Wennekers, Ana; Martín Azara, María Pilar; Dourdil Sahun, Victoria; Bergasa Liberal, Beatriz; Ruiz Laiglesia, José Esteban; Vernet Perna, Patricia; Alvarez Lipe, Rafael

    2016-01-01

    Multiple myeloma (MM) is a haematological tumour that is characterised by uncontrolled proliferation of plasma cells and a significant volume of serum free light chains (sFLCs), which can cause acute renal failure due to intratubular precipitation, resulting in cast nephropathy. Acute renal failure is a complication that can arise in more than 20% of patients with multiple myeloma, half of which will require dialysis. We report our experience with 13 patients who were treated with dialysis using high cut off filters (HCO) between July 2011 and February 2015. A total of 6 consecutive 6-hour sessions were performed using a 2.1 m(2) HCO filter (Theralite® by Gambro®). Afterwards, further 6-hour sessions were continued on alternate days. A total of 151 sessions were conducted, with an average of 11.6 sessions per patient (range 6-27). The treatment proved to be effective in removing both kappa and lambda sFLCs, resulting in a 93.7% fall in sFLCs by the end of treatment. The average reduction was 57.7% per dialysis session. 10 out of the 13 cases recovered sufficient renal function to become independent of dialysis. There were no major changes in albumin levels using an infusion protocol of 2 50-mL vials of 20% albumin at the end of the dialysis session. Combination treatment with chemotherapy and long dialysis with HCO filters was effective in reducing the sFLC levels and recovering sufficient renal function in 77% of cases. With HCO filters, significant cost savings are achieved, contrary to what was previously believed. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  9. Optimal body fat percentage cut-off values for identifying cardiovascular risk factors in Mongolian and Han adults: a population-based cross-sectional study in Inner Mongolia, China.

    Science.gov (United States)

    Li, Yanlong; Wang, Hailing; Wang, Ke; Wang, Wenrui; Dong, Fen; Qian, Yonggang; Gong, Haiying; Xu, Guodong; Li, Guoju; Pan, Li; Zhu, Guangjin; Shan, Guangliang

    2017-04-17

    The present study was designed to determine the optimal cut-off values of body fat percentage (BF%) for the detection of cardiovascular disease (CVD) risk factors in Mongolian and Han adults. This cross-sectional study involving 3221 Chinese adults (2308 Han and 913 Mongolian) aged 20-80 years was conducted in Inner Mongolia Autonomous Region, China, in 2014. Data from a standardised questionnaire, physical examination and blood sample were obtained. The BF% was estimated using bioelectrical impedance analysis. Optimal BF% cut-offs were analysed by receiver operating characteristic curves to predict the risk of diabetes, hypertension and dyslipidaemia. Binary logistic regression analysis was performed to evaluate the OR of each CVD risk factor according to obesity defined by BF%. Mean BF% levels were lower in men than in women (22.54±5.77 vs 32.95±6.18 in Han, 23.86±5.72 vs 33.98±6.40 in Mongolian population, respectively; ppopulation, the area under curve (AUC) values for BF% ranged from 0.589 to 0.699 for men and from 0.711 to 0.763 for women. Compared with men, AUCs for diabetes and clustering of ≥2 risk factors in women were significantly higher (ppopulation. In Han adults, the optimal BF% cut-off values to detect CVD risk factors varied from 18.7% to 24.2% in men and 32.7% to 35.4% in women. In Mongolian population, the optimal cut-off values of BF% for men and women ranged from 21.0% to 24.6% and from 35.7% to 40.0%, respectively. Subjects with high BF% (≥24% in men, ≥34% in women) had higher risk of CVD risk factors in Han (age-adjusted ORs from 1.479 to 3.680, 2.660 to 4.016, respectively). In Mongolia, adults with high BF% (≥25% in men, ≥35% in women) had higher risk of CVD risk factors (age-adjusted ORs from 2.587 to 3.772, 2.061 to 4.882, respectively). The optimal BF% cut-offs for obesity for the prediction of CVD risk factors in Chinese men and women were approximately 24% and 34% for Han adults and 25% and 35% for Mongolian

  10. Elevated plasma D-dimer and hypersensitive C-reactive protein levels may indicate aortic disorders

    OpenAIRE

    Yuan, Shi-Min; Shi, Yong-Hui; Wang, Jun-Jun; Lü, Fang-Qi; Gao, Song

    2011-01-01

    OBJECTIVE: D-dimer and C-reactive protein are of diagnostic and predictive values in patients have thrombotic tendency, such as vascular thrombosis, coronary artery disease and aortic dissection. However, the comparative study in these biomarkers between the patients with acute aortic dissection and coronary artery disease has not been sufficiently elucidated. METHODS: Consecutive surgical patients for acute type A aortic dissection (20 patients), aortic aneurysm (nine patients) or coronary a...

  11. Ordinary mode reflectometry. Modification of the scattering and cut-off responses due to the shape of localized density fluctuations

    International Nuclear Information System (INIS)

    Fanack, C.; Boucher, I.; Heuraux, S.; Leclert, G.; Clairet, F.; Zou, X.L.

    1996-01-01

    Ordinary wave reflectometry in a plasma containing a localized density perturbation is studied with a 1-D model. The phase response is studied as a function of the wavenumber and position of the perturbation. It is shown that it strongly depends upon the perturbation shape and size. For a small perturbation wavenumber, the response is due to the oscillation of the cut-off layer. For larger wavenumbers, two regimes are found: for a broad perturbation, the phase response is an image of the perturbation itself; for a narrow perturbation, it is rather an image of the Fourier transform. For tokamak plasmas it turns out that, for the fluctuation spectra usually observed, the phase response comes primarily from those fluctuations that are localized at the cut-off. Results of a 2-D numerical model show that geometry effects are negligible for the scattering by radial fluctuations. (author)

  12. Factors in selecting serum samples for use in determining the positive/negative threshold (cut-off) in ELISA

    International Nuclear Information System (INIS)

    Jacobson, R.H.

    1998-01-01

    The threshold (cut-off) that defines whether a test result is seropositive or seronegative is calculated by testing serum samples from a subpopulation of animals that is assumed to represent the target population in all aspects. For this proposition to be true, it is essential to consider the variables in the target population that must be represented in the subpopulation. Without representation of the variables in the subpopulation, it is likely that the cut-off selected for the test will be errant and will misclassify animals as to their infection status. The purpose of this paper is to identify a few of the principal variables that need to be taken into account when selecting a subpopulation of animals for test validation. (author)

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

    Science.gov (United States)

    Gill, Ramandeep; Granot, Jonathan

    2018-03-01

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

  14. Age, functional status, and racial differences in plasma D-dimer levels in community-dwelling elderly persons.

    Science.gov (United States)

    Pieper, C F; Rao, K M; Currie, M S; Harris, T B; Cohen, H J

    2000-11-01

    Dysregulation of immunologic and coagulation systems is common in elderly persons and is associated with many diseases of aging. Thrombotic events are a major cause of morbidity and mortality in the elderly population. This study assesses whether D-dimer, a marker of fibrinolytic activity, varies systematically by demographic, health, and functional measures, and derives a prediction model for factors related to D-dimer in a sample of community-dwelling elderly persons. D-dimer levels were assessed in a random sample of 1,727 community-dwelling elderly persons from five rural and urban counties in North Carolina in 1992, as part of the Established Populations for the Epidemiologic Studies of the Elderly (Duke University). All subjects were 72 years or older at the time of the blood draw. In addition, all subjects were surveyed yearly by telephone or in person each year from 1986 to 1992 for a variety of health, functional, and social factors. Levels of D-dimer in 1992 were related cross-sectionally to demographics (age, race, education, income, gender, smoking), function (Nagi, Rosow-Breslau, Katz, Older Americans Resources and Services procedures instrumental activities of daily living), life satisfaction and self-rated health, self-reported diseases (heart attack, cancer, stroke, diabetes, and hypertension), and weight change from 1986 to 1992. D-dimer levels increased with increasing age and functional disability. Among the health variables, only high blood pressure was predictive of D-dimer level. D-dimer levels were dramatically higher in blacks. Blacks were nearly four times more likely to have an extreme value of D-dimer (>600 microg/l) than whites when high D-dimer (yes/no) was analyzed, and blacks had an average level that was nearly 40% higher than whites in analyses of the continuous version of the outcome. This racial effect was not substantively affected in multivariable analyses with demographic and socioeconomic variables controlled. Race, age

  15. Assessing improvement in disease prediction using net reclassification improvement: impact of risk cut-offs and number of risk categories.

    Science.gov (United States)

    Mühlenbruch, Kristin; Heraclides, Alexandros; Steyerberg, Ewout W; Joost, Hans-Georg; Boeing, Heiner; Schulze, Matthias B

    2013-01-01

    Net reclassification improvement (NRI) has received much attention for comparing risk prediction models, and might be preferable over the area under the receiver operating characteristics (ROC) curve to indicate changes in predictive ability. We investigated the influence of the choice of risk cut-offs and number of risk categories on the NRI. Using data of the European Prospective Investigation into Cancer and Nutrition-Potsdam study, three diabetes prediction models were compared according to ROC area and NRI with varying cut-offs for two and three risk categories and varying numbers of risk categories. When compared with a basic model, including age, anthropometry, and hypertension status, a model extension by waist circumference improved discrimination from 0.720 to 0.831 (0.111 [0.097-0.125]) while increase in ROC-AUC from 0.831 to 0.836 (0.006 [0.002-0.009]) indicated moderate improvement when additionally considering diet and physical activity. However, NRI based on these two model comparisons varied with varying cut-offs for two (range: 5.59-23.20%; -0.79 to 4.09%) and three risk categories (20.37-40.15%; 1.22-4.34%). This variation was more pronounced in the model extension showing a larger difference in ROC-AUC. NRI increased with increasing numbers of categories from minimum NRIs of 18.41 and 0.46% to approximately category-free NRIs of 79.61 and 19.22%, but not monotonically. There was a similar pattern for this increase in both model comparisons. In conclusion, the choice of risk cut-offs and number of categories has a substantial impact on NRI. A limited number of categories should only be used if categories have strong clinical importance.

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

    Science.gov (United States)

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

    2010-01-01

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

  17. Cut-Off Value for Pain Sensitivity Questionnaire in Predicting Surgical Success in Patients with Lumbar Disc Herniation.

    Directory of Open Access Journals (Sweden)

    Parisa Azimi

    Full Text Available Various factors related to predict surgical success were studied; however, a standard cut-off point for the Pain Sensitivity Questionnaire (PSQ measure has not yet been established for a favorable surgical outcome for lumbar disc herniation (LDH. This study was to find the optimal cut-off point on the PSQ to distinguish surgical success in patients with LDH. A total of 154 patients with LDH consecutively referred to our clinic were enrolled into this prospective study between February 2011 and January 2014. All participants completed the PSQ. Patients completed the Oswestry Disability Index (ODI score before surgery, and at 2 years after surgery. Surgical success was defined as a 13-point improvement from the baseline ODI scores. The cut-off value for PSQ was determined by the receiver-operating characteristic curve (ROC. The mean age of patients was 49.3±9.6 years, and there were 80 women. The mean time for follow-up assessment was 31±5 months (range 24-35. Post-surgical success was 79.9% (n = 123 at 2 years follow up. The mean score for the total PSQ, PSQ-minor, and PSQ-moderate were 6.0 (SD = 1.6, 5.4 (SD = 1.9 and 6.5 (SD = 1.7, respectively. Total PSQ score was also significantly correlated with the total scores of the ODI. The optimal total PSQ cut-off point was determined as > 5.2 to predict surgical success in LDH patients, with 80.0% sensitivity and 75.6% specificity (AUC-0.814, 95% CI 0.703-0.926. This study showed that the PSQ could be considered a parameter for predicting surgical success in patients with LDH, and can be useful in clinical practice.

  18. Adiposity cut-off points for cardiovascular disease and diabetes risk in the Portuguese population: The PORMETS study

    Science.gov (United States)

    Severo, Milton; Santos, Ana Cristina

    2018-01-01

    Objectives The contribution of adiposity to cardiovascular and diabetes risk justifies the inclusion of an adiposity measure, usually waist circumference, in the definition of metabolic syndrome. However, waist circumference thresholds differ across populations. Our aim was to assess which adiposity measure performs the best in identifying the metabolic syndrome in a sample of Portuguese participants and to estimate cut-off values for these measures. Methods Data were obtained from a cross-sectional study (PORMETS study) conducted in Portugal between 2007 and 2009. A representative sample of non-institutionalized adults, comprising 3,956 participants, aged 18 years and older, was evaluated. A structured questionnaire was administered, collecting information on personal medical history, socio-demographics and behavioral characteristics. Anthropometrics, blood pressure and venous blood samples were also obtained. Metabolic syndrome was defined according to the Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology recommended criteria. Elevated cardiometabolic risk was considered when two or more of the four criteria of metabolic syndrome were present, excluding the waist circumference component. A receiver operating characteristic curve was used to estimate cut-off points. Results This study found that waist-to-height ratio, waist circumference and body adiposity index performed better than other adiposity measures, such as body mass index. The estimated cut-off points for waist-to-height ratio, waist circumference and body adiposity index in women and men were 0.564 / 89 cm / 27.4 and 0.571 / 93.5 cm / 25.5, respectively. Conclusion As waist circumference is currently used as the adiposity measure in the definition of metabolic syndrome and as no relevant differences were observed between this measure and waist-to-height ratio, it is likely that no modification to the metabolic syndrome definition needs to be proposed. Moreover

  19. Cut-off value of body fat in association with metabolic syndrome in Thai peri- and postmenopausal women.

    Science.gov (United States)

    Bintvihok, W; Chaikittisilpa, S; Panyakamlerd, K; Jaisamrarn, U; Taechakraichana, N

    2013-06-01

    Pathophysiologic changes during the menopause transition may contribute to the risk of metabolic syndrome (MetS). Body fat composition, particularly visceral fat, is highly associated with increased insulin resistance, abnormal carbohydrate metabolism and high blood pressure. We purposefully wished to determine the optimal cut-off values of body fat composition, including visceral fat, in order to predict MetS and to assess the prevalence of MetS in peri- and postmenopausal women. This cross-sectional study was conducted in a population-based, prospective cohort at the Menopause and Gynecology clinics, King Chulalongkorn Memorial Hospital. Body fat percentage and visceral fat rating were measured by a bioelectrical impedance analyzer (Tanita SC 330). MetS was diagnosed using the Harmonizing criteria of A Joint Interim Statement of IDF/NHLBI/AHA/WHF/IAS/IASO 2009. Receiver operating characteristic analyses were performed to determine the optimal cut-off values of body fat, visceral fat, waist circumference and body mass index to identify peri- and postmenopausal women at risk of MetS. Ninety-two perimenopausal and 446 postmenopausal women aged 40-60 years were recruited for the analyses. The optimal cut-off values for body fat percentage, visceral fat rating, waist circumference and body mass index for identifying women at risk of MetS were 34%, 7, 88 cm and 24 kg/m(2), respectively. The prevalence of MetS in this study was 27.9%. The optimal cut-off values to predict MetS of body fat percentage, visceral fat and waist circumference were established. Using the Harmonizing 2009 criteria, we found that approximately one out of four peri- and postmenopausal women in this study had MetS.

  20. Successful use of combined high cut-off haemodialysis and bortezomib for acute kidney injury associated with myeloma cast nephropathy.

    LENUS (Irish Health Repository)

    Ward, F

    2012-05-01

    We present the case of a 58-year old female with de novo dialysis-dependent acute kidney injury (AKI) secondary to myeloma cast nephropathy. The patient underwent extended high cut-off haemodialysis (HCO-HD), in conjunction with bortezomib-based chemotherapy, and soon became dialysis independent with normal renal function. To our knowledge, this is the first time this treatment strategy has been employed successfully in an Irish centre.

  1. The Potential of Established Fitness Cut-off Points for Monitoring Women with Fibromyalgia: The al-Ándalus Project.

    Science.gov (United States)

    Castro-Piñero, José; Aparicio, Virginia A; Estévez-López, Fernando; Álvarez-Gallardo, Inmaculada C; Borges-Cosic, Milkana; Soriano-Maldonado, Alberto; Delgado-Fernández, Manuel; Segura-Jiménez, Víctor

    2017-05-01

    The aim of the present study was to determinate whether fitness cut-off points discriminate the severity of major fibromyalgia symptoms and health-related quality of life. Additionally, we investigated which American Colleague of Rheumatology (ACR) fibromyalgia criteria (1990 vs. modified 2010) better discriminate fibromyalgia symptomatology. A total of 488 women with fibromyalgia and 200 non-fibromyalgia (control) women participated. All participants underwent both the 1990 and the modified 2010 ACR preliminary criteria (hereinafter 1990c and m-2010c, respectively). We used fitness cut-off points (Senior Fitness Tests Battery plus handgrip strength test) to discriminate between presence and absence of fibromyalgia. Additionally, we employed several instruments to assess fibromyalgia symptoms. Fitness cut-off points discriminated between high and low levels of the main symptoms the disease in all age groups (P from fibromyalgia diagnosis and monitoring. Moreover, the effect size of the differences in symptoms between women with fibromyalgia and controls were overall larger using the m-2010c compared with the 1990c, except for the tender points count, reflecting better the polysymptomatic distress condition of fibromyalgia. © Georg Thieme Verlag KG Stuttgart · New York.

  2. A statistical study on synergetic effects of atmospheric rivers and cut-off lows upon precipitation

    Science.gov (United States)

    Tsuji, H.; Takayabu, Y. N.

    2017-12-01

    Effects of atmospheric rivers (ARs) on precipitation in the western North Pacific (WNP) region has been less studied compared with that in the eastern Pacific. Recently, Hirota et al. (2016, MWR) analyzed the extreme rainfall event which caused a disastrous flood in Hiroshima, Japan, on 19 August 2014. They showed that a coincidence of very moist troposphere associated with AR and instability and dynamical ascent associated with a cut-off low (COL) played a significant role for the rainfall event. As in this case, AR in the WNP region seems to enhance rainfall with additional instability or ascending motion brought by another system. However, it is not clear how far large-scale conditions such as AR and COL can determine locations of severe rainfall. In this study, we statistically investigate the differences in precipitation between cases in which AR exists near a COL (AR category) and those in which AR does not exist near a COL (non-AR category). Precipitation data are obtained from hourly Global Satellite Mapping of Precipitation (GSMaP) data (0.1 degree grid). We define AR and COL with six-hourly JRA55 (1.25 degree grid) precipitable water (PW) and 350 K isentropic potential vorticity, respectively. The analyses are conducted in the WNP region (100E-160W, 0-60N), from March 2000 to February 2013. Composite results show that precipitation amount around the front side of COL's moving direction (north) in the AR category (139 cases) is larger than that in the non-AR category (63 cases). In particular, the difference of precipitation around the front-left side (north-west) is statistically significant. The relationship among the locations of COL, positive PW anomaly region corresponding to AR, and the region where the difference of precipitation is statistically significant is similar with that among the locations of COL, AR, and extreme precipitation area in the event of Hiroshima. It is indicated that a precipitation enhancement can occur associated with a

  3. Accuracy of unfolded map method for determining the left ventricular border. Evaluation of the cut-off value from autopsy finding

    International Nuclear Information System (INIS)

    Sugibayashi, Keiichi; Abe, Yoshiteru; Suga, Yutaka

    1996-01-01

    To improve the quantification of the left ventricular surface area (LVSA) by unfolded map method, we evaluated the cut-off value for determining the left ventricular border. The LVSA measured by unfolded map was compared with those measured using myocardial phantom and autopsy findings. The relative error (RE) was calculated as difference between LVSA in phantom and area of unfolded map. In phantom study, the cut-off value was calculated as 73.3±0.5% when the RE was zero. In autopsy study, the cut-off value was 74.0±7.2%. The area of unfolded map had good correlation with LVSA at autopsy when the cut-off value was 74% (r=0.83, p<0.003). The diameter of left ventricle at autopsy was compared with that of beating heart obtained by two-dimensional echocardiography, because the area of unfolded map was greater than LVSA at autopsy. The ratio of LVSA at autopsy to beating heart was calculated as 1.37. The suitable cut-off value was evaluated as 55.6% when the unfolded map area obtained by autopsy was increased 1.37 magnifications. There was a good correlation between LVSA of unfolded map (cut-off=56%) and the LVSA at autopsy (r=0.90, p<0.001). These results suggest that the cut-off value for determining the left ventricular border in vivo is 56%. (author)

  4. Serum Potassium Levels Inversely Correlate with D-Dimer In Patients with Acute-Onset Atrial Fibrillation

    OpenAIRE

    Cervellin, Gianfranco; Bonfanti, Laura; Picanza, Alessandra; Lippi, Giuseppe

    2014-01-01

    Background: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared to subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. Objective: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared with subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. The aim ...

  5. Cut-off scores of a brief neuropsychological battery (NBACE for Spanish individual adults older than 44 years old.

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    Montserrat Alegret

    Full Text Available The neuropsychological battery used in Fundació ACE (NBACE is a relatively brief, and easy to administer, test battery that was designed to detect cognitive impairment in the adulthood. The NBACE includes measures of cognitive information processing speed, orientation, attention, verbal learning and memory, language, visuoperception, praxis and executive functions. The aim of the present study was to establish the cut-off scores for impairment for different levels of age and education that could be useful in the cognitive assessment of Spanish subjects who are at risk for cognitive impairment, especially dementia. Data from 1018 patients with a mild dementia syndrome, and 512 cognitively healthy subjects, older than 44 years, from the Memory Clinic of Fundació ACE (Barcelona, Spain were analyzed. In the whole sample, cut-off scores and sensitivity/specificity values were calculated for six conditions after combining 3 age ranges (44 to 64; 65 to 74; and older than 74 years old by 2 educational levels (until Elementary school; and more than Elementary school. Moreover, general cut-offs are reported for Catalan and Spanish speakers. The results showed that most of NBACE tests reached good sensitivity and specificity values, except for Ideomotor praxis, Repetition and Verbal Comprehension tests, which had a ceiling effect. Word List Learning from the Wechsler Memory Scale-III and Semantic Verbal Fluency were the most useful tests to discriminate between cognitively healthy and demented subjects. The NBACE has been shown to be a useful tool able to detect cognitive impairment, especially dementia, in older than 44 years Spanish persons.

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

    Science.gov (United States)

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

    2016-01-01

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

  7. Accurate cut-offs for predicting endoscopic activity and mucosal healing in Crohn's disease with fecal calprotectin

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    Juan María Vázquez-Morón

    Full Text Available Background: Fecal biomarkers, especially fecal calprotectin, are useful for predicting endoscopic activity in Crohn's disease; however, the cut-off point remains unclear. The aim of this paper was to analyze whether faecal calprotectin and M2 pyruvate kinase are good tools for generating highly accurate scores for the prediction of the state of endoscopic activity and mucosal healing. Methods: The simple endoscopic score for Crohn's disease and the Crohn's disease activity index was calculated for 71 patients diagnosed with Crohn's. Fecal calprotectin and M2-PK were measured by the enzyme-linked immunosorbent assay test. Results: A fecal calprotectin cut-off concentration of ≥ 170 µg/g (sensitivity 77.6%, specificity 95.5% and likelihood ratio +17.06 predicts a high probability of endoscopic activity, and a fecal calprotectin cut-off of ≤ 71 µg/g (sensitivity 95.9%, specificity 52.3% and likelihood ratio -0.08 predicts a high probability of mucosal healing. Three clinical groups were identified according to the data obtained: endoscopic activity (calprotectin ≥ 170, mucosal healing (calprotectin ≤ 71 and uncertainty (71 > calprotectin < 170, with significant differences in endoscopic values (F = 26.407, p < 0.01. Clinical activity or remission modified the probabilities of presenting endoscopic activity (100% vs 89% or mucosal healing (75% vs 87% in the diagnostic scores generated. M2-PK was insufficiently accurate to determine scores. Conclusions: The highly accurate scores for fecal calprotectin provide a useful tool for interpreting the probabilities of presenting endoscopic activity or mucosal healing, and are valuable in the specific clinical context.

  8. Screening for Congenital Hypothyroidism: Comparison of Borderline Screening Cut-Off Points and the Effect on the Number of Children Treated with Levothyroxine

    Science.gov (United States)

    Langham, Shirley; Hindmarsh, Peter; Krywawych, Steven; Peters, Catherine

    2013-01-01

    Background The newborn screening programme for congenital hypothyroidism (CH) has led to the prevention of severe developmental delay associated with this condition. In the UK, thyroid-stimulating hormone (TSH) screening cut-off points have changed over time, in some instances prompted by changing methodological platforms. The use of borderline cut-off points varies throughout the country. Objective To use discordance in cut-off points to assess the performance of the UK Newborn Screening Programme Centre (UKNSPC) definitions. Methods Between January 2006 and December 2007, 223,658 newborn infants were screened by the Great Ormond Street Hospital (GOSH) for CH. All children with positive results and those with blood-spot TSH concentrations >6 mU/l on repeat screening were referred to GOSH. We compared the numbers of children detected and treated for CH using the GOSH cut-off points (>6 mU/l) and those of the national screening programme (>10 mU/l). Children were defined as transient CH if levothyroxine treatment had been discontinued by 3 years. Results Of the children screened between January 2006 and December 2007, 167 out of 223,658 fulfilled the GOSH screening criteria; 136 of these required levothyroxine treatment, but 29 (21%) of the children treated would not have been detected by the current UKNSPC guidelines. Transient CH was found in 17/47 (36%) of the treated children detected with a cut-off point >6 mU/l. Raising the cut-off point to >10 mU/l reduced the number of children treated for transient CH to 4/18 (22%). Conclusion A significant number of children with true and transient CH are missed with a screening cut-off point of >10 mU/l. Our data suggests that a cut-off point of 6 mU/l is appropriate. PMID:24847451

  9. The cut-off point of dual energy X-ray and laser of calcaneus osteoporosis diagnosis in postmenopausal women

    International Nuclear Information System (INIS)

    Salimzadeh, A.; Forough, B.; Olia, B.; Alishiri, G. H.; Ghasemzadeh, A.

    2005-01-01

    Dual X-Ray Absorptiometry is a method which can extensively be used for bone mineral densitometry . Another more recent method is dual energy X-ray and laser, which associate with dual X ray absorptiometry, assisted by laser measure heel thickness. In this study the cut off points for dual energy X-ray and laser of calcaneus in the diagnosis of osteoporosis in different bone regions in postmenopausal women had been determined. Materials and Methods: In 268 postmenopausal women, BMD of the spinal and femoral regions was measured by DM, and the value for the calcaneous was measured by dual energy X-ray and laser. The agreement of the two methods in the diagnosis of osteoporosis and optimal cut-off point for dual energy X-ray and laser in defining osteoporosis was obtained. What obtained was the agreement of the two methods in the diagnosis of osteoporosis, as well as the optimal cut-off point for dual energy X-ray and laser in defining osteoporosis. Results: Dual X-Ray Absorptiometry showed osteoporosis in 40.7% of cases with 35.2% in L2-L4, 16.2% in the femoral neck, and 11.7% for the femoral total region. The dual energy X-ray and laser found osteoporosis, considering -2.5 SD as a threshold, in 26.1% of cases. Agreement of the two methods in the diagnosis of osteoporosis (Kappa score) was 0.443 for the lumbar region, 0.464 for the neck, and, 0.421 for total femur regions (all P values were significant). Using Receiver Operating Characteristic curves, it was found that a T-score of -2.1, -2.6 and -2.4 as the optimal cut-off point of dual energy X-ray and laser in the diagnosis of osteoporosis in the lumbar spine, the neck and total region of femur, respectively. Conclusion: The results of this study showed a moderate agreement between the two methods in the diagnosis of osteoporosis. It seems that the dual energy X-ray and laser cannot be used as a substitute for the DM method, but it can be used as a screening method to find (to diagnose) osteoporosis

  10. Exploration of the optimal diameter cut-off value in patients with nonfunctional adrenal tumor suitable for surgery

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    Dan-dan LIU

    2016-12-01

    Full Text Available Objective  To analyze the pathology of the patients with nonfunctional adrenal tumor (NFA, and explore the optimal diameter cut-off value. Methods  The clinical data of 243 patients with NFA, evaluated in the Department of Endocrinology and operated in the Department of Urology of General Hospital of Chinese PLA from Feb. 1996 to Jan. 2016, were collected. The patients were divided into two groups according to pathology: those in real demand of surgery were classified to the surgery-need group (n=57, while the others were categorized as the surgery-unwanted group (n=186. The general situation, pathological type and tumor diameter of the two groups and the factors affecting the surgery were analyzed, and the ROC curve was used to explore the optimal surgery cut-off value, which represents the maximum value of the sum of sensitivity and specificity. Results  Of the 57 patients in surgery-need group (27 males and 30 females, the lesions were on the right in 31 cases, on the left in 25 cases, and on bilateral sides in 1 case; the median of lesion diameter was 4.5cm, and the average age was 41.5±12.1 years old. Of the 186 patients in surgery-unwanted group (87 males and 99 females, the lesions were on the right in 99 cases, on the left in 86 cases, and on bilateral sides in 1 case; the median of lesion diameter was 3.0cm, and the average age was 50.6±10.9 years old. Logistic regression revealed that lesion diameter might be a risk factor (OR=1.340, 95%CI 1.266-1.418, P=0.000 and age be a protective factor (OR=0.942, 95%CI 0.929-0.955, P=0.000 for real demand of surgery. The area under the ROC curve (AUC of lesion diameter was 0.757(95%CI 0.681-0.833. The optimal cut-off value was 4.1cm (sensitivity 60.7% and specificity 83.0%. Conclusions  Younger patients with bigger lesion diameter may have greater possibility for surgery. The optimal surgery cut-off value of the lesion diameter is 4.1cm. DOI: 10.11855/j.issn.0577-7402.2016.11.11

  11. Dynamic monitoring of menopause hormone therapy and defining the cut-off value of endometrial thickness during uterine bleeding

    OpenAIRE

    Sheng, Qiu; Yang, Jun; Zhao, Qiaoling; Li, Fen

    2016-01-01

    Abstract The aim of this study was to evaluate the effects of low-dose tibolone therapy on ovarian area, uterine volume and endometrial thickness, and define the cut-off value of endometrial thickness for curettage during uterine bleeding. We followed 619 postmenopausal women, aged 40-60 years, for two years. There were 301 subjects in the low-dose tibolone treatment group and 318 subjects in the control group. The ovarian area, uterine volume and endometrial thickness in all participants wer...

  12. A limitation of the diagnostic-odds ratio in determining an optimal cut-off value for a continuous diagnostic test.

    Science.gov (United States)

    Böhning, Dankmar; Holling, Heinz; Patilea, Valentin

    2011-10-01

    The article considers the diagnostic odds ratio, a special summarising function of specificity and sensitivity for a given diagnostic test, which has been suggested as a measure of diagnostic discriminatory power. In the situation of a continuous diagnostic test a cut-off value has to be chosen and it is a common practice to choose the cut-off value on the basis of the maximised diagnostic odds ratio. We show that this strategy is not to be recommended since it might easily lead to cut-off values on the boundary of the parameter range. This is illustrated by means of some examples. The source of the deficient behaviour of the diagnostic odds ratio lies in the convexity of the log-diagnostic odds ratio as a function of the cut-off value. This can easily be seen in practice by plotting a non-parametric estimate of the log-DOR against the cut-off value. In fact, it is shown for the case of a normal distributed diseased and a normal distributed non-diseased population with equal variances that the log-DOR is a convex function of the cut-off value. It is also shown that these problems are not present for the Youden index, which appears to be a better choice.

  13. Current MUAC Cut-Offs to Screen for Acute Malnutrition Need to Be Adapted to Gender and Age: The Example of Cambodia

    Science.gov (United States)

    Fiorentino, Marion; Sophonneary, Prak; Laillou, Arnaud; Whitney, Sophie; de Groot, Richard; Perignon, Marlène; Kuong, Khov; Berger, Jacques; Wieringa, Frank T.

    2016-01-01

    Background Early identification of children malnutrition is a priority. Acute malnutrition is defined by the World Health Organization as a mid-upper-arm circumference (MUAC) malnutrition in communities, but MUAC cut-offs currently recommended by WHO do not identify the majority of children with weight-for-height Z-score (5 yrs. Therefore, this study aimed at defining gender and age-specific cut-offs to improve sensitivity of MUAC as an indicator of acute malnutrition. Methods To establish new age and gender-specific MUAC cut-offs, pooled data was obtained for 14,173 children from 5 surveys in Cambodia (2011–2013). Sensitivity, false positive rates, and areas under receiver-operator characteristic curves (AUC) were calculated using wasting for children 80% with the new cut-offs in comparison with the current WHO cut-offs. Conclusion Gender and age specific MUAC cut-offs drastically increased sensitivity to identify children with WHZ-score malnutrition at the community level. PMID:26840899

  14. Preoperative screening of thromboembolism using plasma D-dimer test and proximal vein compression ultrasonography in Japanese gynecologic patients.

    Science.gov (United States)

    Shigemi, Daisuke; Matsuhashi, Tomohiko; Yamada, Takashi; Kamoi, Seiryu; Takeshita, Toshiyuki

    2017-03-01

    Venous thromboembolism (VTE) is a serious complication of surgery, including gynecologic surgery. The plasma D-dimer test and proximal/distal vein compression ultrasonography are frequently used as an easy, preoperative VTE screening method. However, targeted patients for these two examinations have not been established. We retrospectively reviewed 380 gynecologic surgical patients who underwent preoperative VTE screening including the plasma D-dimer test and proximal/distal vein compression ultrasonography from March 2014 to February 2015. All patients underwent laparotomy or laparoscopy. In patients with a high risk of pulmonary thromboembolism, compression ultrasonography was substituted by or combined with contrast-enhanced computed tomography. With regard to D-dimer level, patients were divided to three groups: D-dimer level ≤0.5 μg/mL (group A), D-dimer level between 0.6 and 0.9 μg/mL (group B), and D-dimer level ≥ 1.0 μg/mL (group C). Twenty-seven cases had preoperatively detected VTE. Three patients in group B with benign disease were diagnosed with VTE before surgery. Among benign patients in group B, there was a significant difference in preoperative VTE occurrence between patients without risk factors (0/68 cases) and those with risk factors (3/54 cases). All 11 patients with benign disease having preoperative VTE had one or more risk factors. Even in benign cases with low preoperative D-dimer levels (0.6-0.9 μg/mL), an imaging test should be added when the patient has one or more VTE risk factors.

  15. Complementarity of lung scintigraphy and D-dimer test in pulmonary embolism

    International Nuclear Information System (INIS)

    Bonnin, F.; Hadjikostova, H.; Jebrak, G.; Denninger, M.H.; Vera, P.; Rufat, P.; Seknadji, P.; Bok, B.

    1997-01-01

    D-dimer assay (DDA), measuring fibrin degradation products, was compared with lung scintigraphy (LS) in a prospective unselected series of 83 consecutive patients referred owing to suspicion of pulmonary embolism (PE). This patient series was also used to compare several methods of performing and interpreting LS images. The final diagnosis was established independently by a separate panel with all available information except for the result of DDA. D-dimer was determined by ELISA (threshold value 500 ng/ml). LS, including perfusion (.Q) and pseudo-ventilation (Technegas) (.V), was classified according to PIOPED, (1) immediately by the physician on duty, and (2) retrospectively by a blinded panel. A positive (19) or negative (61) diagnosis of PE was achieved in 80 patients, the prevalence of PE being 24%. Only one false-negative was noted on DDA (sensitivity=95%) but there were 42 false-positives (specificity=31%), resulting in a positive predictive value of 30% and a negative predictive value of 95%. Emergency and retrospective interpretations of LS were close (kappa=0.4). In a minority of patients, PE may be excluded with reasonable certainty if DDA is normal, resulting in a significant saving in terms of time and money. (orig.). With 3 tabs

  16. DIAGNOSTIC VALUE OF D-DIMER MEASUREMENT IN PATIENTS SUSPECTED TO HAVE CEREBRAL VENOUS THROMBOSIS

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    M Ghaffarpour

    2008-12-01

    Full Text Available "nAmong the causes of headache, cerebral venous and/or dural sinus thrombosis (CVT is an important challenge because of its variable clinical presentation, having negative brain CT in up to 30% of cases and unavailability of MRI in some situations. On the other hand as D-Dimer (DD test has been reported to be a sensitive test for the exclusion of venous thromboembolism, we sought whether it could be useful in the diagnosis of cerebral venous thrombosis. A prospective study of 104 consecutive patients with headache or unusual ischemic stroke (infarction in brain CT, but not compatible with any brunch of cerebral arteries, suggesting CVT was conducted between 2003 and 2005. D-Dimer test determined for all patients in the emergency ward before MRI or MRV was performed. Titers above 500 ng/ml were regarded as positive test. From a total 104 patients, 21 cases (20.2% were confirmed (by MRI and/or MRV to have CVT, 20/21 (95.7% of whom had positive DD test. In the remainder 83 (without CVT it was only positive in 16.8% (14/83, which was statistically meaningful (P < 0.001. Specificity, sensitivity, negative and positive predictive values of DD test were 83.1, 95.2, 98.6 and 58.8%, respectively, so application of this test would be useful in the diagnosis of CVT and values below 500 ng/ml make acute thrombosis unlikely.

  17. Distribution pattern of the Ki67 labelling index in breast cancer and its implications for choosing cut-off values.

    Science.gov (United States)

    Cserni, Gábor; Vörös, András; Liepniece-Karele, Inta; Bianchi, Simonetta; Vezzosi, Vania; Grabau, Dorthe; Sapino, Anna; Castellano, Isabella; Regitnig, Peter; Foschini, Maria Pia; Zolota, Vassiliki; Varga, Zsuzsanna; Figueiredo, Paulo; Decker, Thomas; Focke, Cornelia; Kulka, Janina; Kaya, Handan; Reiner-Concin, Angelika; Amendoeira, Isabel; Callagy, Grace; Caffrey, Emer; Wesseling, Jelle; Wells, Clive

    2014-06-01

    The Ki67 labelling index (LI - proportion of staining cells) is widely used to reflect proliferation in breast carcinomas. Several cut-off values have been suggested to distinguish between tumours with low and high proliferative activity. The aim of the current study was to evaluate the distribution of Ki67 LIs in breast carcinomas diagnosed at different institutions by different pathologists using the method reflecting their daily practice. Pathologists using Ki67 were asked to provide data (including the LI, type of the specimen, receptor status, grade) on 100 consecutively stained cases, as well as details of their evaluation. A full dataset of 1709 carcinomas was collected from 19 departments. The median Ki67 LI was 17% for all tumours and 14% for oestrogen receptor-positive and HER2-negative carcinomas. Tumours with higher mitotic counts were associated with higher Ki67 LIs. Ki67 LIs tended to cluster around values ending with 5 or 0 both in cases where the values were obtained by counting the proportion of stained tumour cell nuclei and those where the values were obtained by estimation. On the basis of the distribution pattern described, some currently used Ki67 LI cut off values are not realistic, and it is proposed to select more realistic values ending with 0 or 5. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Preoperative diagnosis of breast diseases by dynamic MR mammography. Cut off point establishment for signal intensity ratio

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchiya, Juji; Nagata, Takayasu; Kawagoe, Hajime; Tachibana, Susumu; Kajima, Toshihiko; Hoshino, Mutsuo [Ibi General Hospital, Gifu (Japan); Uno, Takashi; Shimokawa, Kuniyasu

    1997-12-01

    We have revealed that a dynamic study of the breast using MR imaging technique can estimate objectively benign-malignant differentiative diagnosis. Subjects were 41 cases of breast lesion, including 13 cases of breast cancer, 21 cases of mastopathy, six cases of fibroadenoma and one case of intraductal papillomatosis and the results of them were investigated in comparison with histopathological diagnosis. As so the method, we drew up time-signal intensity ratio curve plotting signal intensity ratio at each 30 second of dynamic MR mammography after Gd-DTPA administration. We found a especially high significant difference between cancer and mastopathy, within 90 second after Gd-DTPA administration (p=0.0000). Still more, we established cut off point concerning with establishment of 95% confidence interval, that is, at 30 second after Gd-DTPA administration of point equivalent 1.53 at 60 second equivalent 2.00, at 90 second equivalent 2.47, and about this estimating maneuver using the cut off point we named Dynamic ratio method. We can estimate preoperatively not only benign-malignant differentiative diagnosis with breast tumor, but also neighboring infiltration and lymph node metastasis of breast cancer using this Dynamic ratio method. Over again, Dynamic ratio method provides fine information to preoperative decision of resecting region for breast conserving surgery. The efficiency of this method is sensitivity=92.3%, specificity=89.3% and positive predictive value=80.0%. (author)

  19. Cut-off scaling of high-harmonic generation driven by a femtosecond visible optical parametric amplifier

    International Nuclear Information System (INIS)

    Cirmi, Giovanni; Lai, Chien-Jen; Granados, Eduardo; Huang, Shu-Wei; Sell, Alexander; Hong, Kyung-Han; Moses, Jeffrey; Keathley, Phillip; Kärtner, Franz X

    2012-01-01

    We studied high-harmonic generation (HHG) in Ar, Ne and He gas jets using a broadly tunable, high-energy optical parametric amplifier (OPA) in the visible wavelength range. We optimized the noncollinear OPA to deliver tunable, femtosecond pulses with 200-500 µJ energy at the 1 kHz repetition rate with excellent spatiotemporal properties, suitable for HHG experiments. By tuning the central wavelength of the OPA while keeping other parameters (energy, duration and beam size) constant, we experimentally studied the scaling law of cut-off energy with the driver wavelength in helium. Our measurements show a λ 1.7+0.2 dependence of the HHG cut-off photon energy over the full visible range in agreement with previous experiments of near- and mid-IR wavelengths. By tuning the central wavelength of the driver source, the high-order harmonic spectra in the extreme ultraviolet cover the full range of photon energy between ∼25 and ∼100 eV. Due to the high coherence intrinsic in HHG, as well as the broad and continuous tunability in the extreme UV range, a high energy, high repetition rate version of this source might be an ideal seed for free electron lasers.

  20. In Vitro Dialysis of Cytokine-Rich Plasma With High and Medium Cut-Off Membranes Reduces Its Procalcific Activity.

    Science.gov (United States)

    Willy, Kevin; Hulko, Michael; Storr, Markus; Speidel, Rose; Gauss, Julia; Schindler, Ralf; Zickler, Daniel

    2017-09-01

    Recently developed high-flux (HF) dialysis membranes with extended permeability provide better clearance of middle-sized molecules such as interleukins (ILs). Whether this modulation of inflammation influences the procalcific effects of septic plasma on vascular smooth muscle cells (VSMCs) is not known. To assess the effects of high cut-off (HCO) and medium cut-off (MCO) membranes on microinflammation and in vitro vascular calcification we developed a miniature dialysis model. Plasma samples from lipopolysaccharide-spiked blood were dialyzed with HF, HCO, and MCO membranes in an in vitro miniature dialysis model. Afterwards, IL-6 concentrations were determined in dialysate and plasma. Calcifying VSMCs were incubated with dialyzed plasma samples and vascular calcification was assessed. Osteopontin (OPN) and matrix Gla protein (MGP) were measured in VSMC supernatants. IL-6 plasma concentrations were markedly lower with HCO and MCO dialysis. VSMC calcification was significantly lower after incubation with MCO- and HCO-serum compared to HF plasma. MGP and OPN levels in supernatants were significantly lower in the MCO but not in the HCO group compared to HF. In vitro dialysis of cytokine-enriched plasma samples with MCO and HCO membranes reduces IL-6 levels. The induction of vascular calcification by cytokine-enriched plasma is reduced after HCO and MCO dialysis. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  1. One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer.

    Science.gov (United States)

    Taylor, F G M; Quirke, P; Heald, R J; Moran, B; Blomqvist, L; Swift, I; St Rose, S; Sebag-Montefiore, D J; Tekkis, P; Brown, G

    2011-06-01

    A pathologically involved margin in rectal cancer is defined as tumour within 1 mm of the surgical resection margin. There is no standard definition of a predicted safe margin on magnetic resonance imaging (MRI). The aim of this study was to assess which cut-off (1, 2 or 5 mm) was the best predictor of local recurrence based on preoperative MRI assessment of the circumferential resection margin (CRM). Data were collected prospectively on the distance between the tumour and mesorectal fascia for patients with documented radiological margin status in the MERCURY study. Positive margin and local recurrence rates were compared for MRI distances from the tumour to the mesorectal fascia of 1 mm or less, more than 1 mm up to 2 mm, more than 2 mm up to 5 mm, and more than 5 mm. The Cox proportional hazard regression method was used to determine the effect of level of margin involvement on time to local recurrence. Univariable analysis showed that, relative to a distance measured by MRI of more than 5 mm, the hazard ratio (HR) for local recurrence was 3·90 (95 per cent confidence interval 1·99 to 7·63; P CRM involvement using MRI is 1 mm. Using a cut-off greater than this does not appear to identify patients at higher risk of local recurrence. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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

    Science.gov (United States)

    Ransom, Khadijah S.; Johnson, Grace K.

    2013-01-01

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

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

    Science.gov (United States)

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

    2016-12-01

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

  4. MGMT pyrosequencing-based cut-off methylation level and clinical outcome in patients with glioblastoma multiforme.

    Science.gov (United States)

    Gurrieri, Lorena; De Carlo, Elisa; Gerratana, Lorenzo; De Maglio, Giovanna; Macerelli, Marianna; Pisa, Federica Edith; Masiero, Elena; Aprile, Giuseppe; Follador, Alessandro; Puglisi, Fabio; Fasola, Gianpiero; Rizzato, Simona; Pizzolitto, Stefano

    2018-03-09

    MGMT promoter methylation has been associated with improved survival in glioblastoma multiforme treated with temozolomide. However, there is no consensus on specific cut-off levels of methylation. The aims of the study were to explore the prognostic impact of MGMT methylation status and to analyze the role of specific cut-off values. We analyzed 108 glioblastoma multiforme patients treated between 2008 and 2013 stratified according to three pyrosequencing-based quantitative methylation in: unmethylated (methylation methylated (>29%). The three-class stratification has a prognostic impact (median progression-free survival: 7.97, 11.6 and 15 months respectively; p = 0.004; median OS: 13.2, 15.8 and 19.5 months, respectively; p = 0.0002), especially in patients exposed to temozolomide. Our study confirmed that the independent prognostic role of MGMT methylation status. An average level of methylation between all investigated CpGs of 9% may help discriminating between methylated and unmethylated tumors.

  5. Systematic review of current guideline appraisals performed with the Appraisal of Guidelines for Research & Evaluation II instrument-a third of AGREE II users apply a cut-off for guideline quality.

    Science.gov (United States)

    Hoffmann-Eßer, Wiebke; Siering, Ulrich; Neugebauer, Edmund A M; Lampert, Ulrike; Eikermann, Michaela

    2018-03-01

    To investigate whether Appraisal of Guidelines for Research & Evaluation (AGREE) II users apply a cut-off based on standardized domain scores or overall guideline quality to distinguish between high- and low-quality guidelines, as well as to investigate which criteria they use to generate this cut-off and which type of cut-off they apply. We conducted a systematic search in MEDLINE, EMBASE, DARE, and the HTA-database for German- and English-language studies appraising guidelines with AGREE II. Information on cut-offs was extracted and analyzed descriptively. We identified 118 relevant publications. Thirty-nine (33%) used a cut-off, of which 24 (62%) used a 2-step and 13 (33%) used a 3-step approach. The cut-off for high quality lay between 50% and 70% (2-step) and 60% and 83% (3-step) of the highest possible rating. Twenty-four (62%) publications applied a cut-off based on standardized domain scores and 7 (18%) based on overall guideline quality. Eleven (28%) applied cut-offs to derive the recommendation for guideline use. A third of AGREE II users apply a cut-off to distinguish between high- and low-quality guidelines, often without clearly describing how the cut-off is generated. Many users might welcome a clear distinction between high- and low-quality guidelines; specifying a cut-off for this purpose might be useful. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. D-dimer is not elevated in asymptomatic high altitude climbers after descent to 5340 m: the Mount Everest Deep Venous Thrombosis Study (Ev-DVT).

    Science.gov (United States)

    Zafren, Ken; Feldman, Joanne; Becker, Robert J; Williams, Sarah R; Weiss, Eric A; Deloughery, Tom

    2011-01-01

    We performed this study to determine the prevalence of elevated D-dimer, a marker for deep venous thrombosis (DVT), in asymptomatic high altitude climbers. On-site personnel enrolled a convenience sample of climbers at Mt. Everest Base Camp (Nepal), elevation 5340 m (17,500 ft), during a single spring climbing season. Subjects were enrolled after descent to base camp from higher elevation. The subjects completed a questionnaire to evaluate their risk factors for DVT. We then performed a D-dimer test in asymptomatic individuals. If the D-dimer test was negative, DVT was considered ruled out. Ultrasound was available to perform lower-extremity compression ultrasounds to evaluate for DVT in case the D-dimer was positive. We enrolled 76 high altitude climbers. None had a positive D-dimer test. The absence of positive D-dimer tests suggests a low prevalence of DVT in asymptomatic high altitude climbers.

  7. Embolic Stroke Diagnosed by Elevated D-Dimer in a Patient With Negative TEE for Cardioembolic Source

    Directory of Open Access Journals (Sweden)

    Irina Y. Sazonova PhD

    2014-12-01

    Full Text Available We report a case of cerebrovascular accident with thromboembolic stroke etiology in a patient who had atrial flutter and negative transesophageal echocardiography (TEE results. The increased D-dimer levels (1877 ng/mL initiated referral for magnetic resonance imaging and magnetic resonance angiography of the brain that showed classic recanalization of an embolic thrombus in the angular branch of the left middle cerebral distribution. The D-dimer level of this patient was normalized after 3 months of anticoagulation therapy. Although TEE is considered the gold standard for evaluation of cardiac source of embolism, exclusion of intracardiac thrombus with TEE alone does not eliminate the risk of thromboembolic events. This case highlights the utility of D-dimer as a potential adjunct in the decision-making process to guide investigation of thromboembolism, determine subsequent therapy, and hence reduce the risk of embolic stroke recurrence.

  8. Trend, projection, and appropriate body mass index cut-off point for diabetes and hypertension in Bangladesh.

    Science.gov (United States)

    Rahman, Md Mizanur; Akter, Shamima; Jung, Jenny; Rahman, Md Shafiur; Sultana, Papia

    2017-04-01

    Rapid increasing of high body mass index (BMI) is a global health concern. Population with high BMI predicts an increased risk of diabetes and hypertension. The objective of the present study is to estimate the trend and prediction of diabetes and hypertension in Bangladesh, to examine the association of BMI with risk of diabetes and hypertension, and to ascertain an appropriate BMI cut-off point for screening diabetes. We searched PubMed from inception to August 2016 and identified studies reporting diabetes and hypertension prevalence in Bangladesh. Bangladesh Demographic and Health Survey 2011 data was also included in this study. Bayesian model was used to estimate trend and projection in diabetes and hypertension prevalence by sex and residence. Receiver operating characteristic curves was used to determine the optimal BMI cut-off point for screening diabetes. Of 535 articles reviewed, 35 studies reported prevalence of diabetes and hypertension. Prevalence of diabetes (95% credible interval) increased between 1992 and 2015 from 3.2% (2.2-4.3) to 12.1% (9.1-15.4) in men, and from 2.5% (1.8-3.5) to 13.4% (9.7-17.6) in women. Diabetes prevalence in 2030 is expected to reach 23.6% (13.6-36.3) for men and 33.5% (19.9-50.9) for women. Hypertension prevalence increased between 1992 and 2015 from 11.0% (8.6-13.7) to 20.4% (18.4-22.4%) in 2015 in men, and from 14.0% (10.3-19.0) to 21.3% (19.0-23.6) in women. Annual average rate of change for diabetes prevalence was higher among women and in rural areas, while for hypertension prevalence it was higher in men and urban areas. Adults with BMI of 22.5kg/m 2 or above had a higher risk of diabetes and hypertension in this study. The optimal BMI cut-off point for screening diabetes was 23kg/m 2 for overall population, 22kg/m 2 for men, and 23kg/m 2 for women. Diabetes is more prevalent among women and rural population groups, while hypertension is more prevalent among men and urban population groups in Bangladesh. A BMI of 22

  9. [Segmental cut-off bridge and local floating technology for the treatment of ossification of ligamentum flavum in thoracic spine].

    Science.gov (United States)

    Liang, Wei-dong; Zhang, Jian; Sheng, Wei-bin

    2013-10-08

    To explore the efficacy and safety of segmental cut-off bridge and local floating technology for the treatment of ossification of ligamentum flavum (OLF) in thoracic spine. Retrospective study was performed in 98 patients with thoracic OLF who under went operation. There was 56 males and 42 females with an average age of 45.8 (35-73) years. The average duration of onset was 17 (3-51) months. The main clinical symptoms were numbness and paraesthesia (n = 90), lower limb weakness and walking trouble (n = 46), positive pyramidal tract signs (n = 33) and sphincter function obstacle (n = 9). OLF was screened and diagnosed by radiology, magnetic resonance imaging (MRI), computed tomography (CT) or CT myelography (CTM). A total of 142 OLF nidus were spotted. The lesions involved single segment (n = 32), double segments (n = 56), three segments (n = 6) and ≥ four segments (n = 4). And the locations were at upper thoracic segment (T1-4) (n = 34), middle thoracic segment (T5-8) (n = 23) and lower thoracic segment (T9-12) (n = 42). The OLF nidus were removed by local floating technology oft windowing at cephalic and caudal ends and a cut-off bridge at both sides of involved segments. Pre- and post-operative Japanese Orthopedic Association (JOA) scores and Epstein grades were recorded to evaluate the outcomes. The mean loss volume of blood was 320 ml and operative duration 155 min. All cases recovered independent activities. The mean follow-up period was 28 (13-48) months. The mean preoperative JOA score was 4.3 (1-8) points and the mean postoperative JOA score 9.7 (5-11) points. The recovery rate was 78.8%. According to Epstein grade, the excellent and good rate was 86.7%. As a common cause of thoracic spinal cord compression, OLF should be operated as early as possible. Based upon clinical and imaging findings, the application of segmental cut-off bridge and local floating technology is both safe and efficacious in the treatment of OLF in thoracic spine.

  10. Values of the Wells and Revised Geneva Scores Combined with D-dimer in Diagnosing Elderly Pulmonary Embolism Patients

    Directory of Open Access Journals (Sweden)

    Dan-Jie Guo

    2015-01-01

    Full Text Available Background: Pulmonary embolism (PE can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken. We aimed to compare the clinical diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients. Methods: Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age (≥65 or <65 years old. The Wells and revised Geneva scores were applied to evaluate the clinical probability of PE, and the positive predictive values of both scores were calculated using computed tomography pulmonary arteriography as a gold standard; overall accuracy was evaluated by the area under the curve (AUC of receiver operator characteristic curve; the negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were calculated. Results: Ninety-six cases (28.6% were definitely diagnosed as PE among 336 cases, among them 56 cases (58.3% were ≥65 years old. The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%, respectively (P < 0.05 in the elderly patients; the AUC for the Wells score and the revised Geneva score in elderly was 0.682 (95% confidence interval [CI]: 0.612-0.746 and 0.655 (95% CI: 0.584-0.722, respectively (P = 0.389. The negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were 93.7%, 100%, and 100% in the elderly, respectively. Conclusions: The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE.

  11. The dischargeable cut-off score of Oswestry Disability Index (ODI) in the inpatient care for low back pain with disability.

    Science.gov (United States)

    Park, Sang-Won; Shin, Ye-Sle; Kim, Hye-Jin; Lee, Jin-Ho; Shin, Joon-Shik; Ha, In-Hyuk

    2014-10-01

    The admission due to low back pain (LBP) became prevalent cause of international economic losses. Since LBP patients with disability are often subject to inpatient care, it is important to determine the appropriate time of discharge. The purpose of this study is to set the cut-off value of appropriate Oswestry Disability Index (ODI) at the time of discharge. Of 1,394 LBP patients admitted in hospital specialized in spinal disease, 774 eligible patients with disability were included in this study. And several clinical variables including numerical rating score, ODI, satisfaction level were observed during the hospital stay. We considered satisfaction level as an important factor for discharge, categorized patients into satisfied group and dissatisfied group. Through the statistical analysis, appropriate factor for determining dischargeable patients satisfied with their current condition and its cut-off value of ODI were found. And proper predictors for the cut-off value were extracted statistically and logically from a pool of several clinical indexes. The ODI at the time of discharge was most accurate in determining dischargeable patients. The cut-off value of ODI was 30. Predictors were ODI questions 4 and 6. We set the cut-off value of dischargeable ODI for LBP inpatient with disability and found its predictor.

  12. Practical use of visual medial temporal lobe atrophy cut-off scores in Alzheimer's disease: Validation in a large memory clinic population

    Energy Technology Data Exchange (ETDEWEB)

    Claus, Jules J.; Holl, Dana C.; Roorda, Jelmen J. [Tergooi Hospital, Department of Neurology, Blaricum (Netherlands); Staekenborg, Salka S. [Tergooi Hospital, Department of Neurology, Blaricum (Netherlands); VU University Medical Center, Department of Neurology, Alzheimer Center, Amsterdam (Netherlands); Schuur, Jacqueline [Tergooi Hospital, Department of Geriatrics, Blaricum (Netherlands); Koster, Pieter [Tergooi Hospital, Department of Radiology, Blaricum (Netherlands); Tielkes, Caroline E.M. [Tergooi Hospital, Department of Medical Psychology, Blaricum (Netherlands); Scheltens, Philip [VU University Medical Center, Department of Neurology, Alzheimer Center, Amsterdam (Netherlands)

    2017-08-15

    To provide age-specific medial temporal lobe atrophy (MTA) cut-off scores for routine clinical practice as marker for Alzheimer's disease (AD). Patients with AD (n = 832, mean age 81.8 years) were compared with patients with subjective cognitive impairment (n = 333, mean age 71.8 years) in a large single-centre memory clinic. Mean of right and left MTA scores was determined with visual rating (Scheltens scale) using CT (0, no atrophy to 4, severe atrophy). Relationships between age and MTA scores were analysed with regression analysis. For various MTA cut-off scores, decade-specific sensitivity and specificity and area under the curve (AUC) values, computed with receiver operator characteristic curves, were determined. MTA strongly increased with age in both groups to a similar degree. Optimal MTA cut-off values for the age ranges <65, 65-74, 75-84 and ≥85 were: ≥1.0, ≥1.5, ≥ 2.0 and ≥2.0. Corresponding values of sensitivity and specificity were 83.3% and 86.4%; 73.7% and 84.6%; 73.7% and 76.2%; and 84.0% and 62.5%. From this large unique memory clinic cohort we suggest decade-specific MTA cut-off scores for clinical use. After age 85 years, however, the practical usefulness of the MTA cut-off is limited. (orig.)

  13. Practical use of visual medial temporal lobe atrophy cut-off scores in Alzheimer's disease: Validation in a large memory clinic population

    International Nuclear Information System (INIS)

    Claus, Jules J.; Holl, Dana C.; Roorda, Jelmen J.; Staekenborg, Salka S.; Schuur, Jacqueline; Koster, Pieter; Tielkes, Caroline E.M.; Scheltens, Philip

    2017-01-01

    To provide age-specific medial temporal lobe atrophy (MTA) cut-off scores for routine clinical practice as marker for Alzheimer's disease (AD). Patients with AD (n = 832, mean age 81.8 years) were compared with patients with subjective cognitive impairment (n = 333, mean age 71.8 years) in a large single-centre memory clinic. Mean of right and left MTA scores was determined with visual rating (Scheltens scale) using CT (0, no atrophy to 4, severe atrophy). Relationships between age and MTA scores were analysed with regression analysis. For various MTA cut-off scores, decade-specific sensitivity and specificity and area under the curve (AUC) values, computed with receiver operator characteristic curves, were determined. MTA strongly increased with age in both groups to a similar degree. Optimal MTA cut-off values for the age ranges <65, 65-74, 75-84 and ≥85 were: ≥1.0, ≥1.5, ≥ 2.0 and ≥2.0. Corresponding values of sensitivity and specificity were 83.3% and 86.4%; 73.7% and 84.6%; 73.7% and 76.2%; and 84.0% and 62.5%. From this large unique memory clinic cohort we suggest decade-specific MTA cut-off scores for clinical use. After age 85 years, however, the practical usefulness of the MTA cut-off is limited. (orig.)

  14. Impact of High-Cut-Off Dialysis on Renal Recovery in Dialysis-Dependent Multiple Myeloma Patients: Results from a Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Hans U Gerth

    Full Text Available High-cut-off hemodialysis (HCO-HD can effectively reduce high concentrations of circulating serum free light chains (sFLC in patients with dialysis-dependent acute kidney injury (AKI due to multiple myeloma (MM. Therefore, the aim of this study was to analyze renal recovery in a retrospective single-center cohort of dialysis-dependent MM patients treated with either conventional HD (conv. HD or HCO-HD.The final cohort consisted of 59 patients treated with HCO-HD (n = 42 or conv. HD (n = 17. A sustained sFLC response was detected in a significantly higher proportion of HCO-HD patients (83.3% compared with conv. HD patients (29.4%; p = 0.007. The median duration of sFLC required to reach values <1000 mg/l was 14.5 days in the HCO-HD group and 36 days in the conv. HD group. The corresponding rates of renal recovery were 64.3% and 29.4%, respectively (chi-squared test, p = 0.014. Multivariate regression and decision tree analysis (recursive partitioning revealed HCO-HD (adjusted odds ratio [OR] 6.1 [95% confidence interval (CI 1.5-24.5], p = 0.011 and low initial uric acid values (adjusted OR 1.3 [95%CI 1.0-1.7], p = 0.045 as independent and paramount variables associated with a favorable renal outcome.In summary, the results from this retrospective case-control study suggest in addition to novel agent-based chemotherapy a benefit of HCO-HD in sFLC removal and renal outcome in dialysis-dependent AKI secondary to MM. This finding was especially pertinent in patients with low initial uric acid values, resulting in a promising renal recovery rate of 71.9%. Further prospective studies are warranted.

  15. D-Dimer Levels and Traditional Risk Factors Are Associated With Incident Hypertension Among HIV-Infected Individuals Initiating Antiretroviral Therapy in Uganda.

    Science.gov (United States)

    Okello, Samson; Asiimwe, Stephen B; Kanyesigye, Michael; Muyindike, Winnie R; Boum, Yap; Mwebesa, Bosco B; Haberer, Jessica E; Huang, Yong; Williams, Kenneth; Burdo, Tricia H; Tracy, Russell P; Bangsberg, David R; Mocello, A Rain; Martin, Jeffrey N; Hunt, Peter W; Siedner, Mark J

    2016-12-01

    We sought to describe blood pressure (BP) changes after antiretroviral therapy (ART) initiation and evaluate the association of markers of inflammation with incident hypertension in a cohort of HIV-infected individuals in Uganda. We used mixed effects linear regression to model changes in systolic BP over time among a cohort of HIV-infected individuals initiating ART in Uganda. After exclusion of participants with preexisting hypertension, we identified participants with normal BP throughout follow-up (controls) and those with elevated BP on ≥3 consecutive visits (cases). Before ART initiation, participants had testing for interleukin 6, kynurenine/tryptophan ratio, lipopolysaccharide, soluble CD14, soluble CD163, and D-dimer and those with viral suppression at 6 months during ART had repeat tests. We fit logistic regression models to estimate associations between biomarkers and risk of incident hypertension. In the entire cohort, systolic BP increased by 9.6 mm Hg/yr (95% CI: 7.3 to 11.8) in the first 6 months of ART, then plateaued. Traditional factors: male gender (adjusted odds ratio (AOR) 2.76, 95% CI: 1.34 to 5.68), age (AOR 1.09, 95% CI: 1.04 to 1.13), overweight (AOR 4.48, 95% CI: 1.83 to 10.97), and a CD4 count <100 cells (AOR 3.08, 95% CI: 1.07 to 8.89) were associated with incident hypertension. After adjusting for these, D-dimer levels at month 6 were inversely associated with incident hypertension (AOR 0.61, 95% CI: 0.37 to 0.99). Although not significant, similar associations were seen with sCD14 and kynurenine/tryptophan ratio. BP increases early after ART initiation in Ugandans. Traditional risk factors, rather than immune activation, were associated with incident hypertension in this population.

  16. Achieving a high cutting-off frequency in the oriented CoFe2O4 nanocubes

    Science.gov (United States)

    Song, Ningning; Gu, Shangzhi; Zhou, Jun; Xia, Weixing; Zhang, Panpan; Gul, Qeemat; Wang, Wei; Yang, Haitao; Cheng, Zhaohua

    2017-09-01

    An effective way for the improvement of resonance frequency was demonstrated by the orientation of CoFe2O4 nanocubes (NCs) after applying a magnetic field. The magnetic holography image of the oriented CoFe2O4 NC arrays was obtained, and the vortex domain structure was found in single CoFe2O4 NCs, which greatly depends on dipolar interactions. Moreover, the cutting-off frequency of oriented CoFe2O4 NCs of 8.8 GHz is achieved with a slight increase in permeability at an extremely low mass fraction (about 10%). This work provides an effective way for optimizing the high-frequency properties of magnetic nanomaterials above GHz.

  17. A cut-off in the TeV gamma-ray spectrum of the SNR Cassiopeia A

    Science.gov (United States)

    Ahnen, M. L.; Ansoldi, S.; Antonelli, L. A.; Arcaro, C.; Babić, A.; Banerjee, B.; Bangale, P.; Barres de Almeida, U.; Barrio, J. A.; Becerra González, J.; Bednarek, W.; Bernardini, E.; Berti, A.; Bhattacharyya, W.; Biasuzzi, B.; Biland, A.; Blanch, O.; Bonnefoy, S.; Bonnoli, G.; Carosi, R.; Carosi, A.; Chatterjee, A.; Colak, M.; Colin, P.; Colombo, E.; Contreras, J. L.; Cortina, J.; Covino, S.; Cumani, P.; Da Vela, P.; Dazzi, F.; De Angelis, A.; De Lotto, B.; de Oña Wilhelmi, E.; Di Pierro, F.; Doert, M.; Domínguez, A.; Dominis Prester, D.; Dorner, D.; Doro, M.; Einecke, S.; Eisenacher Glawion, D.; Elsaesser, D.; Engelkemeier, M.; Fallah Ramazani, V.; Fernández-Barral, A.; Fidalgo, D.; Fonseca, M. V.; Font, L.; Fruck, C.; Galindo, D.; García López, R. J.; Garczarczyk, M.; Gaug, M.; Giammaria, P.; Godinović, N.; Gora, D.; Guberman, D.; Hadasch, D.; Hahn, A.; Hassan, T.; Hayashida, M.; Herrera, J.; Hose, J.; Hrupec, D.; Inada, T.; Ishio, K.; Konno, Y.; Kubo, H.; Kushida, J.; Kuveždić, D.; Lelas, D.; Lindfors, E.; Lombardi, S.; Longo, F.; López, M.; Maggio, C.; Majumdar, P.; Makariev, M.; Maneva, G.; Manganaro, M.; Mannheim, K.; Maraschi, L.; Mariotti, M.; Martínez, M.; Mazin, D.; Menzel, U.; Minev, M.; Mirzoyan, R.; Moralejo, A.; Moreno, V.; Moretti, E.; Neustroev, V.; Niedzwiecki, A.; Nievas Rosillo, M.; Nilsson, K.; Ninci, D.; Nishijima, K.; Noda, K.; Nogués, L.; Paiano, S.; Palacio, J.; Paneque, D.; Paoletti, R.; Paredes, J. M.; Pedaletti, G.; Peresano, M.; Perri, L.; Persic, M.; Prada Moroni, P. G.; Prandini, E.; Puljak, I.; Garcia, J. R.; Reichardt, I.; Rhode, W.; Ribó, M.; Rico, J.; Righi, C.; Saito, T.; Satalecka, K.; Schroeder, S.; Schweizer, T.; Shore, S. N.; Sitarek, J.; Šnidarić, I.; Sobczynska, D.; Stamerra, A.; Strzys, M.; Surić, T.; Takalo, L.; Tavecchio, F.; Temnikov, P.; Terzić, T.; Tescaro, D.; Teshima, M.; Torres-Albà, N.; Treves, A.; Vanzo, G.; Vazquez Acosta, M.; Vovk, I.; Ward, J. E.; Will, M.; Zarić, D.

    2017-12-01

    It is widely believed that the bulk of the Galactic cosmic rays is accelerated in supernova remnants (SNRs). However, no observational evidence of the presence of particles of PeV energies in SNRs has yet been found. The young historical SNR Cassiopeia A (Cas A) appears as one of the best candidates to study acceleration processes. Between 2014 December and 2016 October, we observed Cas A with the MAGIC telescopes, accumulating 158 h of good quality data. We derived the spectrum of the source from 100 GeV to 10 TeV. We also analysed ∼8 yr of Fermi-LAT to obtain the spectral shape between 60 MeV and 500 GeV. The spectra measured by the LAT and MAGIC telescopes are compatible within the errors and show a clear turn-off (4.6σ) at the highest energies, which can be described with an exponential cut-off at E_c = 3.5(^{+1.6}_{-1.0})_{stat} (^{+0.8}_{-0.9})_{sys} TeV. The gamma-ray emission from 60 MeV to 10 TeV can be attributed to a population of high-energy protons with a spectral index of ∼2.2 and an energy cut-off at ∼10 TeV. This result indicates that Cas A is not contributing to the high energy (∼PeV) cosmic ray sea in a significant manner at the present moment. A one-zone leptonic model fails to reproduce by itself the multiwavelength spectral energy distribution. Besides, if a non-negligible fraction of the flux seen by MAGIC is produced by leptons, the radiation should be emitted in a region with a low magnetic field (B⪅180 μG) like in the reverse shock.

  18. Power function of the reference change value in relation to cut-off points, reference intervals and index of individuality.

    Science.gov (United States)

    Iglesias, Natàlia; Petersen, Per Hyltoft; Ricós, Carmen

    2005-01-01

    The reference change value, defined as RCV = 1.96 x 2(1/2) x(s(I)(2) +s A(2))(1/2), where s(I) is within-subject biological variation and s A is analytical variation, has been used for many years to take clinical decisions in patient monitoring. Furthermore, the index of individuality was defined as II = (s(I)(2) +s(A)(2))(1/2)/s(G) , where s(G) is the between-subject biological variation. This index has been simplified by later authors to s(I)/s(G) and has been used in monitoring situations to determine the utility of population-based reference intervals. Harris stated that when the index of individuality is lower than 0.6, the specific reference interval of the individual - when available - is better than the population-based reference interval. However, if a change within a patient is equivalent to the RCV applied for the significant difference between two measurements, the probability of detecting this change is only 50% (the same probability of missing it). Therefore, to obtain a higher probability of detecting a change by the RCV (e.g., 90%) the interpretation of the index of individuality has to be reconsidered. This contribution compares the power of the RCV to the use of cut-off points and population-based reference intervals. The benefits of the RCV compared to the distance to cut-off point or reference limit are also described in relation to the index of individuality.

  19. The Development of Appropriate Waist-to-Hip Ratio Cut- off Points: Survey in Large Iranian Adult Population

    Directory of Open Access Journals (Sweden)

    A.S. Jahanlou

    2015-07-01

    Full Text Available Introduction & Objective: Proportion of Waist-to-Hip Ratio (WHR is an indicator of abdominal obesity, which is supported by some studies but rejected by others. The aim of this study was to examine the accuracy of the WHR and obtain suitable cut- off points for detecting obesity among adult Iranians. Materials & Methods: In this cross-sectional-descriptive study the sample consisted of 19366 adults. The data collection took place from 2009 to 2014, using Bioelectrical Impedance Analysis (BIA. The following data were obtained: WHR, Percentile of Body Fat (PBF, To-tal Fat (TF, and Soft Lean Mass (SLM. Sensitivity and specificity, based on World Health Organization’s Gold Standards were calculated for both sexes at three age groups. The data analysis included t-test, chi-square, ROC curve, and linear regression. Results: All study variables were correlated with each other. Age was only correlated with the WHR. Percentages of sensitivity and Negative Predictive Value (NPV were 84.2% and 85.6% in women; 21% and 50.7% in men. Increase in age was associated with increase in sensitivity in men and women, and NPV in men. The suitable cut-off points for men and women were found to be 87.5% and 83.5%, respectively. Conclusion: Waist-to-Hip ration is a suitable indictor of obesity for Iranian women but not men, especially among those who are under 59 years old. (Sci J Hamadan Univ Med Sci 2015; 22 (2: 144-151

  20. Therapeutic Efficacy and Cost Effectiveness of High Cut-Off Dialyzers Compared to Conventional Dialysis in Patients with Cast Nephropathy.

    Directory of Open Access Journals (Sweden)

    Adriano Curti

    Full Text Available High Cut-Off (HCO dialysis membranes efficiently reduce serum free light chain (FLC concentrations and may improve renal recovery and survival from multiple myeloma (MM associated renal failure with cast nephropathy. However, clinical trials comparing dialysis with HCO versus conventional filters are lacking. The aim of this study was to assess clinical outcomes and economic impact of HCO dialyzers compared to conventional hemodialysis membranes in cast nephropathy.Multicenter retrospective analysis of 19 patients treated for renal failure from FLC associated cast nephropathy with standard induction chemotherapy (bortezomib/dexamethasone. We compared hemodialysis treatment with High Cut-Off (n = 12 versus conventional dialyzers (n = 7. Primary endpoint was survival; secondary endpoints were renal recovery, renal function and treatment costs.At 12 months, patient survival was 25% in the HCO group versus 0% in controls (p = NS. A tendency towards faster renal recovery (p = 0.066 and better renal function at 3, 6 and 12 months (p = 0.109 after diagnosis of MM was noted in the HCO group. Complete renal response rate was achieved in 10.5 and 0% of HCO and control patients, respectively, partial renal response in 15.8 and 5.3%, and minor renal response in 26.3 and 15.8%, respectively. Both patient survival and renal recovery were significantly correlated with the extent of free light chain (FLC reduction in serum. Median treatment costs were CHF 230'000 and 223'000 (p = NS in the HCO and control group, respectively.Hemodialysis treatment with HCO membranes for cast nephropathy tended towards better survival as well as faster and better recovery of renal function versus conventional dialyzers. Moreover, total medical costs were comparable between groups. In the absence of results from randomized prospective trials on this topic, the use of HCO dialyzers in patients with renal failure from cast nephropathy may be recommended. Prospective randomized

  1. Appropriate neck circumference cut-off points for metabolic syndrome in Turkish patients with type 2 diabetes.

    Science.gov (United States)

    Ozkaya, Ismail; Yardimci, Bulent; Tunckale, Aydin

    2017-12-01

    To investigate the association between neck circumference (NC), overweight, and metabolic syndrome (MS) in Turkish patients with type 2 diabetes. A total of 264 diabetic patients (mean age: 52.9±8.1 years) were recruited from two centers in Istanbul to perform anthropometric measurements, including waist and hip circumference, NC, and body mass index. Blood pressure, fasting glucose, and lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride levels) were determined. NC correlated with waist circumference, systolic blood pressure, and triglycerides in men, whereas NC only correlated with waist circumference in women. Additionally, NC was shown to negatively correlate with high-density lipoprotein cholesterol in both men and women. Receiver operating characteristic analysis showed that the area under the curve for NC and overweight was 0.95 for both men and women (P<0.001). Moreover, a NC of 38cm for men and 37cm for women was the best cut-off point for determining overweight. The area under the curve for NC and MS was 0.87 for men and 0.83 for women (P<0.001). A NC of 39cm for men and 37cm for women was the best cut-off point to determine participants with MS. Our findings suggest a positive correlation of NC with MetS in Turkish patients with type 2 diabetes, and could be a useful and accurate tool to identify MS. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Prospective Study of Optimal Obesity Index Cut-Off Values for Predicting Incidence of Hypertension in 18-65-Year-Old Chinese Adults.

    Science.gov (United States)

    Ren, Qian; Su, Chang; Wang, Huijun; Wang, Zhihong; Du, Wenwen; Zhang, Bing

    2016-01-01

    Overweight and obesity increase the risk of elevated blood pressure; most of the studies that serve as a background for the debates on the optimal obesity index cut-off values used cross-sectional samples. The aim of this study was to determine the cut-off values of anthropometric markers for detecting hypertension in Chinese adults with data from prospective cohort. This study determines the best cut-off values for the obesity indices that represent elevated incidence of hypertension in 18-65-year-old Chinese adults using data from the China Health and Nutrition Survey (CHNS) 2006-2011 prospective cohort. Individual body mass index (BMI), waist circumference (WC), waist:hip ratio (WHR) and waist:stature ratio (WSR) were assessed. ROC curves for these obesity indices were plotted to estimate and compare the usefulness of these obesity indices and the corresponding values for the maximum of the Youden indices were considered the optimal cut-off values. Five-year cumulative incidences of hypertension were 21.5% (95% CI: 19.4-23.6) in men and 16.5% (95% CI: 14.7-18.2) in women, and there was a significant trend of increased incidence of hypertension with an increase in BMI, WC, WHR or WSR (P for trend Obesity in China (WGOC), the cut-off values for WHR that were developed by the World Health Organization (WHO), and a global WSR cut-off value of 0.50 may be the appropriate upper limits for Chinese adults.

  3. Exploring optimum cut-off scores to screen for probable posttraumatic stress disorder within a sample of UK treatment-seeking veterans

    Science.gov (United States)

    Murphy, Dominic; Ross, Jana; Ashwick, Rachel; Armour, Cherie; Busuttil, Walter

    2017-01-01

    ABSTRACT Background: Previous research exploring the psychometric properties of the scores of measures of posttraumatic stress disorder (PTSD) suggests there is variation in their functioning depending on the target population. To date, there has been little study of these properties within UK veteran populations. Objective: This study aimed to determine optimally efficient cut-off values for the Impact of Event Scale-Revised (IES-R) and the PTSD Checklist for DSM-5 (PCL-5) that can be used to assess for differential diagnosis of presumptive PTSD. Methods: Data from a sample of 242 UK veterans assessed for mental health difficulties were analysed. The criterion-related validity of the PCL-5 and IES-R were evaluated against the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Kappa statistics were used to assess the level of agreement between the DSM-IV and DSM-5 classification systems. Results: The optimal cut-off scores observed within this sample were 34 or above on the PCL-5 and 46 or above on the IES-R. The PCL-5 cut-off is similar to the previously reported values, but the IES-R cut-off identified in this study is higher than has previously been recommended. Overall, a moderate level of agreement was found between participants screened positive using the DSM-IV and DSM-5 classification systems of PTSD. Conclusions: Our findings suggest that the PCL-5 and IES-R can be used as brief measures within veteran populations presenting at secondary care to assess for PTSD. The use of a higher cut-off for the IES-R may be helpful for differentiating between veterans who present with PTSD and those who may have some sy`mptoms of PTSD but are sub-threshold for meeting a diagnosis. Further, the use of more accurate optimal cut-offs may aid clinicians to better monitor changes in PTSD symptoms during and after treatment. PMID:29435200

  4. The assessment of anorexia in patients with cancer: cut-off values for the FAACT-A/CS and the VAS for appetite.

    Science.gov (United States)

    Blauwhoff-Buskermolen, S; Ruijgrok, C; Ostelo, R W; de Vet, H C W; Verheul, H M W; de van der Schueren, M A E; Langius, J A E

    2016-02-01

    Anorexia is a frequently observed symptom in patients with cancer and is associated with limited food intake and decreased quality of life. Diagnostic instruments such as the Anorexia/Cachexia Subscale (A/CS) of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) questionnaire and the visual analog scale (VAS) for appetite have been recommended in the assessment of anorexia, but validated cut-off values are lacking. This study aimed to obtain cut-off values of these instruments for the assessment of anorexia in patients with cancer. The FAACT-A/CS and the VAS for appetite were administered to patients with cancer before start of chemotherapy. As reference standard for anorexia, two external criteria were used: (1) a cut-off value of ≥2 on the anorexia symptom scale of the EORTC QLQ C-30 and (2) the question "Do you experience a decreased appetite?" (yes/no). ROC curves were used to examine the optimal cut-off values for the FAACT-A/CS and VAS. A total of 273 patients (58 % male; 64.0 ± 10.6 years) were included. The median score on the FAACT-A/CS was 38 (IQR 32-42) points and 77 (IQR 47-93) points on the VAS. Considering both external criteria, the optimal cut-off value for the FAACT-A/CS was ≤37 (sensitivity (se) 80 %, specificity (sp) 81 %, positive predictive value (PV(+)) 79 %, negative predictive value (PV(-)) 82 %) and for the VAS was ≤70 (se 76 %, sp 83 %, PV(+) 80 %, PV(-) 79 %). For the assessment of anorexia in patients with cancer, our study suggests cut-off values of ≤37 for the FAACT-A/CS and ≤70 for the VAS. Future studies should confirm our findings in other patient samples.

  5. Amputee locomotion: Frequency content of prosthetic vs. intact limb vertical ground reaction forces during running and the effects of filter cut-off frequency.

    Science.gov (United States)

    Kiernan, Dovin; Miller, Ross H; Baum, Brian S; Kwon, Hyun Joon; Shim, Jae Kun

    2017-07-26

    Compared to intact limbs, running-specific prostheses have high resonance non-biologic materials and lack active tissues to damp high frequencies. These differences may lead to ground reaction forces (GRFs) with high frequency content. If so, ubiquitously applying low-pass filters to prosthetic and intact limb GRFs may attenuate veridical high frequency content and mask important and ecologically valid data from prostheses. To explore differences in frequency content between prosthetic and intact limbs we divided signal power from transtibial unilateral amputees and controls running at 2.5, 3.0, and 3.5m/s into Low (25Hz) frequency bandwidths. Faster speeds tended to reduce the proportion of signal power in the Low bandwidth while increasing it in the High and Non-biologic bandwidths. Further, prostheses had lower proportions of signal power at the High frequency bandwidth but greater proportions at the Non-biologic bandwidth. To evaluate whether these differences in frequency content interact with filter cut-offs and alter results, we filtered GRFs with cut-offs from 1 to 100Hz and calculated vertical impact peak (VIP). Changing cut-off had inconsistent effects on VIP across speeds and limbs: Faster speeds had significantly larger changes in VIP per change in cut-off while, compared to controls, prosthetic limbs had significantly smaller changes in VIP per change in cut-off. These findings reveal differences in GRF frequency content between prosthetic and intact limbs and suggest that a cut-off frequency that is appropriate for one limb or speed may be inappropriate for another. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Isidoro González-Álvaro

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

  7. Exploring optimum cut-off scores to screen for probable posttraumatic stress disorder within a sample of UK treatment-seeking veterans.

    Science.gov (United States)

    Murphy, Dominic; Ross, Jana; Ashwick, Rachel; Armour, Cherie; Busuttil, Walter

    2017-01-01

    Background : Previous research exploring the psychometric properties of the scores of measures of posttraumatic stress disorder (PTSD) suggests there is variation in their functioning depending on the target population. To date, there has been little study of these properties within UK veteran populations. Objective : This study aimed to determine optimally efficient cut-off values for the Impact of Event Scale-Revised (IES-R) and the PTSD Checklist for DSM-5 (PCL-5) that can be used to assess for differential diagnosis of presumptive PTSD. Methods : Data from a sample of 242 UK veterans assessed for mental health difficulties were analysed. The criterion-related validity of the PCL-5 and IES-R were evaluated against the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Kappa statistics were used to assess the level of agreement between the DSM-IV and DSM-5 classification systems. Results : The optimal cut-off scores observed within this sample were 34 or above on the PCL-5 and 46 or above on the IES-R. The PCL-5 cut-off is similar to the previously reported values, but the IES-R cut-off identified in this study is higher than has previously been recommended. Overall, a moderate level of agreement was found between participants screened positive using the DSM-IV and DSM-5 classification systems of PTSD. Conclusions : Our findings suggest that the PCL-5 and IES-R can be used as brief measures within veteran populations presenting at secondary care to assess for PTSD. The use of a higher cut-off for the IES-R may be helpful for differentiating between veterans who present with PTSD and those who may have some sy`mptoms of PTSD but are sub-threshold for meeting a diagnosis. Further, the use of more accurate optimal cut-offs may aid clinicians to better monitor changes in PTSD symptoms during and after treatment.

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

    Science.gov (United States)

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

    2016-01-01

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

  9. Optimal cut-off value for homeostasis model assessment (HOMA) index of insulin-resistance in a population of patients admitted electively in a Portuguese cardiology ward.

    Science.gov (United States)

    Timóteo, Ana Teresa; Miranda, Fernando; Carmo, Miguel Mota; Ferreira, Rui Cruz

    2014-01-01

    Insulin resistance is the pathophysiological key to explain metabolic syndrome. Although clearly useful, the Homeostasis Model Assessment index (an insulin resistance measurement) has not been systematically applied in clinical practice. One of the main reasons is the discrepancy in cut-off values reported in different populations. We sought to evaluate in a Portuguese population the ideal cut-off for Homeostasis Model Assessment index and assess its relationship with metabolic syndrome. We selected a cohort of individuals admitted electively in a Cardiology ward with a BMI validation cohort of 300 individuals (no exclusion criteria applied). From 7 000 individuals, and after the exclusion criteria, there were left 1 784 individuals. The 90th percentile for Homeostasis Model Assessment index was 2.33. In the validation cohort, applying that cut-off, we have 49.3% of individuals with insulin resistance. However, only 69.9% of the metabolic syndrome patients had insulin resistance according to that cut-off. By ROC curve analysis, the ideal cut-off for metabolic syndrome is 2.41. Homeostasis Model Assessment index correlated with BMI (r = 0.371, p < 0.001) and is an independent predictor of the presence of metabolic syndrome (OR 19.4, 95% CI 6.6 - 57.2, p < 0.001). Our study showed that in a Portuguese population of patients admitted electively in a Cardiology ward, 2.33 is the Homeostasis Model Assessment index cut-off for insulin resistance and 2.41 for metabolic syndrome. Homeostasis Model Assessment index is directly correlated with BMI and is an independent predictor of metabolic syndrome.

  10. Interleukin-6, fibrin D-dimer, and coagulation factors VII and XIIa in prediction of coronary heart disease.

    Science.gov (United States)

    Lowe, Gordon D O; Rumley, Ann; McMahon, Alex D; Ford, Ian; O'Reilly, Denis St J; Packard, Christopher J

    2004-08-01

    Activated inflammation and activated blood coagulation are believed to increase the risk of coronary thrombosis and are related. We therefore compared plasma IL-6 (a key cytokine in the inflammatory process), fibrin D-dimer (a marker of fibrin turnover), and coagulation factors VII and XIIa (initiators of extrinsic and intrinsic blood coagulation, respectively) as predictors of coronary risk in the West of Scotland Coronary Prevention Study of pravastatin in men with hypercholesterolemia. 485 men who had had a coronary event (nonfatal myocardial infarction, death from coronary heart disease, or revascularization) were matched for age and smoking status with 934 controls. Baseline IL-6 and D-dimer were strong univariate predictors of coronary risk (relative risk in the highest quintile approximately twice that in the lowest quintile) and were associated with each other and with C-reactive protein. On multivariate analyses, D-dimer retained a significant association with coronary risk (relative risk, 1.86; 95% CI, 1.24 to 2.80), whereas IL-6 (1.47; 0.95 to 2.28) and C-reactive protein (1.33; 0.85 to 2.08) did not. Neither factor VII nor factor XIIa antigens were predictors of coronary events. Fibrin D-dimer may be a stronger predictor of coronary risk than inflammatory markers, perhaps through its ability to stimulate monocyte release of IL-6.

  11. Raised D-dimer levels in acute sickle cell crisis and their correlation with chest X-ray abnormalities.

    Science.gov (United States)

    Dar, Javeed; Mughal, Inam; Hassan, Hilali; Al Mekki, Taj E; Chapunduka, Zivani; Hassan, Imad S A

    2010-10-08

    Quantitation of D-dimer level during a sickling crisis and its correlation with other clinical abnormalities. Prospective longitudinal study. Armed Forces Hospital, Southern Region, Kingdom of Saudi Arabia. Adult patients (12 years and older) admitted acutely with a sickle cell crisis who consent to taking part in the study. Candidates may re-participate if they are readmitted with a further acute painful crisis. 36 patients with homozygous sickle cell disease consented to take part in the study. D-dimer levels were raised in 31 (68.9%) of 45 episodes of painful crisis of whom 13 had an abnormal chest X-ray. Of those with a normal chest X-ray only one patient had a raised D-dimer level: sensitivity of 92.3%, specificity 40.6%, positive predictive value 38.7% and negative predictive value of 92.9% for an abnormal chest X-ray. D-dimer levels are frequently raised during an acute painful crisis. A normal level has a high negative predictive value for an abnormal chest X-ray.

  12. Sleep disturbance, norepinephrine, and D-dimer are all related in elderly caregivers of people with Alzheimer disease.

    Science.gov (United States)

    Mausbach, Brent T; Ancoli-Israel, Sonia; von Känel, Roland; Patterson, Thomas L; Aschbacher, Kirstin; Mills, Paul J; Ziegler, Michael G; Dimsdale, Joel E; Calleran, Susan; Grant, Igor

    2006-10-01

    Caregiving for a relative with Alzheimer disease has been associated with sympathoadrenal medullary arousal and morbidity and mortality. In this study, we examined if sleep disturbance of elderly caregivers was associated with physiologic markers of cardiovascular risk, including plasma norepinephrine, epinephrine, and the hemostasis marker D-dimer. Cross-sectional. Community-based sample of elderly caregivers of spouses with Alzheimer disease assessed within their homes. A sample of 40 elderly spousal caregivers of patients with Alzheimer disease. Participants underwent in-home full-night polysomnography and had plasma assayed for norepinephrine and epinephrine. Using multiple regression analyses and controlling for a number of cardiovascular risk factors (e.g., age, sex, blood pressure, body mass index), increased wake after sleep onset was positively associated with norepinephrine levels (beta = .35; t = 2.45, df = 32, p = .020) and plasma D-dimer (beta = .31; t = 2.18, df = 29, p = .038). Further, plasma norepinephrine was significantly associated with D-dimer (beta = .34; t = 2.11, df = 29, p = .044). Additional analyses indicated that norepinephrine accounted for 28% of the relationship between wake after sleep onset and D-dimer. No association was observed between sleep variables and epinephrine. These findings provide preliminary evidence that sleep disturbance may contribute to morbidity in caregivers through sympathoadrenal medullary arousal and downstream physiologic effects such as altering the hemostasis environment.

  13. Validity of colour doppler ultrasonography with d-dimers in clinically suspected deep venous thrombosis of the lower limb

    International Nuclear Information System (INIS)

    Babar, T.H.; Nafees, M.N.; Sarwar, S.; Ashraf, N.

    2010-01-01

    Objective: This study was designed to evaluate the validity of colour Doppler ultrasonography with D-dimers in clinically suspected deep venous thrombosis of the lower limb. Study Design: Validation study Place and Duration of study: Radiology Department CMH/MH Rawalpindi Six months from 15 June 2006 to 31 December 2006. Subjects and Methods: Thirty cases of clinically suspected deep venous thrombosis of the lower limb were included in the study selected on non probability convenience sampling technique. Colour Doppler ultrasonography examination of the affected lower limb was carried out and results compared with D-dimers assays results. Results: Among 30 patients who underwent colour Doppler ultrasonography examination of the affected limb for diagnosis of deep venous thrombosis, 27 (90%) were diagnosed to have deep venous thrombosis, 3 (10%) were diagnosed not to have deep venous thrombosis. Amongst them 2 patients had raised D-dimers levels and repeat Doppler ultrasound advised. On revised ultrasound deep venous thrombosis in these patients was confirmed. This showed that colour Doppler ultrasonography examination has sensitivity of 93.1%, specificity 100%, positive predictive value 100%, negative predictive value 33.33% and overall accuracy of 93.33 %. Conclusion: Colour Doppler ultrasonography has a high diagnostic yield in cases of deep venous thrombosis of lower limb when used in conjunction with D-dimers assays. (author)

  14. Normal D-dimer ved dyb venøs trombose i en overekstremitet hos to patienter med pacemaker

    DEFF Research Database (Denmark)

    Byrne, Christina; Abdulla, Jawdat; Christensen, Jan Kim

    2015-01-01

    Danish guidelines recommend the use of D-dimer to exclude deep venous thrombosis (DVT) in the lower extremities. However, guidelines are lacking for DVT in the upper extremities. We describe two young women with transvenous pacemaker electrodes and symptomatic DVT in related veins. Despite a normal...

  15. Diagnostic Value of Blood D-dimer Level in Acute Mesenteric Ischaemia in the Rat: An Experimental Study

    Directory of Open Access Journals (Sweden)

    Hakan Kulacoglu

    2005-04-01

    Conclusion: These results do not adequately support the use of blood D-dimer level as an independent parameter in the diagnosis of mesenteric ischaemia due to arterial thrombosis. However, this parameter can be used together with other tests in eliminating the possibility of a thromboembolic event.

  16. Determinants of self-reported smoking and misclassification during pregnancy, and analysis of optimal cut-off points for urinary cotinine: a cross-sectional study.

    Science.gov (United States)

    Aurrekoetxea, Juan J; Murcia, Mario; Rebagliato, Marisa; López, María José; Castilla, Ane Miren; Santa-Marina, Loreto; Guxens, Mónica; Fernández-Somoano, Ana; Espada, Mercedes; Lertxundi, Aitana; Tardón, Adonina; Ballester, Ferran

    2013-01-24

    To estimate the prevalence and factors associated with smoking and misclassification in pregnant women from INMA (INfancia y Medio Ambiente, Environment and Childhood) project, Spain, and to assess the optimal cut-offs for urinary cotinine (UC) that best distinguish daily and occasional smokers with varying levels of second-hand smoke (SHS) exposure. We used logistic regression models to study the relationship between sociodemographic variables and self-reported smoking and misclassification (self-reported non-smokers with UC >50 ng/ml). Receiver operating characteristic (ROC) curves were used to calculate the optimal cut-off point for discriminating smokers. The cut-offs were also calculated after stratification among non-smokers by the number of sources of SHS exposure. The cut-off points used to discriminate smoking status were the level of UC given by Youden's index and for 50 and 100 ng/ml for daily smokers, or 25 and 50 ng/ml for occasional smokers. At the third trimester of pregnancy, 2263 pregnant women of the INMA Project were interviewed between 2004 and 2008 and a urine sample was collected. Prevalence of self-reported smokers at the third trimester of pregnancy was 18.5%, and another 3.9% misreported their smoking status. Variables associated with self-reported smoking and misreporting were similar, including born in Europe, educational level and exposure to SHS. The optimal cut-off was 82 ng/ml (95% CI 42 to 133), sensitivity 95.2% and specificity 96.6%. The area under the ROC curve was 0.986 (95% CI 0.982 to 0.990). The cut-offs varied according to the SHS exposure level being 42 (95% CI 27 to 57), 82 (95% CI 46 to 136) and 106 ng/ml (95% CI 58 to 227) for not being SHS exposed, exposed to one, and to two or more sources of SHS, respectively. The optimal cut-off for discriminating occasional smokers from non-smokers was 27 ng/ml (95% CI 11 to 43). Prevalence of smoking during pregnancy in Spain remains high. UC is a reliable biomarker for classifying

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

    Directory of Open Access Journals (Sweden)

    Fernanda Mattos de Souza

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

  18. Selecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approach.

    Science.gov (United States)

    Ni, Melody Zhifang; Huddy, Jeremy R; Priest, Oliver H; Olsen, Sisse; Phillips, Lawrence D; Bossuyt, Patrick M M; Hanna, George B

    2017-11-04

    The existing British National Patient Safety Agency (NPSA) safety guideline recommends testing the pH of nasogastric (NG) tube aspirates. Feeding is considered safe if a pH of 5.5 or lower has been observed; otherwise chest X-rays are recommended. Our previous research found that at 5.5, the pH test lacks sensitivity towards oesophageal placements, a major risk identified by feeding experts. The aim of this research is to use a decision analytic modelling approach to systematically assess the safety of the pH test under cut-offs 1-9. We mapped out the care pathway according to the existing safety guideline where the pH test is used as a first-line test, followed by chest x-rays. Decision outcomes were scored on a 0-100 scale in terms of safety. Sensitivities and specificities of the pH test at each cut-off were extracted from our previous research. Aggregating outcome scores and probabilities resulted in weighted scores which enabled an analysis of the relative safety of the checking procedure under various pH cut-offs. The pH test was the safest under cut-off 5 when there was ≥30% of NG tube misplacements. Under cut-off 5, respiratory feeding was excluded; oesophageal feeding was kept to a minimum to balance the need of chest X-rays for patients with a pH higher than 5. Routine chest X-rays were less safe than the pH test while to feed all without safety checks was the most risky. The safety of the current checking procedure is sensitive to the choice of pH cut-offs, the impact of feeding delays, the accuracy of the pH in the oesophagus, as well as the extent of tube misplacements. The pH test with 5 as the cut-off was the safest overall. It is important to understand the local clinical environment so that appropriate choice of pH cut-offs can be made to maximise safety and to minimise the use of chest X-rays. ISRCTN11170249; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No

  19. The cut-off values of anthropometric variables for predicting mild cognitive impairment in Malaysian older adults: a large population based cross-sectional study

    Directory of Open Access Journals (Sweden)

    Won H

    2017-02-01

    Full Text Available Huiloo Won,1 Zahara Abdul Manaf,2 Arimi Fitri Mat Ludin,3 Mohd Azahadi Omar,4 Rosdinom Razali,5 Suzana Shahar2 1Nutrition Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 2Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 3Biomedical Science Program, School of Diagnostic and Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 4Centre for Burden of Disease Research, Institute for Public Health, Ministry of Health Malaysia, 5Department of Psychiatry, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia Purpose: Older adults are at risk of mild cognitive impairment (MCI, and simple anthropometric measurements can be used to screen for this condition. Thus, the aim of this study was to explore the cut-off values of body mass index (BMI and waist circumference (WC for predicting the risk of MCI in older Malaysian adults.Methods: A total of 2,240 Malaysian older adults aged ≥60 years were recruited using multistage random sampling in a population based cross-sectional study. Receiver operating characteristic (ROC curve was used to determine the cut-off values of BMI and WC with optimum sensitivity and specificity for the detection of MCI. Age, gender, years of education, smoking habit, alcohol consumption, depression, and medical conditions were used as confounding factors in this analysis.Results: A BMI cut-off value of 26 kg/m2 (area under the receiver operating characteristic curve [AUC] 0.725; sensitivity 90.5%; specificity 38.8% was appropriate in identifying the risk of getting MCI in both men and women. The optimum WC cut-offs for likelihood of MCI were 90 cm (AUC 0.745; sensitivity 78.0%; specificity 59.8% for men and 82 cm (AUC 0.714; sensitivity 84.3%; specificity 49.7% for women. The optimum calf circumference (CC cut-off values for identifying MCI were 29 cm (AUC 0.731; sensitivity 72.6%; specificity

  20. [Analysis of Cut-off Value in Screening of Thalassemia by Capillary Hemoglobin Electrophoresis for Pregnant Women from Shenzhen Region of China].

    Science.gov (United States)

    Huo, Mei; Wu, Wen-Yuan; Liu, Mei; Gan, Zhi-Biao; Mao, Wei-Yu; Lin, Rong-Yao; Liu, Ai-Qin; He, Gui-Rong

    2016-04-01

    To investigate the cut-off value in screening of thalassemia in pregnant women from Shenzhen region by capillary hemoglobin electrophoresis. The data of capillary hemoglobin electrophoresis and genetic diagnosis of thalassemia from 2122 examined prenatal women were retrospectively analyzed. Capillary hemoglobin electrophoresis and α-, β- genetic diagnosis of thalassemia were carried out for every woman. Hemoglobin electrophoresis was performed using Capillarys 2 full-automated electrophoresis instrument. Gap polymerase chain reaction and reverse dot blot were used for genetic diagnosis of thalassemia genotyping test. The cut-off value in screening of thalassemia was determined by receiver operating characteristic curve and next to analyze the value of HbA2 and HbF in screening of thalassemia using the decided cut-off value. The areas under the curve (AUC(Roc)) of HbA2 for diagnosis of α-, β- thalassemia were 0.75 and 0.981 respectively, and the AUC(Roc) of HbF for diagnosis of β-thalassemia was 0.787. When HbA2 ≤ 2.55 was taken as the cut-off value of HbA2 for diagnosis of α-thalassemia, the sensitivity, specificity, positive likelihood ratio (LR(+)) and negative likelihood ratio (LR(-)) were 89.5%, 54.8%, 1.98, 0.19 respectively. When HbA2 ≥3.9 was taken as the cut off value of HbA2 for diagnosis of β-thalassemia, the sensitivity, specificity, LR(+) and LR(-) were 96.1%, 99.8% 480.5, 0.04 respectively. When HbF ≥0.75 was taken as the cut off value of HbF for diagnosis of β-thalassemia, the sensitivity, specificity, LR(+) and LR(-) were 83.6%, 61.8% respectively. The cut-off value in screening of thalassemia by capillarys 2 full automated electrophoresis instrument is different from that of the traditional method of hemoglobin electrophoresis, such as cellulose acetate membrane electrophoresis and agarose gel electrophoresis. Each laboratory should establish their own respective cut off value.

  1. Can a glucagon stimulation test characterized by lower GH cut-off value be used for the diagnosis of growth hormone deficiency in adults?

    Science.gov (United States)

    Diri, Halit; Karaca, Zuleyha; Simsek, Yasin; Tanriverdi, Fatih; Unluhizarci, Kursad; Selcuklu, Ahmet; Kelestimur, Fahrettin

    2015-12-01

    The aim of this study was to assess diagnostic values of insulin tolerance test (ITT), glucagon stimulation test (GST), and insulin like growth factor-I (IGF-I) level, to find optimal GH cut-off values for GST, and to evaluate efficiencies of patient age, gender, body-mass index (BMI), and additional pituitary hormone deficiencies (PHDs) in the diagnosis of growth hormone deficiency (GHD). This retrospective study involved 216 patients with a pituitary disease and 26 healthy controls. Age, gender, BMI, medical histories, and hormonal data including baseline and stimulated hormone values were evaluated. Three cut-off values for peak GH responses to stimulation tests were evaluated: (a) 3.00 µg/L on ITT, (b) 3.00 µg/L on GST, and (c) 1.07 µg/L on GST. According to the ITT, GST with 3.00 µg/L cut-off, and GST with 1.07 µg/L cut-off, GHD was present in 86.1, 74.5, and 54.2 % patients, respectively. Patient age, BMI, and number of PHDs, but not gender, were found to be correlated with IGF-I and peak GH concentrations. All patients with an IGF-I concentration ≤95 ng/ml or ≥3 PHD had GHD. None of the patients with adequate GH response to the GST with 1.07 µg/L cut-off, but blunted responses to ITT and GST with 3.00 µg/L cut-off, had ≥3 PHDs. 12 out of 26 (46.2 %) healthy subjects failed the GST with 3.00 µg/L cut-off, but not with 1.07 µg/L cut-off. Patient age, IGF-I, BMI, and number of PHDs are efficient factors associated with the diagnosis of GHD. A 4 h GST with a diagnostic GH threshold of 1.07 µg/L seems to be a good diagnostic method for GHD.

  2. Definition of new cut-offs of BMI and waist circumference based on body composition and insulin resistance: differences between children, adolescents and adults.

    Science.gov (United States)

    Hübers, M; Pourhassan, M; Braun, W; Geisler, C; Müller, M J

    2017-09-01

    This study aims to determine associations between anthropometric traits, regional fat depots and insulin resistance in children, adolescents and adults to define new cut-offs of body mass index (BMI) or waist circumference (WC). Cross-sectional data were assessed in 433 children, adolescents and adults (aged: 6-60 years, BMI: 23.6 [21.0-27.7] kg m -2 ). Total adipose tissue (TAT), regional subcutaneous adipose tissue (SAT total , SAT trunk ) and visceral adipose tissue (VAT) were determined by whole-body magnetic resonance imaging, fat mass by air-displacement plethysmography. Insulin resistance was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR). Bivariate as well as partial correlations and regression analyses were used. Cut-off values of BMI and WC related to regional fat depots and HOMA-IR were analysed by receiver operating characteristics curve. In adults, TAT, SAT total and SAT trunk increased linearly with increasing BMI and WC, whereas they followed a cubic function in children and adolescents with a steep increase at BMI and WC ≥1 standard deviation score and VAT at WC ≥2 standard deviation score. Sex differences were apparent in adults with women having higher masses of TAT and SAT and men having higher VAT. Using established BMI or WC cut-offs, correspondent masses of TAT, SAT total , SAT trunk and VAT increased from childhood to adulthood. In all age groups, there were positive associations between BMI, WC, SAT trunk , VAT and HOMA-IR. When compared with normative cut-offs of BMI or WC, HOMA-IR-derived cut-offs of regional fat depots were lower in all age groups. Associations between BMI, WC and regional fat depots varied between children, adolescents, young and older adults. When compared with BMI-derived and WC-derived values, an insulin resistance-derived cut-off corresponded to lower masses of regional fat depots. Thus, established BMI and WC cut-offs are not appropriate to assess metabolic disturbances associated

  3. Discrepant coagulation profile in HIV infection: elevated D-dimer but impaired platelet aggregation and clot initiation.

    Science.gov (United States)

    Haugaard, Anna K; Lund, Tamara T; Birch, Carsten; Rönsholt, Frederikke; Trøseid, Marius; Ullum, Henrik; Gerstoft, Jan; Johansson, Per I; Nielsen, Susanne D; Ostrowski, Sisse R

    2013-11-13

    In HIV infection, cardiovascular disease (CVD) has emerged as a clinical problem, and elevated D-dimer has been reported. The pathophysiologic mechanisms underlying this remain unclear. We aimed to investigate whether untreated HIV-infected individuals display evidence of functional coagulopathy and whether this was associated with microbial translocation. The study population consisted of 50 HIV-infected untreated individuals and 50 HIV-infected individuals on combination antiretroviral therapy (cART). Groups were matched for age, sex and current CD4cell count. Coagulation analyses included D-dimer and the functional haemostatic whole blood tests, thromboelastography (TEG) and platelet aggregation (Multiplate, impedance aggregometry). Microbial translocation was assessed by plasma levels of lipopolysaccharide (LPS). A larger proportion of untreated individuals compared with treated individuals had D-dimer above normal reference range (27.7 vs. 2.2%, P = 0.001). In both treated and untreated individuals, delayed clot initiation with TEG R-time above upper reference range (18 and 28%, respectively, both P < 0.001) and TEG angle below lower reference range [14% (P = 0.004) and 24% (P < 0.001), respectively] was found. In untreated individuals, 64.6% had aggregation response below threshold in at least two of four tests compared with 36.7% in treated individuals (P = 0.010). Untreated individuals with increased D-dimer levels were relatively hypercoagulable by thromboelastography. Furthermore, in untreated patients, a negative association between microbial translocation and platelet aggregation was found. Elevated D-dimer in untreated HIV-infected individuals was confirmed. However, in both untreated and treated individuals, reduced platelet aggregation and clot initiation was found. The impact of reduced platelet function in HIV infection and a potential role of microbial translocation warrant further investigation.

  4. D-dimer for the exclusion of cerebral venous thrombosis : A meta-analysis of low risk patients with isolated headache

    NARCIS (Netherlands)

    Alons, Imanda M E; Jellema, Korné; Wermer, Marieke J H; Algra, Ale

    2015-01-01

    Background: Patients with isolated headache may have cerebral venous thrombosis (CVT). D-dimers are proven sensitive in excluding deep venous thrombosis (DVT) and pulmonary embolism (PE) in low risk patients. We aimed to determine whether D-dimer may play the same role in low risk CVT patients with

  5. The use of a rapid D-dimer blood test in the diagnostic work-up for pulmonary embolism: a management study

    NARCIS (Netherlands)

    de Groot, M. R.; van Marwijk Kooy, M.; Pouwels, J. G.; Engelage, A. H.; Kuipers, B. F.; Büller, H. R.

    1999-01-01

    D-dimer assays have a potential to rule out pulmonary embolism in case of a normal test result. We studied the clinical utility of incorporating the SimpliRED D-dimer test result and clinical probability in the routine diagnostic work-up of patients with suspected acute pulmonary embolism. In a

  6. Large D-Dimer Fluctuation in Normal Pregnancy: A Longitudinal Cohort Study of 4,117 Samples from 714 Healthy Danish Women

    Directory of Open Access Journals (Sweden)

    Katrine K. Hedengran

    2016-01-01

    Full Text Available Introduction. D-dimer levels increase throughout pregnancy, hampering the usefulness of the conventional threshold for dismissing thromboembolism. This study investigates the biological fluctuation of D-dimer in normal pregnancy. Methods. A total of 801 healthy women with expected normal pregnancies were recruited. D-dimer was repeatedly measured during pregnancy, at active labor, and on the first and second postpartum days. Percentiles for each gestational week were calculated. Each individual D-dimer was normalized by transformation into percentiles for the relevant gestational age or delivery group. The range in percentage points during the pregnancy and the delivery was calculated, and reference intervals were calculated for each pregnancy trimester, during vaginal delivery and scheduled and emergency cesarean section, and for the first and second day postpartum. Results. D-dimer increased during pregnancy; the maximal fluctuation was approximately 20 percentile points in approximately half of the women. In one out of ten women, the D-dimer values fluctuated by more than 50 percentile points. Conclusions. Due to the biological variation in D-dimer within each individual woman during normal pregnancy, repeated D-dimer measurements are of no clinical use in the evaluation of thromboembolic events during pregnancy.

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

    Science.gov (United States)

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

    2016-01-01

    To determine the cut-off points for FEV1, FEV0.75, FEV0.5, and FEF25-75% bronchodilator responses in healthy preschool children and to generate reference values for FEV0.75. This was a cross-sectional community-based study involving children 3-5 years of age. Healthy preschool children were selected by a standardized questionnaire. Spirometry was performed before and after bronchodilator use. The cut-off point of the response was defined as the 95th percentile of the change in each parameter. We recruited 266 children, 160 (60%) of whom were able to perform acceptable, reproducible expiratory maneuvers before and after bronchodilator use. The mean age and height were 57.78 ± 7.86 months and 106.56 ± 6.43 cm, respectively. The success rate for FEV0.5 was 35%, 68%, and 70% in the 3-, 4-, and 5-year-olds, respectively. The 95th percentile of the change in the percentage of the predicted value in response to bronchodilator use was 11.6%, 16.0%, 8.5%, and 35.5% for FEV1, FEV0.75, FEV0.5, and FEF25-75%, respectively. Our results provide cut-off points for bronchodilator responsiveness for FEV1, FEV0.75, FEV0.5, and FEF25-75% in healthy preschool children. In addition, we proposed gender-specific reference equations for FEV0.75. Our findings could improve the physiological assessment of respiratory function in preschool children. Determinar os pontos de corte de resposta ao broncodilatador do VEF1, VEF0,75, VEF0,5 e FEF25-75% em crianças pré-escolares saudáveis e gerar valores de referência para o VEF0,75. Foi realizado um estudo transversal de base comunitária em crianças de 3-5 anos de idade. Pré-escolares saudáveis foram selecionados por um questionário padronizado. Foi realizada espirometria antes e depois do uso de broncodilatador. Foram definidos os pontos de corte dessa resposta como o percentil 95 de variação em cada parâmetro. Foram recrutadas 266 crianças, e 160 (60,0%) foram capazes de gerar manobras expiratórias aceitáveis e reprodut

  8. D-Dimer in African Americans: Whole Genome Sequence Analysis and Relationship to Cardiovascular Disease Risk in the Jackson Heart Study.

    Science.gov (United States)

    Raffield, Laura M; Zakai, Neil A; Duan, Qing; Laurie, Cecelia; Smith, Joshua D; Irvin, Marguerite R; Doyle, Margaret F; Naik, Rakhi P; Song, Ci; Manichaikul, Ani W; Liu, Yongmei; Durda, Peter; Rotter, Jerome I; Jenny, Nancy S; Rich, Stephen S; Wilson, James G; Johnson, Andrew D; Correa, Adolfo; Li, Yun; Nickerson, Deborah A; Rice, Kenneth; Lange, Ethan M; Cushman, Mary; Lange, Leslie A; Reiner, Alex P

    2017-11-01

    Plasma levels of the fibrinogen degradation product D-dimer are higher among African Americans (AAs) compared with those of European ancestry and higher among women compared with men. Among AAs, little is known of the genetic architecture of D-dimer or the relationship of D-dimer to incident cardiovascular disease. We measured baseline D-dimer in 4163 AAs aged 21 to 93 years from the prospective JHS (Jackson Heart Study) cohort and assessed association with incident cardiovascular disease events. In participants with whole genome sequencing data (n=2980), we evaluated common and rare genetic variants for association with D-dimer. Each standard deviation higher baseline D-dimer was associated with a 20% to 30% increased hazard for incident coronary heart disease, stroke, and all-cause mortality. Genetic variation near F3 was associated with higher D-dimer (rs2022030, β=0.284, P =3.24×10 -11 ). The rs2022030 effect size was nearly 3× larger among women (β=0.373, P =9.06×10 -13 ) than among men (β=0.135, P =0.06; P interaction =0.009). The sex by rs2022030 interaction was replicated in an independent sample of 10 808 multiethnic men and women ( P interaction =0.001). Finally, the African ancestral sickle cell variant ( HBB rs334) was significantly associated with higher D-dimer in JHS (β=0.507, P =1.41×10 -14 ), and this association was successfully replicated in 1933 AAs ( P =2.3×10 -5 ). These results highlight D-dimer as an important predictor of cardiovascular disease risk in AAs and suggest that sex-specific and African ancestral genetic effects of the F3 and HBB loci contribute to the higher levels of D-dimer among women and AAs. © 2017 American Heart Association, Inc.

  9. Measurement uncertainty of 25-OH vitamin D determination with different commercially available kits: impact on the clinical cut offs.

    Science.gov (United States)

    Cavalier, E; Rozet, E; Gadisseur, R; Carlisi, A; Monge, M; Chapelle, J-P; Hubert, P; Souberbielle, J-C; Delanaye, P

    2010-06-01

    Due to "measurement uncertainty", the "true" 25-OH vitamin D (25(OH)D) of a patient (whatever the commercially available assay tested) will be >80 nmol/L if its measured concentration is >100 nmol/L. Thus, if a physician considers that a normal VTD status is a 25(OH)D level >or=80 nmol/L, he should ensure that the patient's results are >or=100 nmol/L. Many experts recommend that serum levels of 25(OH)D should be above a lower normal limit of 75-80 nmol/L. However, the value delivered by laboratories is only an estimation of the "true" value due to "measurement uncertainty." When using a cut off, measurement uncertainty around the cut off is important because therapeutic actions may differ if the measured value is below or above the limit. We aimed to establish the "measurement uncertainty" at different levels of concentration for several commercially available 25(OH)D analytical techniques. We constituted three pools of serum with different 25(OH)D concentrations. Each pool was assayed in triplicate during 5 days with the DiaSorin RIA, Liaison, Elecsys, and Chromsystems-HPLC assays. We report a relatively high "measurement uncertainty" for the measurement of 25(OH)D for the four different techniques: the mean relative uncertainties, all techniques confounded were 19.4%, 16.0%, and 11.3% for pool 1 (35.3 nmol/L), pool 2 (79.5 nmol/L), and pool 3 (126.1 nmol/L), respectively. Our results show that, whatever the assay, the "true" 25(OH)D of a patient will be >80 nmol/L if its measured concentration is >100 nmol/L. In other words, if a physician considers that a normal VTD status is defined by a 25(OH)D level >or=80 nmol/L, he should ensure that the patients present a 25(OH)D >or=100 nmol/L.

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

    Science.gov (United States)

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

    2017-07-19

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

  11. Afkapwaarden van de 'body-mass index' (BMI) voor ondergewicht van Nederlandse kinderen [Body-mass index cut-off values for underweight in Dutch children

    NARCIS (Netherlands)

    Buuren, S. van

    2004-01-01

    Objective. To determine the cut-off values for the body-mass index (BMI) for underweight and serious underweight in children up to 18 years of age based on the Dutch growth standards of 1980, and to determine the prevalence of underweight and serious underweight in the 1997 Dutch growth-study

  12. Using Logistic Regression for Validating or Invalidating Initial Statewide Cut-Off Scores on Basic Skills Placement Tests at the Community College Level

    Science.gov (United States)

    Secolsky, Charles; Krishnan, Sathasivam; Judd, Thomas P.

    2013-01-01

    The community colleges in the state of New Jersey went through a process of establishing statewide cut-off scores for English and mathematics placement tests. The colleges wanted to communicate to secondary schools a consistent preparation that would be necessary for enrolling in Freshman Composition and College Algebra at the community college…

  13. DMol3/COSMO-RS prediction of aqueous solubility and reactivity of selected Azo dyes: Effect of global orbital cut-off and COSMO segment variation

    CSIR Research Space (South Africa)

    Wahab, OO

    2018-01-01

    Full Text Available Aqueous solubility and reactivity of four azo dyes were investigated by DMol3/COSMO-RS calculation to examine the effects of global orbital cut-off and COSMO segment variation on the accuracies of theoretical solubility and reactivity. The studied...

  14. Increased tissue factor, MMP-8, and D-dimer expression in diabetic patients with unstable advanced carotid atherosclerosis

    Directory of Open Access Journals (Sweden)

    Jerzy Krupinski

    2007-09-01

    Full Text Available Jerzy Krupinski1,2, Marta M Turu1,2, M Angels Font1, Nesser Ahmed3, Matthew Sullivan3, Ana Luque1,2, Francisco Rubio1, Lina Badimon2, Mark Slevin31Department of Neurology, Stroke Unit, University Hospital of Bellvitge (HUB, Fundacio IDIBELL, Barcelona, Spain; 2Cardiovascular Research Centre, IIBB/CSIC-HSCSP-UAB, Barcelona, Spain; 3School of Biology, Chemistry and Health Science, Manchester Metropolitan University, Manchester, United KingdomAbstract: Advanced atherogenesis is characterized by the presence of markers of enhanced prothrombotic capacity, attenuated fibrinolysis, and by clinical conditions associated with defective coagulation. Diabetes may be associated with enhanced lesion instability and atherosclerotic plaque rupture. Plaques obtained from 206 patients undergoing carotid endarterectomy were divided into diabetic (type 2 and nondiabetic and analyzed by Western blotting and immunohistochemistry to detect tissue factor (TF, metalloproteinases (MMP-2, -8, -9, and fibrin/fibrinogen related antigens, and in situ zymography to detect MMP activity. Plasma samples were quantified for TF procoagulant activity, C-reactive protein, fibrinogen and D-dimer. Diabetic and symptomatic patients with hypoechogenic plaques had increased plasma TF activity and D-dimer, compared with those with hyperechogenic plaques (p = 0.03, p = 0.007, respectively. Diabetic, symptomatic patients had higher plasma D-dimer levels than asymptomatic patients (p = 0.03. There was a significant correlation between intramural TF levels and D-dimer in diabetic patients with symptomatic disease (p = 0.001, r2 = 0.4. In diabetic patients, plasma fibrinogen levels were higher in patients with hypoechogenic plaques (p = 0.007. Diabetic patients with ulcerated plaques had higher plasma D-dimer and MMP-8 levels than those with fibrous plaques (p = 0.02, p = 0.01, respectively. This data suggests that currently available circulating markers may be clinically useful to select

  15. Insulin Resistance Distribution and Cut-Off Value in Koreans from the 2008-2010 Korean National Health and Nutrition Examination Survey

    Science.gov (United States)

    Yun, Kyung-Jin; Han, Kyungdo; Kim, Mee Kyoung; Park, Yong-Moon; Baek, Ki-Hyun; Song, Ki-Ho; Kwon, Hyuk-Sang

    2016-01-01

    Background We sought to identify the distribution and cut-off value of the ‘homeostasis model assessment of insulin resistance’ (HOMA-IR) according to gender and menopausal status for metabolic syndrome in Koreans. Methods Data were from the Korean National Health and Nutrition Examination Survey in 2008–2010. The subjects included adults aged 20 years or older. We excluded participants who had diabetes or fasting serum glucose ≥ 7 mmol/L. Finally, 11,121 subjects (4,911 men, 3,597 premenopausal women, 2,613 postmenopausal women) were enrolled. The modified Adult Treatment Panel III criteria were used to define metabolic syndrome. Results The mean HOMA-IR was 2.11 (2.07–2.15) for men, 2.0 (1.97–2.04) for premenopausal women, and 2.14 (2.2–2.19) for postmenopausal women. The first cut-off values in men, premenopausal women, and postmenopausal women were 2.23 (sensitivity 70.6%, specificity 66.9%), 2.39 (sensitivity 72.3%, specificity 76.4%), and 2.48 (sensitivity 51.9%, specificity 80.2%), respectively. Based on the first HOMA-IR cut-off value, the prevalence of metabolic syndrome was 22.9% in men, 13.7% in premenopausal women, and 51.6% in postmenopausal women. The second cut-off value was around 3.2 in all three groups. Based on the second HOMA-IR cut-off value, the prevalence of metabolic syndrome was 50.8% in men, 42.5% in premenopausal women, and 71.6% in postmenopausal women. Conclusion In conclusion, the first cut-off values for HOMA-IR were 2.2–2.5 and the second cut-off value was 3.2 in Korea. The distribution of HOMA-IR showed differences according to gender and menopausal status. When we apply HOMA-IR, we should consider gender, menopausal status, and the prevalence of metabolic syndrome. PMID:27128847

  16. Endotoxin removal using 6,000 molecular weight cut-off polyacrylonitrile (PAN) and polysulfone (PS) hollow fiber ultrafilters.

    Science.gov (United States)

    Evans-Strickfaden, T T; Oshima, K H; Highsmith, A K; Ades, E W

    1996-01-01

    The removal of pyrogenic and microbial contaminants from high purity water and parental solutions during production is a concern to pharmaceutical manufacturers. In a previous study, 6000 molecular weight cut-off (MWCO) polyacrylonitrile (PAN) and polysulfone (PS) ultrafilters were shown to remove poliovirus (Titer reduction [Tr], > 6 logs) and phages T1 and PP7 (Tr, 7 logs) from ultrapure water, 0.85% saline with 1% trypicase soy broth, and Dulbecco's Eagle minimal essential medium with 10% fetal bovine serum (15). In this study, we evaluated the ability of the 6,000 MWCO PAN and PS ultrafilters to remove purified endotoxin (Escherichia coli lipopolysaccharide) which was added to commercial Water for Irrigation. An endotoxin concentration reduction of > 6 logs was achieved with both PAN and PS ultrafilters (detection sensitivity, 0.0031 EU/ml) when a minimum of 3.92 x 10(3) EU/ml of endotoxin was added to Water for Irrigation. These results indicate that the 6,000 MWCO PAN and PS ultrafilters are very effective in removing endotoxin from fluids such as Water for Irrigation.

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

    Science.gov (United States)

    Fitzpatrick, Jeremy M; Roberts, David W; Patlewicz, Grace

    2017-01-01

    It is widely accepted that substances must have a molecular weight (MW) system and identified that of the 13 substances with a MW > 500, five were sensitizers. This provided good evidence to refute such a MW 500 threshold. While Roberts et al. (2012) made a convincing case that the MW > 500 cut-off was not a true requirement for sensitization, the number of counter examples identified were too few to draw any statistical conclusions. This updated analysis systematically interrogated a large repository of sensitization information collected under the EU REACH regulation. A data set of 2904 substances that had been tested for skin sensitization, using guinea pigs and/or mice were collected. The data set contained 197 substances with a MW > 500; 33 of these were skin sensitizers. Metal containing complexes, reaction products and mixtures were excluded from further consideration. The final set of 14 sensitizers substantiated the original findings. The study also assessed whether the same reaction chemistry principles established for low MW sensitizers applied to chemicals with a MW > 500. The existing reaction chemistry considerations were found appropriate to rationalize the sensitization behaviour of the 14 sensitizers with a MW > 500. The existence of the MW 500 threshold, based on the widespread misconception that the ability to penetrate efficiently the stratum corneum is a key determinant of skin sensitization potential and potency, was refuted. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  18. Investigation of the performance of cement-bentonite cut-off walls in aggressive ground at a disused gasworks site

    International Nuclear Information System (INIS)

    Tedd, P.; Holton, I.R.; Butcher, A.P.; Wallace, S.

    1997-01-01

    There has been an increased use of cement-bentonite slurry trench cut-off walls to control the lateral migration of pollution in the UK. Concerns inevitably exist about their performance in chemically aggressive ground particularly in the long term. To address some of the uncertainties a programme of field and laboratory research is being undertaken at a disused gasworks in the UK. Elevated levels of sulphate and other contaminants are present on the site and could potentially change the properties of the cement-bentonite. Two boxes, 10m square in plan, by 5m deep have been constructed, one with and one without an HDPE membrane, to isolate parts of the site. Local hydraulic gradients across the walls have been created by pumping from within the boxes. Isolated lengths of wall have been constructed which are being used to assess and develop in-situ testing techniques such as the piezocone for measuring permeability, strength and overall integrity of the wall

  19. Optimal cut-off points for two-step strategy in screening of undiagnosed diabetes: a population-based study in China.

    Science.gov (United States)

    Ye, Zhen; Cong, Liming; Ding, Gangqiang; Yu, Min; Zhang, Xinwei; Hu, Ruying; Wu, Jianjun; Fang, Le; Wang, Hao; Zhang, Jie; He, Qingfang; Su, Danting; Zhao, Ming; Wang, Lixin; Gong, Weiwei; Xiao, Yuanyuan; Liang, Mingbin; Pan, Jin

    2014-01-01

    To identify optimal cut-off points of fasting plasma glucose for two-step strategy in screening of undiagnosed diabetes in Chinese people, data were selected from two cross-sectional studies of Metabolic Syndrome in Zhejiang Province of China, Zhejiang Statistical Yearbook (2010), and published literatures. Two-step strategy was used among 17437 subjects sampled from population to screen undiagnosed diabetes. Effectiveness (proportion of cases identified), costs (including medical and non-medical costs), and efficiency (cost per case identified) of these different two-step screening strategies were evaluated. This study found the sensitivities of all the two-step screening strategies with further Oral Glucose Tolerance Test (OGTT) at different Fasting Plasma Glucose (FPG) cut-off points from 5.0 to 7.0 (mmol/L) ranged from 0.66 to 0.91. For the FPG point of 5.0 mmol/L, 91 percent of undiagnosed cases were identified. The total cost of detecting one undiagnosed diabetes case ranged from 547.1 to 1294.5 CNY/case, and the strategy with FPG at cut-off point of 6.1 (mmol/L) resulted in the least cost. Considering both sensitivity and cost of screening diabetes, FPG cut-off point at 5.4 mmol/L was optimized for the two-step strategy. In conclusion, different optimal cut-off points of FPG for two-step strategy in screening of undiagnosed diabetes should be used for different screening purposes.

  20. Detection of relevant colonic neoplasms with PET/CT: promising accuracy with minimal CT dose and a standardised PET cut-off

    International Nuclear Information System (INIS)

    Luboldt, Wolfgang; Volker, Teresa; Zoephel, Klaus; Kotzerke, Joerg; Wiedemann, Baerbel; Wehrmann, Ursula; Koch, Arne; Abolmaali, Nasreddin; Toussaint, Todd; Luboldt, Hans-Joachim; Middendorp, Markus; Gruenwald, Frank; Aust, Daniela; Vogl, Thomas J.

    2010-01-01

    To determine the performance of FDG-PET/CT in the detection of relevant colorectal neoplasms (adenomas ≥10 mm, with high-grade dysplasia, cancer) in relation to CT dose and contrast administration and to find a PET cut-off. 84 patients, who underwent PET/CT and colonoscopy (n=79)/sigmoidoscopy (n=5) for (79 x 6+5 x 2)=484 colonic segments, were included in a retrospective study. The accuracy of low-dose PET/CT in detecting mass-positive segments was evaluated by ROC analysis by two blinded independent reviewers relative to contrast-enhanced PET/CT. On a per-lesion basis characteristic PET values were tested as cut-offs. Low-dose PET/CT and contrast-enhanced PET/CT provide similar accuracies (area under the curve for the average ROC ratings 0.925 vs. 0.929, respectively). PET demonstrated all carcinomas (n=23) and 83% (30/36) of relevant adenomas. In all carcinomas and adenomas with high-grade dysplasia (n=10) the SUV max was ≥5. This cut-off resulted in a better per-segment sensitivity and negative predictive value (NPV) than the average PET/CT reviews (sensitivity: 89% vs. 82%; NPV: 99% vs. 98%). All other tested cut-offs were inferior to the SUV max . FDG-PET/CT provides promising accuracy for colorectal mass detection. Low dose and lack of iodine contrast in the CT component do not impact the accuracy. The PET cut-off SUV max ≥ 5 improves the accuracy. (orig.)

  1. D-dimer as a marker of acute pyelonephritis in infants younger than 24 months with urinary tract infection.

    Science.gov (United States)

    Lee, Jung Won; Her, Sun Mi; Kim, Ji Hong; Lee, Keum Hwa; Eisenhut, Michael; Park, Se Jin; Shin, Jae Il

    2018-01-06

    D-dimer, as well as other biomarkers related to coagulation, is significantly increased during severe bacterial infection and sepsis. The aim of this study was to evaluate the usefulness of serum D-dimer as a biological marker in diagnosing acute pyelonephritis (APN) and in predicting vesicoureteric reflux (VUR) in infants with urinary tract infection (UTI). We retrospectively analyzed the data of 177 young infants (D-dimer were measured. The WBC counts (P = 0.002), ESR (P P D-dimer levels (P = 0.006) and the presence of VUR (P D-dimer (odds ratio [OR]:1.003, 95% CI: 1.001-1.006, P = 0.002) was an independent predictive factor for VUR in young children with UTI. The area under the curve (AUC) value from the receiver operating characteristic (ROC) curve of D-dimer (0.621, P = 0.046, 95% CI: 0.499-0.743) for prediction of VUR was higher than other inflammatory markers, but was inferior to CRP in predicting APN. Our results demonstrate that D-dimer can be used as an inflammatory marker in infants with febrile UTI in addition to other inflammatory markers.

  2. D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study.

    Science.gov (United States)

    Palareti, Gualtiero; Cosmi, Benilde; Legnani, Cristina; Antonucci, Emilia; De Micheli, Valeria; Ghirarduzzi, Angelo; Poli, Daniela; Testa, Sophie; Tosetto, Alberto; Pengo, Vittorio; Prandoni, Paolo

    2014-07-10

    The optimal duration of anticoagulation in patients with venous thromboembolism (VTE) is uncertain. We investigated whether persistently negative D-dimers in patients with vein recanalization or stable thrombotic burden can identify subjects at low recurrence risk. Outpatients with a first VTE (unprovoked or associated with weak risk factors) were eligible after at least 3 months (12 in those with residual thrombosis) of anticoagulation. They received serial D-dimer measurements using commercial assays with predefined age/sex-specific cutoffs and were followed for up to 2 years. Of 1010 patients, anticoagulation was stopped in 528 (52.3%) with persistently negative D-dimer who subsequently experienced 25 recurrences (3.0% pt-y; 95% confidence interval [CI], 2.0-4.4%). Of the remaining 482 patients, 373 resumed anticoagulation and 109 refused it. Recurrent VTE developed in 15 patients (8.8% pt-y; 95% CI, 5.0-14.1) of the latter group and in 4 of the former (0.7% pt-y; 95% CI, 0.2-1.7; hazard ratio = 2.92; 95% CI, 1.87-9.72; P = .0006). Major bleeding occurred in 14 patients (2.3% pt-y; 95% CI, 1.3-3.9) who resumed anticoagulation. Serial D-dimer measurement is suitable in clinical practice for the identification of VTE patients in whom anticoagulation can be safely discontinued. This study was registered at clinicaltrials.gov as #NCT00954395. © 2014 by The American Society of Hematology.

  3. Elevated D-dimer level is a risk factor for coronary artery lesions accompanying intravenous immunoglobulin-unresponsive Kawasaki disease.

    Science.gov (United States)

    Masuzawa, Yuko; Mori, Masaaki; Hara, Takuma; Inaba, Aya; Oba, Mari S; Yokota, Shumpei

    2015-04-01

    Although there are many reports on the resistance of Kawasaki disease (KD) to initial intravenous immunoglobulin (IVIg) therapy, risk factors for coronary artery lesions in such cases remain to be established. The objective of this study was to explore when additional therapies should be administered and to identify factors helpful for selecting a therapeutic option. Based on their written clinical records, we performed a retrospective review of KD patients who did not respond to initial IVIg therapy and who therefore then underwent plasma exchange (PE) therapy. This was a case-control study to compare the presence or absence of acute coronary lesions in patients treated by PE for IVIg-unresponsive KD at Yokohama City University Hospital or at Yokohama City University Medical Center. Fifteen of 44 patients had acute coronary artery lesions (CAL) correlating with high levels of white blood cells (WBC) (P = 0.045), D-dimer (P = 0.008), and fibrin/fibrinogen degradation products (P = 0.009) and lower levels of fibrinogen (P = 0.013) prior to PE therapy. There was a strong correlation between pre-PE levels of albumin and D-dimer (Pearson's correlation coefficient of 0.610). Multivariate analyses revealed that the odds ratio for CAL when D-dimer was ≥ 4.5 μg/mL was 25.06 (95% CI, 2.56-244.91, P = 0.006). D-dimer elevation and albumin decline in IVIg-unresponsive KD patients could be risk factors for acute CAL, suggesting the possibility that angitis has spread throughout the arterial system, as far as the coronary artery. © 2014 The Authors. Therapeutic Apheresis and Dialysis © 2014 International Society for Apheresis.

  4. Antithrombin III and D-dimer levels as indicators of disease severity in patients with hyperlipidaemic or biliary acute pancreatitis

    OpenAIRE

    Yang, Ning; Hao, Jianyu; Zhang, Donglei

    2017-01-01

    Objective To assess changes in anticoagulation and fibrinolytic systems between biliary and hyperlipidaemic acute pancreatitis (AP). Methods Patients with biliary or hyperlipidaemic AP were enrolled. Demographic and clinical data were collected, and antithrombin III (ATIII), protein C, protein S, and D-dimer levels were investigated. Results A total of 45 patients with biliary AP and 50 patients with hyperlipidaemic AP were included (68 with mild AP and 27 with moderately-severe AP). ATIII an...

  5. Two-hour diagnostic algorithms for early assessment of patients with acute chest pain--Implications of lowering the cardiac troponin I cut-off to the 97.5th percentile.

    Science.gov (United States)

    Eggers, Kai M; Aldous, Sally; Greenslade, Jaimi H; Johnston, Nina; Lindahl, Bertil; Parsonage, William A; Pickering, John W; Than, Martin; Cullen, Louise

    2015-05-20

    Assessment of patients with suspected non-ST elevation myocardial infarction (NSTEMI) is based on cardiac troponin (cTn) levels with the 99th percentile as cut-off. However, cardiovascular risk starts already at lower troponin concentrations. We therefore, aimed to investigate the utility of 2-hour algorithms using the high-sensitivity cardiac troponin I (hs-cTnI) 97.5th percentile as cut-off which corresponds to the standard URL for most biomarkers. Hs-cTnI was measured at presentation and 2h in 1624 chest pain patients. Diagnostic algorithms were developed applying hs-cTnI levels dichotomized at the 99th and 97.5th percentiles combined with hs-cTnI changes and/or ECG findings. The prevalence of NSTEMI was 13.9%. The adjusted odds ratios for 1-year mortality were 2.7 (95% CI 1.4-5.1) for the 99th percentile and 3.1 (95% CI 1.6-5.9) for the 97.5th percentile. The best-performing 99th percentile-based algorithms provided a positive predictive value (PPV) of 86.3% and a negative predictive value (NPV) of 99.3%. Using 97.5th percentile-based algorithms to define NSTEMI resulted in few reclassifications and yielded similar diagnostic estimates (PPV 85.4%, NPV 99.4%). The hs-cTnI 97.5th percentile integrated into 2-hour algorithms provided high diagnostic estimates and could, due to better prognostic properties serve as an alternative to the 99th percentile. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. Combined Effect of an Atmospheric River and a Cut-off Low in Hiroshima Flooding Event on August 19, 2014

    Science.gov (United States)

    Takayabu, Y. N.; Hirota, N.; Kato, M.; Arakane, S.

    2015-12-01

    An extraordinary precipitation over 100 mmhr-1in Hiroshima on August 19, 2014, caused a flash flood which resulted in 74 fatalities and collapse of 330 houses. In order to examine the meteorological background of this flooding event, we carried out a detailed analysis utilizing rain gauge data, satellite precipitation dataset, and a meso scale and a global scale objective analyses provided from the Japan Meteorological Agency. Then, we performed numerical experiments using a nonhydrostatic compressible equation model called the Cloud-Resolving Storm Simulator (CReSS). As a result, a combined effect of an atmospheric river (AR) and a cut-off low (COL) in this flooding event was elucidated. During the event, a filamentary transport of moisture extending from the Indochina Peninsula to the Japanese Islands was observed along the southern side of the subtropical jet, forming an AR. This AR had a deep structure with an amount of free tropospheric moisture comparable to that of the boundary layer. Concurrently, there was a COL, detached from the Mid-Pacific Trough, moving northwestward toward the Japanese Archipelago. With various sensitivity experiments, we concluded that a mid-tropospheric instability associated with the cold core of the COL and a dynamical ascent induced in its foreside, collaboratively worked with the anomalous moisture in the free troposphere associated with the AR, to extraordinarily enhance the precipitation over Hiroshima region. An orographic effect to concentrate the precipitation in this region was also confirmed. An implication on a difference in effects of AR in this event with a climatologically moist boundary layer, from those in the US west coast with a very dry environment, was also obtained. Acknowledgment: This study is supported by the Environment Research and Technology Development Fund (2-1503) of the Ministry of the Environment, Japan, and by the Ministry of Education, Culture, Sports, Science and Technology, Japan.

  7. Modelling the Turbocharger Cut Off Application Due to Slow Steaming Operation 12RTA96C-B Engine

    Directory of Open Access Journals (Sweden)

    Karsten Wehner

    2017-09-01

    Full Text Available Out of the total operational costs of a ship, fuel costs account for by far the highest proportion. In view of the global economic situation and the rising oil prices, shipowners and charterers are looking for solutions to cut costs by reducing fuel consumption. Low load operation, also well-known as “slow steaming”, represents the currently most effective and popular measure to cut fuel costs and, in consequence, the total operational costs for increased competitiveness in the market. Low load operation is possible and there is an increasing trend to operate in these very low engine load ranges. As the engines were not designed for this operational condition, various retrofit modifications to the engine can compensate for this. By using low load operation, the reduction of the RPM gives problems when sailing at low speed.  A turbocharger (TC compresses inlet air to a high pressure and after cooling this compressed air it results in higher mass of air in the cylinder. But when running at a low power load this air reaches temperatures that are too low for an optimal combustion process. One of the solution comes from the company Wärtsilä. They install so called “low steam engine kits”. When this kit is installed it allows the engine operators to cut off one turbocharger of the engine, this result’s in a higher RPM for the operating turbochargers. When the remaining TC’s have a higher RPM their efficiency improves and gives the engine more air for combustion.The goal of this Bachelor thesis is to make a calculation modelling and prove that by switching off one or more turbocharger on the system will improve the efficiency in slow steaming operation. Beside that, this thesis is aims to estimated the performance of the engine in both operation condition.

  8. Effect of Cutting off Irrigation at Flowering Stage on Physiological Characters, Yield and Yield Components of Wheat Genotypes in Shiraz

    Directory of Open Access Journals (Sweden)

    S. Moori

    2012-08-01

    Full Text Available To evaluate the response of wheat genotypes to terminal drought stress and to identify drought tolerant and sensitive genotypes, 20 wheat genotypes were compared in two stress and normal conditions, in a field experiment carried out at the Experimental Farm of College of Agriculture, Shiraz University, Shiraz, Iran, as a split-plot arrangement using complete randomized blocks design with four replications, during 2008-9 growing season. Main plot was irrigation (normal irrigation and cutting off irrigation at flowering stage and sub plot was 20 wheat genotypes. The results of ANOVA showed that there was highly significant difference among genotypes for all measured traits, indicating genetic variation among genotypes, which allowed genotype selection for drought tolerance. Comparison of traits’ means showed that the highest grain yield was obtained from Derakhshan cultivar (894.7 g/m2 in irrigation treatment and in drought conditions from M-73-6 genotype (442.1 g/m2. However, the least grain yield in both stress and non-stress conditions was obtained from Souraplata cultivar (362.4 and 149.7 g/m2, respectively. Results also showed that chlorophyll concentration of flag leaf was increased under drought conditions with the highest percentage in Yavarous cultivar (65.02%. Relative water content (RWC for flag leaf was decreased under drought stress conditions and the highest reduction was found in Shiraz cultivar (31.06%. While there was no significant correlation between chlorophyll concentration and grain yield, RWC of flag leaf showed a significant correlation with grain yield of genotypes. Therefore, RWC could be used as a suitable index for screening drought tolerant wheat genotypes.

  9. Evaluation of an Optimal Cut-Off Point for the Ki-67 Index as a Prognostic Factor in Primary Breast Cancer: A Retrospective Study.

    Directory of Open Access Journals (Sweden)

    Rumiko Tashima

    Full Text Available The Ki-67 index is an important biomarker for indicating the proliferation of cancer cells and is considered to be an effective prognostic factor for breast cancer. However, a standard cut-off point for the Ki-67 index has not yet been established. Therefore, the aim of this retrospective study was to determine an optimal cut-off point in order to establish it as a more accurate prognostic factor. Immunohistochemical analysis of the Ki-67 index was performed on 4329 patients with primary breast cancer from August 1987 to March 2012. Out of this sample, there were 3186 consecutive cases from September 1997 with simultaneous evaluations of ER, PgR and HER2 status. Cox's proportional hazard model was used to perform univariate and multivariate analyses of the factors related to OS. The hazard ratios (HR and the p values were then compared to determine the optimal cut-off point for the Ki-67 index. The median Ki-67 index value was 20.5% (mean value 26.2%. The univariate analysis revealed that there was a statistically significant negative correlation with DFS and OS and the multivariate analysis revealed that the Ki-67 index value was a significant factor for DFS and OS. The top seven cut-off points were then carefully chosen based on the results of the univariate analysis using the lowest p-values and the highest HR as the main selection criteria. The multivariate analysis of the factors for OS showed that the cut-off point of 20% had the highest HR in all of the cases. However, the cutoff point of 20% was only a significant factor for OS in the Luminal/HER2- subtype. There was no correlation between the Ki-67 index value and OS in any of the other subtypes. These data indicate that the optimal cut-off point of 20% is the most effective prognostic factor for Luminal/HER2- breast cancer.

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

    Science.gov (United States)

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

    2017-08-29

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

  11. Combined use of clinical pre-test probability and D-dimer test in the diagnosis of preoperative deep venous thrombosis in colorectal cancer patients

    DEFF Research Database (Denmark)

    Stender, Mogens Tornby; Frøkjaer, Jens Brøndum; Hagedorn Nielsen, Tina Sandie

    2008-01-01

    preoperative DVT in colorectal cancer patients admitted for surgery. Preoperative D-dimer test and compression ultrasonography for DVT were performed in 193 consecutive patients with newly diagnosed colorectal cancer. Diagnostic accuracy indices of the D-dimer test were assessed according to the PTP score......The preoperative prevalence of deep venous thrombosis (DVT) in patients with colorectal cancer may be as high as 8%. In order to minimize the risk of pulmonary embolism, it is important to rule out preoperative DVT. A large study has confirmed that a negative D-dimer test in combination with a low...... clinical pre-test probability (PTP) can be safely used to rule out the tentative diagnosis of DVT in cancer patients. However, the accuracy in colorectal cancer patients is uncertain. This study assessed the diagnostic accuracy of a quantitative D-dimer assay in combination with the PTP score in ruling out...

  12. Comparative study of food transfers in the three castes of the honeybee (Apis mellifica ligustica S.) in which four distal sections of both antennae have been cut off

    International Nuclear Information System (INIS)

    Pain, Janine; Roger, Bernard; Douault, Philippe

    1978-01-01

    The study of food transfers between the three castes of Apis mellifica ligustica S., in which four distal sections have been cut off, has been carried out by means of a radioactive tracer 198 Au, which cannot be metabolized. The begging behavior of queens with cut off antennae towards 4-day-old worker Bees and workers of unknown age is not changed. So it is with drones and operated worker Bees which beg food of a worker Bee, that is 4 days old and undamaged. On the other hand the begging behavior of drones and workers of unknown age is reduced towards other worker Bees of unknown age that are undamaged. The two-sided amputation of antennal sections of donor worker Bees of both categories does not change their behavior towards undamaged worker Bees [fr

  13. Human variation and body mass index: a review of the universality of BMI cut-offs, gender and urban-rural differences, and secular changes.

    Science.gov (United States)

    Mascie-Taylor, C G Nicholas; Goto, Rie

    2007-03-01

    Use of BMI as a surrogate for body fat percentage is debatable and universal BMI cut-off points do not seem appropriate; lower cut-off points than currently recommended by WHO should be used in some populations, especially in Asia. The adult WHO BMI database indicates that, on average, women are more obese than men, while men are more likely to be pre-obese than women. Urban rates of overweight and obesity are generally higher than rural rates in both sexes. The trend in pre-obesity and obesity over time is generally upward, with very marked increases in the USA and UK in both sexes over the last 10 years.

  14. Optimal Ki67 cut-off for luminal breast cancer prognostic evaluation: a large case series study with a long-term follow-up.

    Science.gov (United States)

    Bustreo, Sara; Osella-Abate, Simona; Cassoni, Paola; Donadio, Michela; Airoldi, Mario; Pedani, Fulvia; Papotti, Mauro; Sapino, Anna; Castellano, Isabella

    2016-06-01

    Although Ki67 index suffers from poor reproducibility, it is one of the most important prognostic markers used by oncologists to select the treatment of estrogen receptor (ER) positive breast cancer patients. In this study, we aim to establish the optimal Ki67 cut-offs for stratifying patient prognosis and to create a comprehensive prognostic index for clinical applications. A mono-institutional cohort of 1.577 human epidermal growth factor receptor 2 negative/ER+ breast cancer patients having complete clinical, histological, and follow-up data was collected. The 14 and 20 % Ki67 cut-offs were correlated to disease-free interval (DFI) and disease-specific survival (DSS). To create a comprehensive prognostic index, we used independent variables selected by uni/multivariate analyses. In terms of DFI and DSS, patients bearing tumors with Ki67 Ki67 values between 14 and 20 %. Patients with tumor with Ki67 > 20 % showed the poorest prognosis. Moreover, to tumor size, the number of metastatic lymph nodes and Ki67 > 20 % was given a score value, varying depending on definite cut-offs and used to create a prognostic index, which was applied to the population. Patients with a prognostic index ≥3 were characterized by significant risk of relapse [DFI: Hazard Ratio (HR) = 4.74, p Ki67 cut-off is the best to stratify high-risk patients in luminal breast cancers, and we suggest to integrate it with other prognostic factors, to better stratify patients at risk of adverse outcome.

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

    Science.gov (United States)

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

    2013-01-01

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

  16. A new method for detection of the electron temperature in laser-plasma short wave cut off of stimulated Raman scattering spectrum

    International Nuclear Information System (INIS)

    Zhang Jiatai

    1994-01-01

    From the theory of stimulated Raman scattering (SRS) three wave interaction, a new method of detecting the electron temperature in laser-plasma is obtained. SRS spectrum obtained from Shenguang No. 12 Nd-laser experiments are analysed. Using the wave length of short wave cut off of SRS, the electron temperature in corona plasma region is calculated consistently. These results agree reasonable with X-ray spectrum experiments

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

    Science.gov (United States)

    Chang, Shu Fang; Yang, Rong Sen

    2014-09-01

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

  18. Cut-off optimization for13C-urea breath test in a community-based trial by mathematic, histology and serology approach.

    Science.gov (United States)

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

    2017-05-18

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

  19. Triceps and subscapular skinfold thicknesses percentiles and cut-offs for overweight and obesity in a population-based sample of schoolchildren in Bogota, Colombia

    OpenAIRE

    Lopez Cifuentes, Mario Ferney

    2016-01-01

    OBJECTIVES: The aims of this study were to establish a Colombian smoothed centile charts and LMS tables for tríceps, subscapular and sum tríceps+subscapular skinfolds; appropriate cut-offs were selected using receiver operating characteristic analysis based in a populationbased sample of schoolchildren in Bogota, Colombia and to compare them with international studies. METHODS: A total of 9 618 children and adolescents attending public schools in Bogota, Colombia (55.7% girl...

  20. Survival functions for defining a clinical management Lost To Follow-Up (LTFU) cut-off in Antiretroviral Therapy (ART) program in Zomba, Malawi.

    Science.gov (United States)

    Rachlis, Beth; Cole, Donald C; van Lettow, Monique; Escobar, Michael

    2016-05-05

    While, lost to follow-up (LTFU) from antiretroviral therapy (ART) can be considered a catch-all category for patients who miss scheduled visits or medication pick-ups, operational definitions and methods for defining LTFU vary making comparisons across programs challenging. Using weekly cut-offs, we sought to determine the probability that an individual would return to clinic given that they had not yet returned in order to identify the LTFU cut-off that could be used to inform clinical management and tracing procedures. Individuals who initiated ART with Dignitas International supported sites (n = 22) in Zomba, Malawi between January 1 2007-June 30 2010 and were ≥ 1 week late for a follow-up visit were included. Lateness was categorized using weekly cut-offs from ≥1 to ≥26 weeks late. At each weekly cut-off, the proportion of patients who returned for a subsequent follow-up visit were identified. Cumulative Distribution Functions (CDFs) were plotted to determine the probability of returning as a function of lateness. Hazard functions were plotted to demonstrate the proportion of patients who returned each weekly interval relative to those who had yet to return. In total, n = 4484 patients with n = 7316 follow-up visits were included. The number of included follow-up visits per patient ranged from 1-10 (median: 1). Both the CDF and hazard function demonstrated that after being ≥9 weeks late, the proportion of new patients who returned relative to those who had yet to return decreased substantially. We identified a LTFU definition useful for clinical management. The simple functions plotted here did not require advanced statistical expertise and were created using Microsoft Excel, making it a particularly practical method for HIV programs in resource-constrained settings.

  1. Utility of the T-SPOT®.TB test's borderline category to increase test resolution for results around the cut-off point.

    Science.gov (United States)

    Rego, Karen; Pereira, Kristen; MacDougall, James; Cruikshank, William

    2018-01-01

    Accurate identification of individuals with TB infection, is required to achieve the WHO's End TB Strategy goals. While there is general acceptance that the T-SPOT.TB test borderline category provides an opportunity to increase test resolution of results around the test cut-off point, this has not been investigated. 645,947 tests were analyzed to determine frequency of borderline results, effect of age and time between tests and associations between subjects' clinical risk factors and retest results. 645,947 tests produced 93.5% negatives, 4% positives, 0.6% invalids, and 1.8% borderlines. Within the borderline results, 5044 were repeated, with 59.2%, 20.0% and 20.2% resolving to negative, positive and borderline, respectively. Age of subject did not affect retest results; however, time between tests indicated that retest resolution occurred with greatest frequency after 90 days. TB risk factors were provided for 2640 subjects and 17% of low risk subjects with a high initial borderline resolved to negative while 27.6% of subjects with high risk and an initial low borderline resolved to positive, suggesting that these subjects could have been inappropriately classified if using a single cut-off point test with no borderline category. This study demonstrates the utility of the T-SPOT.TB test's borderline category to increase test resolution around the test cut-off point. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. Prediction of individual patient response to chemotherapy by the fluorometric microculture cytotoxicity assay (FMCA) using drug specific cut-off limits and a Bayesian model.

    Science.gov (United States)

    Larsson, R; Nygren, P

    1993-01-01

    The semiautomated fluorometric microculture cytotoxicity assay (FMCA) based on the measurement of fluorescence generated from cellular hydrolysis of fluorescein diacetate (FDA) to fluorescein in microtiter plates, has been used for determination of cytotoxic drug resistance of tumor cells from patients with hematological and solid tumors. In the present study we describe a calibration procedure based on statistically derived cut-off limits and assay-predicted response probabilities using Bayes' theorem. Test results at a specified drug concentration were divided into three categories: low, intermediate or extreme drug resistance (LDR, IDR and EDR, respectively) using the median and median +1 standard deviation as the cut-off limits. When correlated with clinical outcome, LDR samples showed a higher response rate than expected, IDR a lower and EDR samples no response at all. The sensitivity and specificity of the test, using the median as cut-off limit, were 0.92 and 0.69 respectively. By fitting these test characteristics to a statistical model based on Bayes' theorem it is possible to calculate response probabilities for each individual patient taking into consideration not only the test characteristics and the particular assay result, but also the clinical and patient specific characteristics influencing the pre-test probability of response. EDR predicts clinical drug resistance with high specificity and is also observed in tumor types with high response rate.

  3. The cut-off values of dietary energy intake for determining metabolic syndrome in hemodialysis patients: A clinical cross-sectional study

    Science.gov (United States)

    Duong, Tuyen Van; Wong, Te-Chih; Chen, Hsi-Hsien; Chen, Tzen-Wen; Chen, Tso-Hsiao; Hsu, Yung-Ho; Peng, Sheng-Jeng; Kuo, Ko-Lin; Wang, Chi-Sin; Tseng, I-Hsin; Feng, Yi-Wei; Chang, Tai-Yue; Su, Chien-Tien

    2018-01-01

    Dietary energy intake strongly linked to dialysis outcomes. We aimed to explore the optimal cut-off point of energy intake (EI) for identification of metabolic syndrome (MetS) in hemodialysis patients. The cross-sectional data of 243 hemodialysis patients from multi-dialysis centers in Taiwan was used. The dietary intake was assessed by using the three-day dietary questionnaire, and a 24-hour dietary recall, clinical and biochemical data were also evaluated. The MetS was diagnosed by the Harmonized Metabolic Syndrome criteria. The receiver operating characteristic (ROC) curve was to depict the optimal cut-off value of EI for the diagnosis of MetS. The logistic regression was also used to explore the association between inadequate EI and MetS. The optimal cut-off points of EI for identifying the MetS were 26.7 kcal/kg/day for patients aged less than 60 years, or with non-diabetes, and 26.2 kcal/kg/day for patients aged 60 years and above, or with diabetes, respectively. The likelihood of the MetS increased with lower percentiles of energy intake in hemodialysis patients. In the multivariate analysis, the inadequate dietary energy intake strongly determined 3.24 folds of the MetS. The assessment of dietary EI can help healthcare providers detecting patients who are at risk of metabolic syndrome. PMID:29538427

  4. Return to Work: A Cut-Off of FIM Gain with Montebello Rehabilitation Factor Score in Order to Identify Predictive Factors in Subjects with Acquired Brain Injury.

    Science.gov (United States)

    Franceschini, Marco; Massimiani, Maria Pia; Paravati, Stefano; Agosti, Maurizio

    2016-01-01

    Return to work (RTW) for people with acquired brain injury (ABI) represents a main objective of rehabilitation: this work presents a strong correlation between personal well-being and quality of life. The aim of this study is to investigate the prognostic factors that can predict RTW after ABI (traumatic or non- traumatic aetiology) in patients without disorders of consciousness (e.g. coma, vegetative or minimally conscious state) at the beginning of their admission to rehabilitation. At the end of a 6-month follow-up after discharge, data were successfully collected in 69 patients. The rehabilitation effectiveness (functional Recovery) between admission and discharge was assessed by Functional Independent Measure (FIM) gain, through the Montebello Rehabilitation Factor Score (MRFS), which was obtained as follows: (discharge FIM-admission FIM)/(Maximum possible FIM-Admission FIM) x 100. The cut-off value (criterion) deriving from MRFS, which helped identify RTW patients, resulted in .659 (sn 88.9%; sp 52.4%). Considering the Mini Mental State Examination (MMSE) and the MRFS data, the multivariable binary logistic regression analysis presented 62.96% of correct RTW classification cases, 80.95% of non-RTW leading to an overall satisfactory predictability of 73.91%. The results of the present study suggest that occupational therapy intervention could modify cut-off in patients with an MFRS close to target at the end of an in-hospital rehabilitative program thus developing their capabilities and consequently surpassing cut-off itself.

  5. Return to Work: A Cut-Off of FIM Gain with Montebello Rehabilitation Factor Score in Order to Identify Predictive Factors in Subjects with Acquired Brain Injury.

    Directory of Open Access Journals (Sweden)

    Marco Franceschini

    Full Text Available Return to work (RTW for people with acquired brain injury (ABI represents a main objective of rehabilitation: this work presents a strong correlation between personal well-being and quality of life. The aim of this study is to investigate the prognostic factors that can predict RTW after ABI (traumatic or non- traumatic aetiology in patients without disorders of consciousness (e.g. coma, vegetative or minimally conscious state at the beginning of their admission to rehabilitation. At the end of a 6-month follow-up after discharge, data were successfully collected in 69 patients. The rehabilitation effectiveness (functional Recovery between admission and discharge was assessed by Functional Independent Measure (FIM gain, through the Montebello Rehabilitation Factor Score (MRFS, which was obtained as follows: (discharge FIM-admission FIM/(Maximum possible FIM-Admission FIM x 100. The cut-off value (criterion deriving from MRFS, which helped identify RTW patients, resulted in .659 (sn 88.9%; sp 52.4%. Considering the Mini Mental State Examination (MMSE and the MRFS data, the multivariable binary logistic regression analysis presented 62.96% of correct RTW classification cases, 80.95% of non-RTW leading to an overall satisfactory predictability of 73.91%. The results of the present study suggest that occupational therapy intervention could modify cut-off in patients with an MFRS close to target at the end of an in-hospital rehabilitative program thus developing their capabilities and consequently surpassing cut-off itself.

  6. Methods for identifying the cost effective case definition cut-off for sequential monitoring tests: an extension of Phelps and Mushlin

    Science.gov (United States)

    Longo, Roberta; Baxter, Paul; Hall, Peter; Hewison, Jenny; Afshar, Mehran; Hall, Geoff; McCabe, Christopher

    2015-01-01

    The arrival of personalized medicine in the clinic means that treatment decisions will increasingly rely on test results. The challenge of limited health care resources means that the dissemination of these technologies will be dependent on their value in relation to their cost; i.e. their cost effectiveness. Phelps and Mushlin have described how to optimize tests to meet cost effectiveness target. However, when tests are applied repeatedly the case mix of the patients tested changes with each administration, and this impacts upon the value of each subsequent test administration. In this paper we present a modification of Phelps and Mushlin’s framework for diagnostic tests; to identify the cost effective cut-off for monitoring tests. Using the Ca125 test monitoring for relapse in Ovarian Cancer, we show how the repeated use of the initial cut-off can lead to a substantially increased false negative rate compared to the monitoring cut-off – over 20% higher than in this example – with the associated harms for individual and population health. PMID:24488576

  7. Prevalence of body mass index and body weight cut-off points for in vitro fertilization treatment at U.S. clinics and current clinic weight loss strategy recommendations.

    Science.gov (United States)

    Turner-McGrievy, Gabrielle M; Grant, Breănna L

    2015-09-01

    The goal of this study was to determine how many clinics providing in vitro fertilization (IVF) in the United States require a body mass index (BMI) or body weight cut-off point to determine treatment eligibility. US clinics listed as members on the Society of Assisted Reproduction website in late 2013 were contacted by phone between January and March 2014. Clinic personnel were asked if a BMI or body weight cut-off points was used to determine IVF treatment eligibility and what strategies they recommended for their patients to achieve a healthy body weight. Of the 379 clinics contacted, 347 responded (92% response rate) and 35% (n = 120) reported using a BMI or body weight cut-off points to determine eligibility for IVF treatment. Mean BMI (± SD) cut-off points was 38.4 ± 5.2 kg/m(2) and mean body weight (± SD) cut-off points was 130.2 ± 14.8 kg. Of the clinics using a set cut-off points, half (46%) provided no weight loss recommendations for patients. A sizable portion of US IVF clinics report a required or preferred BMI or body weight cut-off points for treatment. Despite this, most clinics did not provide a recommended program or approach for weight loss with very few clinics reporting an in-house program.

  8. Prognostic impact of proliferation for resected early stage 'pure' invasive lobular breast cancer: Cut-off analysis of Ki67 according to histology and clinical validation.

    Science.gov (United States)

    Carbognin, Luisa; Sperduti, Isabella; Fabi, Alessandra; Dieci, Maria Vittoria; Kadrija, Dzenete; Griguolo, Gaia; Pilotto, Sara; Guarneri, Valentina; Zampiva, Ilaria; Brunelli, Matteo; Orvieto, Enrico; Nortilli, Rolando; Fiorio, Elena; Parolin, Veronica; Manfrin, Erminia; Caliò, Anna; Nisticò, Cecilia; Pellini, Francesca; Scarpa, Aldo; Pollini, Giovanni Paolo; Conte, Pierfranco; Tortora, Giampaolo; Bria, Emilio

    2017-10-01

    The intent of this analysis was to investigate and validate the prognostic potential of Ki67 in a multi-center series of patients affected by early stage 'pure' invasive lobular carcinoma (ILC). Clinical-pathological data of patients affected by ILC were correlated with overall survival and disease-free survival (OS/DFS); data from a parallel invasive ductal carcinoma (IDC) patients' cohort were gathered as well. The maximally selected Log-Rank statistics analysis was applied to Ki67 continuous variable to estimate the appropriate cut-off. The Subpopulation Treatment Effect Pattern Plot (STEPP) analysis was performed as well. Data from overall 1097 (457/222 ILC: training/validation set; 418 IDC) patients were gathered. The identified optimal Ki67 cut-offs were 4% and 14% for DFS in ILC and IDC cohort, respectively. In ILC patients, the Ki67 cut-off was an independent OS predictor. Ten-years OS and DFS were 89.9% and 77.2% (p = 0.007) and 79.4% and 69.2% (p = 0.03) for patients with Ki67 ≤ 4% and >4%, respectively. In IDC patients, 10-years OS was 93.8% and 71.7%, p = 0.02, DFS was 84.0% and 52.6%, p = 0.0003, for patients with Ki67 ≤ 14% and >14%, respectively. In the validation set, the optimal Ki67 OS cut-off was 5%. The STEPP analysis showed that in the presence of low Ki67 values, IDC patients have a better DFS than ILC patients, while with the increase of values the prognosis tends to overlap. Despite the retrospective design of the study, the prognostic relevance of Ki67 (as well as its optimal cut-off) seems to significantly differ according to breast cancer histology. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Determining a Cut-Off Point for Scores of the Breastfeeding Self-Efficacy Scale-Short Form: Secondary Data Analysis of an Intervention Study in Japan.

    Directory of Open Access Journals (Sweden)

    Keiko Nanishi

    Full Text Available Breastfeeding self-efficacy can be measured with the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF. Mothers with low BSES-SF scores stop exclusive breastfeeding prematurely, but specific interventions can prevent that undesirable outcome. Because those interventions can be expensive, often one must decide which mothers will receive them. For that purpose, a cut-off BSES-SF score would be useful, but none is available. Therefore, we aimed to assess the overall accuracy of BSES-SF scores as predictors of not practicing post-discharge exclusive breastfeeding, and to choose an appropriate cut-off score for making that prediction.This is a secondary data analysis of an intervention study. Data from 378 women in two non-Baby-Friendly Hospitals were analyzed. Participants were women in their third trimester who were 16 years of age or older, were able to read and write Japanese, were expected to have a singleton birth, and had completed the BSES-SF before discharge. BSES-SF scores were measured before discharge. Breastfeeding status was assessed 4 weeks and 12 weeks postpartum. Receiver Operating Characteristic (ROC curves were used to assess the predictive ability of the BSES-SF and to inform the choice of a cut-off point.For both of the ROC curves (4 and 12 weeks postpartum the area under the curve was 0.74. To obtain a high sensitivity, a cut-off score of 50 was chosen. With that cut-off score the sensitivity was 79% and the specificity was 52% 4 weeks postpartum, and they were 77% and 52%, respectively, 12 weeks postpartum.In conclusion, the BSES-SF has moderate overall accuracy to distinguish women who will not practice exclusive breastfeeding after discharge from those who will. At non-Baby-Friendly hospitals in Japan, interventions to support exclusive breastfeeding might be considered for new mothers who have BSES-SF scores that are less than or equal to 50.

  10. Real-Time Monitoring of Results During First Year of Dutch Colorectal Cancer Screening Program and Optimization by Altering Fecal Immunochemical Test Cut-Off Levels.

    Science.gov (United States)

    Toes-Zoutendijk, Esther; van Leerdam, Monique E; Dekker, Evelien; van Hees, Frank; Penning, Corine; Nagtegaal, Iris; van der Meulen, Miriam P; van Vuuren, Anneke J; Kuipers, Ernst J; Bonfrer, Johannes M G; Biermann, Katharina; Thomeer, Maarten G J; van Veldhuizen, Harriët; Kroep, Sonja; van Ballegooijen, Marjolein; Meijer, Gerrit A; de Koning, Harry J; Spaander, Manon C W; Lansdorp-Vogelaar, Iris

    2017-03-01

    After careful pilot studies and planning, the national screening program for colorectal cancer (CRC), with biennial fecal immunochemical tests (FITs), was initiated in The Netherlands in 2014. A national information system for real-time monitoring was developed to allow for timely evaluation. Data were collected from the first year of this screening program to determine the importance of planning and monitoring for optimal screening program performance. The national information system of the CRC screening program kept track of the number of invitations sent in 2014, FIT kits returned, and colonoscopies performed. Age-adjusted rates of participation, the number of positive test results, and positive predictive values (PPVs) for advanced neoplasia were determined weekly, quarterly, and yearly. In 2014, there were 741,914 persons invited for FIT; of these, 529,056 (71.3%; 95% CI, 71.2%-71.4%) participated. A few months into the program, real-time monitoring showed that rates of participation and positive test results (10.6%; 95% CI, 10.5%-10.8%) were higher than predicted and the PPV was lower (42.1%; 95% CI, 41.3%-42.9%) than predicted based on pilot studies. To reduce the burden of unnecessary colonoscopies and alleviate colonoscopy capacity, the cut-off level for a positive FIT result was increased from 15 to 47 μg Hb/g feces halfway through 2014. This adjustment decreased the percentage of positive test results to 6.7% (95% CI, 6.6%-6.8%) and increased the PPV to 49.1% (95% CI, 48.3%-49.9%). In total, the first year of the Dutch screening program resulted in the detection of 2483 cancers and 12,030 advanced adenomas. Close monitoring of the implementation of the Dutch national CRC screening program allowed for instant adjustment of the FIT cut-off levels to optimize program performance. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  11. D-dimer and risk of thromboembolic and bleeding events in patients with atrial fibrillation--observations from the ARISTOTLE trial.

    Science.gov (United States)

    Christersson, C; Wallentin, L; Andersson, U; Alexander, J H; Ansell, J; De Caterina, R; Gersh, B J; Granger, C B; Hanna, M; Horowitz, J D; Huber, K; Husted, S; Hylek, E M; Lopes, R D; Siegbahn, A

    2014-09-01

    D-dimer is related to adverse outcomes in arterial and venous thromboembolic diseases. To evaluate the predictive value of D-dimer level for stroke, other cardiovascular events, and bleeds, in patients with atrial fibrillation (AF) treated with oral anticoagulation with apixaban or warfarin; and to evaluate the relationship between the D-dimer levels at baseline and the treatment effect of apixaban vs. warfarin. In the ARISTOTLE trial, 18 201 patients with AF were randomized to apixaban or warfarin. D-dimer was analyzed in 14 878 patients at randomization. The cohort was separated into two groups; not receiving vitamin K antagonist (VKA) treatment and receiving VKA treatment at randomization. Higher D-dimer levels were associated with increased frequencies of stroke or systemic embolism (hazard ratio [HR] [Q4 vs. Q1] 1.72, 95% confidence interval [CI] 1.14-2.59, P = 0.003), death (HR [Q4 vs. Q1] 4.04, 95% CI 3.06-5.33) and major bleeding (HR [Q4 vs. Q1] 2.47, 95% CI 1.77-3.45, P < 0.0001) in the no-VKA group. Similar results were obtained in the on-VKA group. Adding D-dimer level to the CHADS2 score improved the C-index from 0.646 to 0.655 for stroke or systemic embolism, and from 0.598 to 0.662 for death, in the no-VKA group. D-dimer level improved the HAS-BLED score for prediction of major bleeds, with an increase in the C-index from 0.610 to 0.641. There were no significant interactions between efficacy and safety of study treatment and D-dimer level. In anticoagulated patients with AF, the level of D-dimer is related to the risk of stroke, death, and bleeding, and adds to the predictive value of clinical risk scores. The benefits of apixaban were consistent, regardless of the baseline D-dimer level. © 2014 International Society on Thrombosis and Haemostasis.

  12. Adjustable collimator

    International Nuclear Information System (INIS)

    Carlson, R.W.; Covic, J.; Leininger, G.

    1981-01-01

    In a rotating fan beam tomographic scanner there is included an adjustable collimator and shutter assembly. The assembly includes a fan angle collimation cylinder having a plurality of different length slots through which the beam may pass for adjusting the fan angle of the beam. It also includes a beam thickness cylinder having a plurality of slots of different widths for adjusting the thickness of the beam. Further, some of the slots have filter materials mounted therein so that the operator may select from a plurality of filters. Also disclosed is a servo motor system which allows the operator to select the desired fan angle, beam thickness and filter from a remote location. An additional feature is a failsafe shutter assembly which includes a spring biased shutter cylinder mounted in the collimation cylinders. The servo motor control circuit checks several system conditions before the shutter is rendered openable. Further, the circuit cuts off the radiation if the shutter fails to open or close properly. A still further feature is a reference radiation intensity monitor which includes a tuning-fork shaped light conducting element having a scintillation crystal mounted on each tine. The monitor is placed adjacent the collimator between it and the source with the pair of crystals to either side of the fan beam

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

    Directory of Open Access Journals (Sweden)

    Monika Grygorowicz

    Full Text Available To measure the sensitivity and specificity of differences cut-off values for isokinetic Hcon/Qcon ratio in order to improve the capacity to evaluate (retrospectively the injury of hamstring muscles in professional soccer screened with knee isokinetic tests.Retrospective study.Medical and biomechanical data of professional football players playing for the same team for at least one season between 2010 and 2016 were analysed. Hamstring strain injury cases and the reports generated via isokinetic testing were investigated. Isokinetic concentric(con hamstring(H and quadriceps(Q absolute strength in addition with Hcon/Qcon ratio were examined for the injured versus uninjured limbs among injured players, and for the injured and non-injured players. 2 x 2 contingency table was used for comparing variables: predicted injured or predicted uninjured with actual injured or actual uninjured. Sensitivity, specificity, accuracy, positive and negative predictive values, and positive and negative likelihood ratio were calculated for three different cut-off values (0.47 vs. 0.6 vs. 0.658 to compare the discriminative power of an isokinetic test, whilst examining the key value of Hcon/Qcon ratio which may indicate the highest level of ability to predispose a player to injury. McNemar's chi2 test with Yates's correction was used to determine agreement between the tests. PQStat software was used for all statistical analysis, and an alpha level of p <0.05 was used for all statistical comparisons.340 isokinetic test reports on both limbs of 66 professional soccer players were analysed. Eleven players suffered hamstring injuries during the analysed period. None of these players sustained recurrence of hamstring injury. One player sustained hamstring strain injury on both legs, thus the total number of injuries was 12. Application of different cut-off values for Hcon/Qcon significantly affected the sensitivity and specificity of isokinetic test used as a tool for

  14. Cushing`s disease: Fibrinogen and D-dimer levels fail to normalize despite early postoperative remission - a prospective, controlled study.

    Science.gov (United States)

    Witek, Przemysław; Zieliński, Grzegorz; Szamotulska, Katarzyna; Witek, Joanna; Kamiński, Grzegorz

    2016-01-01

    Effective transsphenoidal surgery (TSS) for Cushing`s disease (CD) normalizes cortisol levels and reduces complications of hypercortisolism. However, there is evidence of increased cardiovascular morbidity even after successful surgery. A prospective, controlled study on the dynamics of fibrinogen and D-dimer levels with a six-month follow-up after an effective TSS for CD. Forty patients with CD and forty healthy age- and sex-matched subjects were included. We assessed ACTH, urinary and serum cortisol, and fibrinogen and D-dimer levels before TSS and during follow-up. Baseline BMI (P < 0.001), fibrinogen (P = 0.002), and D-dimer (P = 0.001) levels in CD patients were significantly higher than those in healthy controls. High fibrinogen levels in the CD group were independent of BMI, and were positively associated with hsCRP (rS = 0.61, P < 0.001) and arterial hypertension (P = 0.029). After the six-month follow-up we confirmed a sustained difference between the remission group and controls in fibrinogen and D-dimer levels (P = 0.001 and P = 0.017, respectively). Despite early biochemical remission of CD the levels of fibrinogen and D-dimer failed to decrease. This probably contributes to the high risk of thrombotic events and indicates the need for a close follow-up for signs of thromboembolic and cardiovascular complications in patients with early CD remission. (Endokrynol Pol 2016; 67 (3): 283-291).

  15. Cut-off value of initial serum β-hCG level predicting a successful MTX therapy in tubal ectopic pregnancy: a retrospective cohort study.

    Science.gov (United States)

    Helmy, S; Bader, Y; Pablik, E; Tiringer, D; Pils, S; Laml, T; Kölbl, H; Koch, M

    2014-08-01

    To determine the optimal serum β-hCG cut-off level to predict MTX treatment success in tubal ectopic pregnancy (EP). Data of 240 women, who presented between 2003 and 2011 at the Department of Gynecology and Obstetrics, Medical University of Vienna, with tubal EP and who received MTX as primary treatment, were retrieved from the hospital information system (KIS). 198 patients could be included for final evaluation. Statistical analysis included area under the ROC curve, maximal Euclidean and Youden index, chi-squared and a five-fold cross validation. The serum β-hCG level cut-off value was calculated at 2121mlU/ml with a specificity of 76.54% and sensitivity of 80.56% (AUC 0.789; ptreatment failure in 5.3% (n=7), compared to 43.3% (n=29) of patients with an initial serum β-hCG level equal to or above 2121mlU/ml (n=67). There was no statistically significant correlation between clinical symptoms and the MTX therapy outcome (p=0.580; likelihood quotient p=0.716). The correct decision of therapy in patients with tubal ectopic pregnancy still represents a challenge. In this study we can conclude that, according to our results there is no endpoint of initial serum β-hCG levels, which can be clearly used as cut-off value for the optimal management of tubal EP. However, an initial serum β-hCG level of less than 2121mlU/ml seems to be a good value to expect a successful MTX treatment. Limitations are the retrospective study design and the inability of classifying clinical symptoms like pain as an objective parameter. Wider implications of the findings may include more detailed patient information and more accurate selection of suitable patients for MTX therapy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. Proposed cut-off value of CA19-9 for detecting pancreatic cancer in patients with diabetes: a case-control study.

    Science.gov (United States)

    Murakami, Mariko; Nagai, Yoshio; Tenjin, Ayumi; Tanaka, Yasushi

    2018-04-11

    Pancreatic cancer is a highly lethal malignancy. CA19-9 is a well-known marker for diagnosis of pancreatic cancer, but the serum CA19-9 level is reported to be elevated in patients with poorly controlled diabetes. This study evaluated the sensitivity, specificity, and cut-off value of serum CA19-9 for detection of pancreatic cancer in patients with diabetes. A case-control study of 236 patients was performed. The case group was selected from diabetic patients with pancreatic cancer, while one control was selected for each case from among diabetic patients without pancreatic cancer during the same period. The case group (n = 118) and the control group (n = 118) were matched for age, sex, and pancreatic cancer risk factors. Receiver operating characteristic (ROC) curves were plotted to determine the serum CA19-9 level that predicted pancreatic cancer. Then the sensitivity and specificity of CA19-9 were calculated for the threshold value. There were no significant differences of age, sex, BMI, smoking, alcohol intake, and HbA1c between the case and control groups. According to ROC analysis, a serum CA19-9 level of 75 U/mL had the maximum sensitivity and specificity for separating diabetic patients with or without pancreatic cancer. Using this cut-off value, the sensitivity and specificity of CA19-9 for pancreatic cancer was 69.5% and 98.2%, respectively, while the area under the ROC curve was 0.875 [95%CI: 0.826-0.924]. We propose that a serum CA19-9 level of 75 U/mL should be used as the cut-off value when screening patients with diabetes for pancreatic cancer.

  17. Using a 3% Proton Density Fat Fraction as a Cut-Off Value Increases Sensitivity of Detection of Hepatic Steatosis, Based on Results From Histopathology Analysis.

    Science.gov (United States)

    Nasr, Patrik; Forsgren, Mikael F; Ignatova, Simone; Dahlström, Nils; Cedersund, Gunnar; Leinhard, Olof Dahlqvist; Norén, Bengt; Ekstedt, Mattias; Lundberg, Peter; Kechagias, Stergios

    2017-07-01

    It is possible to estimate hepatic triglyceride content by calculating the proton density fat fraction (PDFF), using proton magnetic resonance spectroscopy ( 1 H-MRS), instead of collecting and analyzing liver biopsy specimens to detect steatosis. However, the current PDFF cut-off value (5%) used to define steatosis by magnetic resonance was derived from studies that did not use histopathology as the reference standard. We performed a prospective study to determine the accuracy of 1 H-MRS PDFF in the measurement of steatosis using histopathology analysis as the standard. We collected clinical, serologic, 1 H-MRS PDFF, and liver biopsy data from 94 adult patients with increased levels of liver enzymes (≥6 mo) referred to the Department of Gastroenterology and Hepatology at Linköping University Hospital in Sweden from 2007 through 2014. Steatosis was graded using the conventional histopathology method and fat content was quantified in biopsy samples using stereologic point counts (SPCs). We correlated the 1 H-MRS PDFF findings with SPCs (r = 0.92; P histopathology results (ρ = 0.87; P histopathology results (ρ = 0.88; P histopathology findings (100% specificity for PDFF). However, of 69 subjects with PDFF values less than 5.0% (negative result), 22 were determined to have steatosis based on histopathology findings (53% sensitivity for PDFF). Reducing the PDFF cut-off value to 3.0% identified patients with steatosis with 100% specificity and 79% sensitivity; a PDFF cut-off value of 2.0% identified patients with steatosis with 94% specificity and 87% sensitivity. These findings might be used to improve noninvasive detection of steatosis. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2013-10-16

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

  19. Night-time heart rate cut-off point definition by resting office tachycardia in untreated hypertensive patients: data of the Spanish ABPM registry.

    Science.gov (United States)

    Vinyoles, Ernest; de la Sierra, Alejandro; Roso, Albert; de la Cruz, Juan J; Gorostidi, Manuel; Segura, Julián; Banegas, José R; Martell-Claros, Nieves; Ruilope, Luís M

    2014-05-01

    Epidemiological studies have shown that an elevated resting heart rate (HR) is a risk factor for both total and cardiovascular mortality. Our aim was to estimate the night-time HR cut-off point that best predicts cardiovascular risk office tachycardia in hypertensive patients. Untreated hypertensive patients without concomitant cardiovascular diseases were included. Office and ambulatory HRs were measured. Cardiovascular risk office tachycardia was defined by office HR at least 85 beats per minute (bpm). Different night-time HR cut-offs were estimated by receiver operating characteristic curve analyses to predict cardiovascular risk office tachycardia. The best cut-off was selected on the basis of its combined sensitivity and specificity. A total of 32 569 hypertensive patients were included: 46.5% women, mean age (SD) 52 (14) years, office blood pressure 146 (16)/89 (11) mmHg, diabetes 10.3%, smoking 19.2%, BMI 29 (6.8) kg/m, office HR 77 (11.2) bpm, and night-time HR 64.9 (9.3) bpm. A total of 7070 (21.7%) patients were found to have cardiovascular risk office tachycardia. The night-time HR value that better predicted cardiovascular risk office tachycardia was more than 66 bpm. In comparison with patients with night HR below this value, those with night-time tachycardia were predominantly women, younger, with higher ambulatory blood pressure, greater BMI, and higher prevalence of diabetes and smoking. All comparisons were statistically significant (P less than 0.001). A mean night-time HR more than 66 bpm is a good predictor of cardiovascular risk office tachycardia in untreated hypertensive patients and could be considered a variable associated with an increased cardiovascular risk.

  20. Bovine Tuberculosis in Cattle in the Highlands of Cameroon: Seroprevalence Estimates and Rates of Tuberculin Skin Test Reactors at Modified Cut-Offs

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    J. Awah-Ndukum

    2012-01-01

    Full Text Available The aim of this study was to obtain epidemiological estimates of bovine tuberculosis (TB prevalence in cattle in the highlands of Cameroon using two population-based tuberculin skin test (TST surveys in the years 2009 and 2010. However, prior to the TST survey in 2010, blood was collected from already chosen cattle for serological assay. Anti-bovine TB antibodies was detected in 37.17% of tested animals and bovine TB prevalence estimates were 3.59%–7.48%, 8.92%–13.25%, 11.77%–17.26% and 13.14%–18.35% for comparative TST at ≥4 mm, ≥3 mm and ≥2 mm cut-off points and single TST, respectively. The agreement between TST and lateral flow was generally higher in TST positive than in TST negative subjects. The K coefficients were 0.119, 0.234, 0.251 and 0.254 for comparative TST at ≥4 mm, ≥3 mm and ≥2 mm cut-off points and the single TST groups, respectively. Chi square statistics revealed that strong (P48 associations existed between seroprevalence rates and TST reactors. The study suggested that using lateral flow assay and TST at severe interpretations could improve the perception of bovine TB in Cameroon. The importance of defining TST at modified cut-offs and disease status by post-mortem detection and mycobacterial culture of TB lesions in local environments cannot be overemphasised.

  1. Raising cut-off value of prostate specific antigen (PSA) for biopsy in symptomatic men in India to reduce unnecessary biopsy.

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    Agnihotri, Shalini; Mittal, R D; Kapoor, R; Mandhani, Anil

    2014-06-01

    The characteristics of prostate specific antigen (PSA) for trans-rectal ultrasonography guided prostate biopsy in men with lower urinary tract symptoms (LUTS) are not well defined. This study was carried out to analyse the threshold of PSA for biopsy in symptomatic men in India. From January 2000 to June 2011, consecutive patients who had digital rectal examination (DRE) and PSA testing done for LUTS were included in this study. PSA was done with ELISA technique. Patients with acute or chronic prostatitis, prostatic abscess, history of surgery on prostate within the previous three months and patients on 5α-reductase inhibitors or on urethral catheter were excluded. Of the 4702 patients evaluated, 70.9 per cent had PSA of less than 4 ng/ml and 29.1 per cent had PSA of more than 4 ng/ml. Of these, 875 men with a mean age of 65.72±7.4 (range 50-75 yr) had trans rectal ultrasonography (TRUS) guided biopsy. Twenty five men had biopsy at PSA level of 20 ng/ml. Positive predictive value of PSA in ranges of 4.1-10, 10.1-20, >20 ng/ml was 15.2, 24 and 62.6 per cent, respectively with negative DRE. PSA cut-off to do biopsy was derived by ROC curve as 5.82 ng/ml for all the men. When the subjects were further stratified on the basis of DRE findings, a cut-off of 5.4 ng/ml was derived in men with normal DRE. A cut-off for biopsy in symptomatic men with negative DRE could safely be raised to 5.4 ng/ml, which could avoid subjecting 10 per cent of men to undergo unnecessary biopsy.

  2. Evaluation of serum galactomannan enzyme immunoassay at two different cut-offs for the diagnosis of invasive aspergillosis in patients with febrile neutropenia

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    Ritin Mohindra

    2017-01-01

    Full Text Available Background: Invasive aspergillosis (IA is an increasingly common and fatal opportunistic fungal infection in patients with haematological diseases. Early diagnosis is difficult as mycological culture techniques have low sensitivity and the radiological tools have low specificity. Galactomannan enzyme immunoassay (GEI detects galactomannan in the human serum with a reported sensitivity and specificity between 30% and 100%. Aims: The aim of this study was to analyse the role of GEI in diagnosis of IA in patients with febrile neutropenia and to evaluate the role of GEI in the diagnosis of IA as per the revised (2008 European Organization for Research and Treatment of Cancer–Mycoses Study Group (EORTC–MSG criteria at two different optical density (OD cut-offs of 0.5 and 1.0. Setting: This prospective study was conducted in Safdarjung Hospital, New Delhi, India. Methods: GEI testing was performed in adult patients of febrile neutropenia with evidence of IA. Results at two different OD indices (ODIs of 0.5 and 1.0 were analysed. The evaluation of the diagnostic parameter, that is, GEI was measured in terms of sensitivity, specificity and positive and negative predictive value and was validated with the revised (2008 EORTC–MSG diagnostic criteria of IA. Results: One hundred and eleven patients had evidence of IA, of which 79 patients were GEI positive when cut-off ODI was 0.5, whereas with cut-off ODI 1.0, 55 patients were GEI positive. Conclusion: ODI of 1.0 should be considered as positive while in patients with OD between 0.5 and 1.0, repeat sampling from the patient is recommended.

  3. A cut-off of 2150 cytokeratin 19 mRNA copy number in sentinel lymph node may be a powerful predictor of non-sentinel lymph node status in breast cancer patients.

    Science.gov (United States)

    Terrenato, Irene; D'Alicandro, Valerio; Casini, Beatrice; Perracchio, Letizia; Rollo, Francesca; De Salvo, Laura; Di Filippo, Simona; Di Filippo, Franco; Pescarmona, Edoardo; Maugeri-Saccà, Marcello; Mottolese, Marcella; Buglioni, Simonetta

    2017-01-01

    Since 2007, one-step nucleic acid amplification (OSNA) has been used as a diagnostic system for sentinel lymph node (SLN) examination in patients with breast cancer. This study aimed to define a new clinical cut-off of CK19 mRNA copy number based on the calculation of the risk that an axillary lymph node dissection (ALND) will be positive. We analyzed 1529 SLNs from 1140 patients with the OSNA assay and 318 patients with positive SLNs for micrometastasis (250 copies) and macrometastasis (5000 copies) underwent ALND. Axillary non-SLNs were routinely examined. ROC curves and Youden's index were performed in order to identify a new cut-off value. Logistic regression models were performed in order to compare OSNA categorical variables created on the basis of our and traditional cut-off to better identify patients who really need an axillary dissection. 69% and 31% of OSNA positive patients had a negative and positive ALND, respectively. ROC analysis identified a cut-off of 2150 CK19 mRNA copies with 95% sensitivity and 51% specificity. Positive and negative predictive values of this new cut-off were 47% and 96%, respectively. Logistic regression models indicated that the cut-off of 2150 copies better discriminates patients with node negative or positive in comparison with the conventional OSNA cut-off (ppatients really need an ALND and which patients can avoid one. This is why we suggest that the negative cut-off should be raised from 250 to 2150. Furthermore, we propose that for patients with a copy number that ranges between 2150 and 5000, there should be a multidisciplinary discussion concerning the clinical and bio-morphological features of primary breast cancer before any decision is taken on whether to perform an ALND or not.

  4. Optimal cut-off points of fasting plasma glucose for two-step strategy in estimating prevalence and screening undiagnosed diabetes and pre-diabetes in Harbin, China.

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    Chundan Bao

    Full Text Available To identify optimal cut-off points of fasting plasma glucose (FPG for two-step strategy in screening abnormal glucose metabolism and estimating prevalence in general Chinese population. A population-based cross-sectional study was conducted on 7913 people aged 20 to 74 years in Harbin. Diabetes and pre-diabetes were determined by fasting and 2 hour post-load glucose from the oral glucose tolerance test in all participants. Screening potential of FPG, cost per case identified by two-step strategy, and optimal FPG cut-off points were described. The prevalence of diabetes was 12.7%, of which 65.2% was undiagnosed. Twelve percent or 9.0% of participants were diagnosed with pre-diabetes using 2003 ADA criteria or 1999 WHO criteria, respectively. The optimal FPG cut-off points for two-step strategy were 5.6 mmol/l for previously undiagnosed diabetes (area under the receiver-operating characteristic curve of FPG 0.93; sensitivity 82.0%; cost per case identified by two-step strategy ¥261, 5.3 mmol/l for both diabetes and pre-diabetes or pre-diabetes alone using 2003 ADA criteria (0.89 or 0.85; 72.4% or 62.9%; ¥110 or ¥258, 5.0 mmol/l for pre-diabetes using 1999 WHO criteria (0.78; 66.8%; ¥399, and 4.9 mmol/l for IGT alone (0.74; 62.2%; ¥502. Using the two-step strategy, the underestimates of prevalence reduced to nearly 38% for pre-diabetes or 18.7% for undiagnosed diabetes, respectively. Approximately a quarter of the general population in Harbin was in hyperglycemic condition. Using optimal FPG cut-off points for two-step strategy in Chinese population may be more effective and less costly for reducing the missed diagnosis of hyperglycemic condition.

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

    Science.gov (United States)

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

    2018-01-19

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

  6. Optimal cut-off points of fasting plasma glucose for two-step strategy in estimating prevalence and screening undiagnosed diabetes and pre-diabetes in Harbin, China.

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    Bao, Chundan; Zhang, Dianfeng; Sun, Bo; Lan, Li; Cui, Wenxiu; Xu, Guohua; Sui, Conglan; Wang, Yibaina; Zhao, Yashuang; Wang, Jian; Li, Hongyuan

    2015-01-01

    To identify optimal cut-off points of fasting plasma glucose (FPG) for two-step strategy in screening abnormal glucose metabolism and estimating prevalence in general Chinese population. A population-based cross-sectional study was conducted on 7913 people aged 20 to 74 years in Harbin. Diabetes and pre-diabetes were determined by fasting and 2 hour post-load glucose from the oral glucose tolerance test in all participants. Screening potential of FPG, cost per case identified by two-step strategy, and optimal FPG cut-off points were described. The prevalence of diabetes was 12.7%, of which 65.2% was undiagnosed. Twelve percent or 9.0% of participants were diagnosed with pre-diabetes using 2003 ADA criteria or 1999 WHO criteria, respectively. The optimal FPG cut-off points for two-step strategy were 5.6 mmol/l for previously undiagnosed diabetes (area under the receiver-operating characteristic curve of FPG 0.93; sensitivity 82.0%; cost per case identified by two-step strategy ¥261), 5.3 mmol/l for both diabetes and pre-diabetes or pre-diabetes alone using 2003 ADA criteria (0.89 or 0.85; 72.4% or 62.9%; ¥110 or ¥258), 5.0 mmol/l for pre-diabetes using 1999 WHO criteria (0.78; 66.8%; ¥399), and 4.9 mmol/l for IGT alone (0.74; 62.2%; ¥502). Using the two-step strategy, the underestimates of prevalence reduced to nearly 38% for pre-diabetes or 18.7% for undiagnosed diabetes, respectively. Approximately a quarter of the general population in Harbin was in hyperglycemic condition. Using optimal FPG cut-off points for two-step strategy in Chinese population may be more effective and less costly for reducing the missed diagnosis of hyperglycemic condition.

  7. Differences in psychometric properties, cut-off scores, and outcomes between the Barthel Index and Modified Rankin Scale in pharmacotherapy-based stroke trials: systematic literature review.

    Science.gov (United States)

    Balu, Sanjeev

    2009-06-01

    Review published clinical trial studies on pharmacological treatment of stroke using both the Barthel Index (BI) and Modified Rankin Scale (MRS) as outcome measures, and to highlight the differences in psychometric properties and cut-off scores through a systematic review. A systematic literature search on stroke studies involving a pharmacological treatment was conducted between 1955-2008. Key words included Barthel index, Rankin, modified Rankin, pharmacotherapy, validity, reliability, responsiveness, sensitivity, specificity, outcomes, psychometrics, prediction, randomized clinical trials, analysis, and stroke. All search terms were limited to Medical Subjects Headings (MESH) terms, English-language abstracts, and human subjects. Overall, 44 studies were identified, six studies comparing the psychometric properties of the BI and the MRS, 24 studies on use of both the BI and the MRS in clinical stroke trials involving a pharmacological treatment, and 14 studies reviewed the cut-off scores and statistical issues related to scale selection. Most studies measured outcomes at 90 days after initiating therapy although differences were observed in this lag time. There was inconsistency in cut-off points used for both scales in the studies. There was no apparent relation between time to initiation of stroke therapy and outcomes measured by the BI and the MRS. The time window ranged from 3 hours to 72 hours although most of the studies reported outcomes after therapy initiation within 3-6 hours of stroke onset. BI may not be an appropriate scale to measure treatment effects due to the inherent ceiling and floor effects. Use of total distribution scores on the scales rather that dichotomizing or trichotomizing the scales has been favored recently. In mild to moderate stroke patients, the MRS seems to detect small and significant treatment effect changes as compared to the BI. Since most stroke studies try to exhibit the effects of treatment within 3 hours after symptom

  8. Determination of sensitivity, specificity and cut off point of visual- Motor Bender Gestalt Test in the diagnosis of traumatic brain injury

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    tayebeh Rezaie nasab

    2013-02-01

    Results: In this study, cut-off point was calculated as 6.5%, sensitivity as 55.8%, characteristic as 81.2%, and the area under the Roc curve as 0.69. Moreover, positive predictive value, negative predictive value and efficiency were 95.08%, 22.03%, and 59.17%, respectively. Conclusion: Results of this study revealed that Bender Gestalt Test is relatively weak in diagnosis of mild TBI. Hence, its characteristic is high and it was successful in diagnosing healthy individuals.

  9. Safety and feasibility of a diagnostic algorithm combining clinical probability, d-dimer testing, and ultrasonography for suspected upper extremity deep venous thrombosis: a prospective management study.

    Science.gov (United States)

    Kleinjan, Ankie; Di Nisio, Marcello; Beyer-Westendorf, Jan; Camporese, Giuseppe; Cosmi, Benilde; Ghirarduzzi, Angelo; Kamphuisen, Pieter W; Otten, Hans-Martin; Porreca, Ettore; Aggarwal, Anita; Brodmann, Marianne; Guglielmi, Maria Domenica; Iotti, Matteo; Kaasjager, Karin; Kamvissi, Virginia; Lerede, Teresa; Marschang, Peter; Meijer, Karina; Palareti, Gualtiero; Rickles, Frederick R; Righini, Marc; Rutjes, Anne W S; Tonello, Chiara; Verhamme, Peter; Werth, Sebastian; van Wissen, Sanne; Büller, Harry R

    2014-04-01

    Although well-established for suspected lower limb deep venous thrombosis, an algorithm combining a clinical decision score, d-dimer testing, and ultrasonography has not been evaluated for suspected upper extremity deep venous thrombosis (UEDVT). To assess the safety and feasibility of a new diagnostic algorithm in patients with clinically suspected UEDVT. Diagnostic management study. (ClinicalTrials.gov: NCT01324037) SETTING: 16 hospitals in Europe and the United States. 406 inpatients and outpatients with suspected UEDVT. The algorithm consisted of the sequential application of a clinical decision score, d-dimer testing, and ultrasonography. Patients were first categorized as likely or unlikely to have UEDVT; in those with an unlikely score and normal d-dimer levels, UEDVT was excluded. All other patients had (repeated) compression ultrasonography. The primary outcome was the 3-month incidence of symptomatic UEDVT and pulmonary embolism in patients with a normal diagnostic work-up. The algorithm was feasible and completed in 390 of the 406 patients (96%). In 87 patients (21%), an unlikely score combined with normal d-dimer levels excluded UEDVT. Superficial venous thrombosis and UEDVT were diagnosed in 54 (13%) and 103 (25%) patients, respectively. All 249 patients with a normal diagnostic work-up, including those with protocol violations (n = 16), were followed for 3 months. One patient developed UEDVT during follow-up, for an overall failure rate of 0.4% (95% CI, 0.0% to 2.2%). This study was not powered to show the safety of the substrategies. d-Dimer testing was done locally. The combination of a clinical decision score, d-dimer testing, and ultrasonography can safely and effectively exclude UEDVT. If confirmed by other studies, this algorithm has potential as a standard approach to suspected UEDVT. None.

  10. Triceps and Subscapular Skinfold Thickness Percentiles and Cut-Offs for Overweight and Obesity in a Population-Based Sample of Schoolchildren and Adolescents in Bogota, Colombia

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    Robinson Ramírez-Vélez

    2016-09-01

    Full Text Available The assessment of skinfold thickness is an objective measure of adiposity. The aims of this study were to establish Colombian smoothed centile charts and LMS L (Box–Cox transformation, M (median, and S (coefficient of variation tables for triceps, subscapular, and triceps + subscapular skinfolds; appropriate cut-offs were selected using receiver operating characteristic (ROC analysis based on a population-based sample of children and adolescents in Bogotá, Colombia. A cross-sectional study was conducted in 9618 children and adolescents (55.7% girls; age range of 9–17.9 years. Triceps and subscapular skinfold measurements were obtained using standardized methods. We calculated the triceps + subscapular skinfold (T + SS sum. Smoothed percentile curves for triceps and subscapular skinfold thickness were derived using the LMS method. ROC curve analyses were used to evaluate the optimal cut-off point of skinfold thickness for overweight and obesity, based on the International Obesity Task Force definitions. Subscapular and triceps skinfolds and T + SS were significantly higher in girls than in boys (p < 0.001. The ROC analysis showed that subscapular and triceps skinfolds and T + SS have a high discriminatory power in the identification of overweight and obesity in the sample population in this study. Our results provide sex- and age-specific normative reference standards for skinfold thickness values from a population from Bogotá, Colombia.

  11. Triceps and Subscapular Skinfold Thickness Percentiles and Cut-Offs for Overweight and Obesity in a Population-Based Sample of Schoolchildren and Adolescents in Bogota, Colombia

    Science.gov (United States)

    Ramírez-Vélez, Robinson; López-Cifuentes, Mario Ferney; Correa-Bautista, Jorge Enrique; González-Ruíz, Katherine; González-Jiménez, Emilio; Córdoba-Rodríguez, Diana Paola; Vivas, Andrés; Triana-Reina, Hector Reynaldo; Schmidt-RioValle, Jacqueline

    2016-01-01

    The assessment of skinfold thickness is an objective measure of adiposity. The aims of this study were to establish Colombian smoothed centile charts and LMS L (Box–Cox transformation), M (median), and S (coefficient of variation) tables for triceps, subscapular, and triceps + subscapular skinfolds; appropriate cut-offs were selected using receiver operating characteristic (ROC) analysis based on a population-based sample of children and adolescents in Bogotá, Colombia. A cross-sectional study was conducted in 9618 children and adolescents (55.7% girls; age range of 9–17.9 years). Triceps and subscapular skinfold measurements were obtained using standardized methods. We calculated the triceps + subscapular skinfold (T + SS) sum. Smoothed percentile curves for triceps and subscapular skinfold thickness were derived using the LMS method. ROC curve analyses were used to evaluate the optimal cut-off point of skinfold thickness for overweight and obesity, based on the International Obesity Task Force definitions. Subscapular and triceps skinfolds and T + SS were significantly higher in girls than in boys (p < 0.001). The ROC analysis showed that subscapular and triceps skinfolds and T + SS have a high discriminatory power in the identification of overweight and obesity in the sample population in this study. Our results provide sex- and age-specific normative reference standards for skinfold thickness values from a population from Bogotá, Colombia. PMID:27669294

  12. Clinical significance of circulating tumor cells (CTCs) with respect to optimal cut-off value and tumor markers in advanced/metastatic breast cancer.

    Science.gov (United States)

    Shiomi-Mouri, Yukako; Kousaka, Junko; Ando, Takahito; Tetsuka, Rie; Nakano, Shogo; Yoshida, Miwa; Fujii, Kimihito; Akizuki, Miwa; Imai, Tsuneo; Fukutomi, Takashi; Kobayashi, Katsumasa

    2016-01-01

    Although carcinoembryonic antigen (CEA) and cancer antigen 15-3 (CA15-3) are useful tumor markers (TMs) in metastatic breast cancer (MBC), circulating tumor cells (CTCs) are also detected in patients with advanced or metastatic breast cancer. We analyzed CTCs in MBC patients in order to establish the optimal cut-off value, to evaluate the prognostic utility of CTC count, and to clarify whether CTC count could provide information in addition to CEA and CA15-3. We studied 98 MBC patients enrolled between June 2007 and March 2013. To quantify CTCs, 7.5 ml of blood was collected and CEA and CA15-3 were measured simultaneously. CTCs were counted using the CellSearch™ System. The CTC count was dichotomized as 0 (CTC-negative) or ≥1 (CTC-positive). The clinical significance of CTCs was evaluated in terms of its relationship with levels of CEA and CA15-3. Associations between qualitative variables were evaluated using the chi-square test. In order to evaluate the predictive value of CTCs for advanced or metastatic breast cancer, multivariate Cox proportional hazards modeling was used to calculate hazard ratios. With a CTC cut-off value of 1, there were 53 (54.1 %) CTC-negative patients and 45 (45.9 %) CTC-positive patients. Patients in the CTC-positive group had worse survival than those in the CTC-negative group (p CEA and CA15-3.

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

    Science.gov (United States)

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

    2018-04-01

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

  14. Which are the best cut-off values for predicting different stages of liver fibrosis for 2d-swe.ge in daily practice?

    Directory of Open Access Journals (Sweden)

    Felix Bende1,

    2016-12-01

    Full Text Available OBJECTIVES AND BACKGROUND To evaluate the performance of 2D share wave elastography from General Electric (2D-SWE.GE for the noninvasive assessment of liver fibrosis and to identify liver stiffness (LS cut-off values for predicting different stages of fibrosis, using Transient Elastography (TE as the reference method. MATERIALS AND METHODS The study group included 331 consecutive subjects with or without chronic hepatopathies in whom liver stiffness (LS was evaluated in the same session by means of 2 elastographic techniques: TE (FibroScan, EchoSens, Paris, France, M or XL probes and 2D-SWE.GE (LOGIQ E9, GE Healthcare, Chalfont St Giles, United Kingdom, C1-6-D convex probe. Reliable LS measurements were defined as follows: for TE – the median value of 10 measurements with a success rate of ≥60% and an interquartile range <30% and for 2DSWE.GE - the median value of 10 measurements acquired in a homogenous area and an interquartile range (IQR <30%. To discriminate between various stages of fibrosis using TE we applied the following cut-offs: F2 - 7 kPa; F3 - 9.5 kPa and F4 - 12 kPa (1. RESULTS Reliable LS measurements were obtained in 317/331 (95.8% subjects by 2D-SWE.GE, and in 312/331 (94.2% by TE (p=0.44. The final analysis was performed on 303 subjects with valid measurements using both methods. Based on TE cut-off values we divided our cohort into the following groups: F<2: 30.1%; F=2: 10.2%; F=3: 12.2%; F=4: 47.5%. We found a strong correlation between the obtained LS values following the application of the 2 methods: r=0.83, p<0.0001. Overall, LS values obtained by means of 2D-SWE.GE were significantly lower than those obtained by TE: 10.14±4.24 kPa vs. 16.72±13.4 (p<0.0001. The best cut-off value for F≥2 was 6.7 kPa, for F≥3 it was 8.2 kPa and for F=4 it was 9.3 kPa. CONCLUSIONS The best 2D-SWE.GE cut-off values for predicting F≥2, F≥3 and F=4 were 6.7, 8.2 and 9.3 kPa. REFERENCES 1.Tsochatzis EA, Gurusamy KS, Ntaoula S

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

    Science.gov (United States)

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

    2017-01-01

    To measure the sensitivity and specificity of differences cut-off values for isokinetic Hcon/Qcon ratio in order to improve the capacity to evaluate (retrospectively) the injury of hamstring muscles in professional soccer screened with knee isokinetic tests. Retrospective study. Medical and biomechanical data of professional football players playing for the same team for at least one season between 2010 and 2016 were analysed. Hamstring strain injury cases and the reports generated via isokinetic testing were investigated. Isokinetic concentric(con) hamstring(H) and quadriceps(Q) absolute strength in addition with Hcon/Qcon ratio were examined for the injured versus uninjured limbs among injured players, and for the injured and non-injured players. 2 x 2 contingency table was used for comparing variables: predicted injured or predicted uninjured with actual injured or actual uninjured. Sensitivity, specificity, accuracy, positive and negative predictive values, and positive and negative likelihood ratio were calculated for three different cut-off values (0.47 vs. 0.6 vs. 0.658) to compare the discriminative power of an isokinetic test, whilst examining the key value of Hcon/Qcon ratio which may indicate the highest level of ability to predispose a player to injury. McNemar's chi2 test with Yates's correction was used to determine agreement between the tests. PQStat software was used for all statistical analysis, and an alpha level of p hamstring injuries during the analysed period. None of these players sustained recurrence of hamstring injury. One player sustained hamstring strain injury on both legs, thus the total number of injuries was 12. Application of different cut-off values for Hcon/Qcon significantly affected the sensitivity and specificity of isokinetic test used as a tool for muscle injury detection. The use of 0.47 of Hcon/Qcon as a discriminate value resulted in significantly lower sensitivity when compared to 0.658 threshold (sensitivity of 16.7% vs

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

    Science.gov (United States)

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

    2017-01-01

    Objective To measure the sensitivity and specificity of differences cut-off values for isokinetic Hcon/Qcon ratio in order to improve the capacity to evaluate (retrospectively) the injury of hamstring muscles in professional soccer screened with knee isokinetic tests. Design Retrospective study. Methods Medical and biomechanical data of professional football players playing for the same team for at least one season between 2010 and 2016 were analysed. Hamstring strain injury cases and the reports generated via isokinetic testing were investigated. Isokinetic concentric(con) hamstring(H) and quadriceps(Q) absolute strength in addition with Hcon/Qcon ratio were examined for the injured versus uninjured limbs among injured players, and for the injured and non-injured players. 2 x 2 contingency table was used for comparing variables: predicted injured or predicted uninjured with actual injured or actual uninjured. Sensitivity, specificity, accuracy, positive and negative predictive values, and positive and negative likelihood ratio were calculated for three different cut-off values (0.47 vs. 0.6 vs. 0.658) to compare the discriminative power of an isokinetic test, whilst examining the key value of Hcon/Qcon ratio which may indicate the highest level of ability to predispose a player to injury. McNemar’s chi2 test with Yates’s correction was used to determine agreement between the tests. PQStat software was used for all statistical analysis, and an alpha level of p reports on both limbs of 66 professional soccer players were analysed. Eleven players suffered hamstring injuries during the analysed period. None of these players sustained recurrence of hamstring injury. One player sustained hamstring strain injury on both legs, thus the total number of injuries was 12. Application of different cut-off values for Hcon/Qcon significantly affected the sensitivity and specificity of isokinetic test used as a tool for muscle injury detection. The use of 0.47 of Hcon/Qcon as

  17. Yield and Water Productivity Responses to Irrigation Cut-off Strategies after Fruit Set Using Stem Water Potential Thresholds in a Super-High Density Olive Orchard

    Directory of Open Access Journals (Sweden)

    Luis E. Ahumada-Orellana

    2017-07-01

    Full Text Available An increase in the land area dedicated to super-high density olive orchards has occurred in Chile in recent years. Such modern orchards have high irrigation requirements, and optimizing water use is a priority. Moreover, this region presents low water availability, which makes necessary to establish irrigation strategies to improve water productivity. An experiment was conducted during four consecutive growing seasons (2010–2011 to 2013–2014 to evaluate the responses of yield and water productivity to irrigation cut-off strategies. These strategies were applied after fruit set using midday stem water potential (Ψstem thresholds in a super-high density olive orchard (cv. Arbequina, located in the Pencahue Valley, Maule Region, Chile. The experimental design was completely randomized with four irrigation cut-off treatments based on the Ψstem thresholds and four replicate plots per treatment (five trees per plot. Similar to commercial growing conditions in our region, the Ψstem in the T1 treatment was maintained between -1.4 and -2.2 MPa (100% of actual evapotranspiration, while T2, T3 and T4 treatments did not receive irrigation from fruit set until they reached a Ψstem threshold of approximately -3.5, -5.0, and -6.0 MPa, respectively. Once the specific thresholds were reached, irrigation was restored and maintained as T1 in all treatments until fruits were harvested. Yield and its components were not significantly different between T1 and T2, but fruit yield and total oil yield, fruit weight, and fruit diameter were decreased by the T3 and T4 treatments. Moreover, yield showed a linear response with water stress integral (SΨ, which was strongly influenced by fruit load. Total oil content (% and pulp/stone ratio were not affected by the different irrigation strategies. Also, fruit and oil water productivities were significantly greater in T1 and T2 than in the T3 and T4. Moreover, the T2, T3, and T4 treatments averaged 37, 51, and 72 days

  18. Yield and Water Productivity Responses to Irrigation Cut-off Strategies after Fruit Set Using Stem Water Potential Thresholds in a Super-High Density Olive Orchard

    Science.gov (United States)

    Ahumada-Orellana, Luis E.; Ortega-Farías, Samuel; Searles, Peter S.; Retamales, Jorge B.

    2017-01-01

    An increase in the land area dedicated to super-high density olive orchards has occurred in Chile in recent years. Such modern orchards have high irrigation requirements, and optimizing water use is a priority. Moreover, this region presents low water availability, which makes necessary to establish irrigation strategies to improve water productivity. An experiment was conducted during four consecutive growing seasons (2010–2011 to 2013–2014) to evaluate the responses of yield and water productivity to irrigation cut-off strategies. These strategies were applied after fruit set using midday stem water potential (Ψstem) thresholds in a super-high density olive orchard (cv. Arbequina), located in the Pencahue Valley, Maule Region, Chile. The experimental design was completely randomized with four irrigation cut-off treatments based on the Ψstem thresholds and four replicate plots per treatment (five trees per plot). Similar to commercial growing conditions in our region, the Ψstem in the T1 treatment was maintained between -1.4 and -2.2 MPa (100% of actual evapotranspiration), while T2, T3 and T4 treatments did not receive irrigation from fruit set until they reached a Ψstem threshold of approximately -3.5, -5.0, and -6.0 MPa, respectively. Once the specific thresholds were reached, irrigation was restored and maintained as T1 in all treatments until fruits were harvested. Yield and its components were not significantly different between T1 and T2, but fruit yield and total oil yield, fruit weight, and fruit diameter were decreased by the T3 and T4 treatments. Moreover, yield showed a linear response with water stress integral (SΨ), which was strongly influenced by fruit load. Total oil content (%) and pulp/stone ratio were not affected by the different irrigation strategies. Also, fruit and oil water productivities were significantly greater in T1 and T2 than in the T3 and T4. Moreover, the T2, T3, and T4 treatments averaged 37, 51, and 72 days without

  19. Combined use of the National Early Warning Score and D-dimer levels to predict 30-day and 365-day mortality in medical patients

    DEFF Research Database (Denmark)

    Nickel, Christian H; Kellett, John; Cooksley, Tim

    2016-01-01

    AIM: To investigate the combined use of NEWS and D-dimer levels to predict the 30-day and 365-day mortality rates of a cohort of Danish patients with complete follow-up. METHODS: Post-hoc retrospective observational study of acutely admitted medical patients aged 18 years or older who had D...... with a NEWS on admission score

  20. Use of a clinical decision rule in combination with D-dimer concentration in diagnostic workup of patients with suspected pulmonary embolism - A prospective management study

    NARCIS (Netherlands)

    Kruip, Marieke J. H. A.; Slob, Marjan J.; Schijen, Joost H. E. M.; van der Heul, Cees; Büller, Harry R.

    2002-01-01

    Background: We designed a diagnostic strategy, based on clinical probability and D-dimer concentration, to select patients who were unlikely to have pulmonary embolism (PE), before further diagnostic workup was performed. The utility and safety of this strategy were evaluated in a prospective

  1. Safety and feasibility of a diagnostic algorithm combining clinical probability, d-dimer testing, and ultrasonography for suspected upper extremity deep venous thrombosis : a prospective management study

    NARCIS (Netherlands)

    Kleinjan, Ankie; Di Nisio, Marcello; Beyer-Westendorf, Jan; Camporese, Giuseppe; Cosmi, Benilde; Ghirarduzzi, Angelo; Kamphuisen, Pieter W.; Otten, Hans-Martin; Porreca, Ettore; Aggarwal, Anita; Brodmann, Marianne; Guglielmi, Maria Domenica; Iotti, Matteo; Kaasjager, Karin; Kamvissi, Virginia; Lerede, Teresa; Marschang, Peter; Meijer, Karina; Palareti, Gualtiero; Rickles, Frederick R.; Righini, Marc; Rutjes, Anne W.S.; Tonello, Chiara; Verhamme, Peter; Werth, Sebastian; Van Wissen, Sanne; Büller, Harry R.

    2014-01-01

    Background: Although well-established for suspected lower limb deep venous thrombosis, an algorithm combining a clinical decision score, D-dimer testing, and ultrasonography has not been evaluated for suspected upper extremity deep venous thrombosis (UEDVT). Objective: To assess the safety and

  2. A cut-off of 2150 cytokeratin 19 mRNA copy number in sentinel lymph node may be a powerful predictor of non-sentinel lymph node status in breast cancer patients.

    Directory of Open Access Journals (Sweden)

    Irene Terrenato

    Full Text Available Since 2007, one-step nucleic acid amplification (OSNA has been used as a diagnostic system for sentinel lymph node (SLN examination in patients with breast cancer. This study aimed to define a new clinical cut-off of CK19 mRNA copy number based on the calculation of the risk that an axillary lymph node dissection (ALND will be positive. We analyzed 1529 SLNs from 1140 patients with the OSNA assay and 318 patients with positive SLNs for micrometastasis (250 copies and macrometastasis (5000 copies underwent ALND. Axillary non-SLNs were routinely examined. ROC curves and Youden's index were performed in order to identify a new cut-off value. Logistic regression models were performed in order to compare OSNA categorical variables created on the basis of our and traditional cut-off to better identify patients who really need an axillary dissection. 69% and 31% of OSNA positive patients had a negative and positive ALND, respectively. ROC analysis identified a cut-off of 2150 CK19 mRNA copies with 95% sensitivity and 51% specificity. Positive and negative predictive values of this new cut-off were 47% and 96%, respectively. Logistic regression models indicated that the cut-off of 2150 copies better discriminates patients with node negative or positive in comparison with the conventional OSNA cut-off (p<0.0001. This cut-off identifies false positive and false negative cases and true-positive and true negative cases very efficiently, and therefore better identifies which patients really need an ALND and which patients can avoid one. This is why we suggest that the negative cut-off should be raised from 250 to 2150. Furthermore, we propose that for patients with a copy number that ranges between 2150 and 5000, there should be a multidisciplinary discussion concerning the clinical and bio-morphological features of primary breast cancer before any decision is taken on whether to perform an ALND or not.

  3. Predictive values of D-dimer assay, GRACE scores and TIMI scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Satilmisoglu MH

    2017-03-01

    Full Text Available Muhammet Hulusi Satilmisoglu,1 Sinem Ozbay Ozyilmaz,1 Mehmet Gul,1 Hayriye Ak Yildirim,2 Osman Kayapinar,3 Kadir Gokturk,4 Huseyin Aksu,1 Korhan Erkanli,5 Abdurrahman Eksik1 1Department of Cardiology, 2Department of Biochemistry, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 3Department of Cardiology, Duzce University Faculty of Medicine, Duzce, 4Department of Infectious Diseases, 5Department of Thoracic and Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey Purpose: To determine the predictive values of D-dimer assay, Global Registry of Acute Coronary Events (GRACE and Thrombolysis in Myocardial Infarction (TIMI risk scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction (NSTEMI.Patients and methods: A total of 234 patients (mean age: 57.2±11.7 years, 75.2% were males hospitalized with NSTEMI were included. Data on D-dimer assay, GRACE and TIMI risk scores were recorded. Logistic regression analysis was conducted to determine the risk factors predicting increased mortality.Results: Median D-dimer levels were 349.5 (48.0–7,210.0 ng/mL, the average TIMI score was 3.2±1.2 and the GRACE score was 90.4±27.6 with high GRACE scores (>118 in 17.5% of patients. The GRACE score was correlated positively with both the D-dimer assay (r=0.215, P=0.01 and TIMI scores (r=0.504, P=0.000. Multivariate logistic regression analysis revealed that higher creatinine levels (odds ratio =18.465, 95% confidence interval: 1.059–322.084, P=0.046 constituted the only significant predictor of increased mortality risk with no predictive values for age, D-dimer assay, ejection fraction, glucose, hemoglobin A1c, sodium, albumin or total cholesterol levels for mortality.Conclusion: Serum creatinine levels constituted the sole independent determinant of mortality risk, with no significant values for D-dimer

  4. Highly scalable 3-D NAND-NOR hybrid-type dual bit per cell flash memory devices with an additional cut-off gate

    International Nuclear Information System (INIS)

    Cho, Seongjae; Shim, Wonbo; Park, Ilhan; Kim, Yoon; Park, Byunggook

    2010-01-01

    In this work, a nonvolatile memory (NVM) device of novel structure in 3 dimensions is introduced, and its operation physics is validated. It is based on a pillar structure in which two identical storage nodes are located for dual-bit operation. The two storage nodes on neighboring pillars are controlled by using one common control gate so that the space between silicon pillars can be further reduced. For compatibility with conventional memory operations, an additional cut-off gate is constructed under the common control gate. This is considered as the ultimate form for a 3-D nonvolatile memory device based on a double-gate structure. The underlying physics is explained, and the operational schemes are validated in various aspects by using a numerical device simulation. Also, critical issues in device design for higher reliability are discussed.

  5. Japanese version of the Montreal Cognitive Assessment cut-off score to clarify improvement of mild cognitive impairment after exercise training in community-dwelling older adults.

    Science.gov (United States)

    Nara, Marina; Sugie, Masamitsu; Takahashi, Tetsuya; Koyama, Teruyuki; Sengoku, Renpei; Fujiwara, Yoshinori; Obuchi, Shuichi; Harada, Kazumasa; Kyo, Shunei; Ito, Hideki

    2018-02-02

    Physical exercise improves cognitive function in people with mild cognitive impairment (MCI). However, information about whether the degree of MCI before exercise training affects improvement in cognitive function is lacking. Therefore, we aimed to investigate the cut-off value in a MCI screening tool that predicts reversal to normal cognitive function after exercise training in older adults with MCI. Participants included 112 Japanese community-dwelling older adult outpatients (37 men, 75 women; mean age 76.3 years). We administered the Japanese version of the Montreal Cognitive Assessment (MoCA-J) before and after exercise training. MCI was defined as a MoCA-J score dwelling Japanese older adults with MCI. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 The Authors Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.

  6. Evaluation of the Value of d-Dimer, P-Selectin, and Platelet Count for Prediction of Portal Vein Thrombosis After Devascularization.

    Science.gov (United States)

    Fei, Yang; Zong, Guang-Quan; Chen, Jian; Liu, Ren-Min

    2016-07-01

    To evaluate the value of d-dimer, P-selectin, and platelet count in patients with cirrhotic portal hypertension (PHT) for prediction of portal vein thrombosis (PVT) after devascularization. A total of 137 patients with cirrhotic PHT who undergone devascularization from January 2012 to April 2014 were retrospectively reviewed, all of them were divided into 2 groups (PVT group and non-PVT group) by Doppler ultrasonography (DU) examination. The level of d-dimer, P-selectin, and platelet count was tested during the perioperative period. In all, 38 (27.7%) patients were found to have PVT by DU examination postoperatively. In contrast to the non-PVT group, the level of d-dimer, P-selectin, and platelet count in the PVT group was much higher significantly at 1, 3, and 7 days after devascularization. (P P-selectin between the 2 groups was not significant (P = .260). It was shown that the highest sensitivity of the 3 markers for PVT was d-dimer, the highest specificity belonged to P-selectin. The area under receiver-operating characteristic (ROC) curve of P-selectin was the biggest of the 3 markers. When the 3 markers were combined to be used to diagnose PVT, the sensitivity was increased to 0.907, with a slight drop of specificity to 0.693, the area under the ROC curve was 0.927. The level of d-dimer, P-selectin, and platelet count might be good candidate predictive markers for PVT in patients with cirrhotic PHT after devascularization. The combined test of the 3 markers can increase the value of prediction. © The Author(s) 2015.

  7. Adult or not? Accuracy of Cameriere's cut-off value for third molar in assessing 18 years of age for legal purposes.

    Science.gov (United States)

    Cameriere, R; Pacifici, A; Viva, S; Carbone, D; Pacifici, L; Polimeni, A

    2014-09-01

    The discovery of reliable means to determine the age of an individual is a fundamental objective in forensic medicine, in consideration of the constant increase of illegal immigration into the European community. In 2008 Cameriere et al. developed a method based on the relationship between age and the third molar index (I3m), which assesses the degree of maturation of the third molar through measurements made on orthopantomography. The purpose of this work was to test the accuracy of Cameriere's cut-off for I3m as a tool to assess full age (18) on a new sample of living subjects. Orthopantomographs of 287 Italian living subjects aged between 13 and 22 years have been randomly selected and included in the study. Identification number, gender, date of birth and date of execution of the radiograph were recorded for each patient on a Microsoft Excel® spreadsheet. Radiographs were digitalized and analyzed using a computerized image-processing program (Adobe® Photoshop® CS4). The results show that the sensitivity of the test was 84.1% and the specificity was 92.5%. The estimated post-test probability was 90.1%, with a confidence interval of 95% (83.6%, 95.2%). Thus, the probability that a person being positive to the test has 18 or more years of age was 90.1%. The results highlight the contribution of Cameriere's cut-off value for the I3m in the assessment of full age, always remembering that the simultaneous employment of previously introduced complementary methods is essential for the purpose.

  8. EARLY APPLICATION OF HIGH CUT-OFF HAEMODYALISIS FOR DE-NOVO MYELOMA NEPHROPATHY IS ASSOCIATED WITH LONG-TERM DIALYSIS-INDEPENDENCY AND RENAL RECOVERY

    Directory of Open Access Journals (Sweden)

    Alhossain A. Khalafallah

    2013-01-01

    Full Text Available Background Multiple myeloma (MM is a haematological malignancy associated with kidney injury resulting from cast nephropathy, which can be caused by monoclonal free light chains (FLC. It has been demonstrated that reduction of FLC can lead to a higher proportion of patients recovering renal function with a better outcome, especially if extended high cut-off haemodialysis (HCO-HD combined with chemotherapy is used. Patients and Methods In this study, four cases of MM nephropathy were treated with HCO-HD and chemotherapy at a single institution during the period from August 2009 to August 2011. All of the patients presented with acute renal failure and high serum FLC. All patients underwent a bone marrow biopsy to confirm the diagnosis of MM, according to the WHO criteria. Three patients had de-novo MM and one patient had relapsed light chain myeloma disease. All patients underwent HCO-HD concomitantly with specific myeloma therapy once the diagnosis or relapse of MM was established. Results After a median follow up of 26 months, (range, 13-36 our data showed that all patients had a significant decrease in serum FLC through HCO-HD, proving the effectiveness of HCO-HD in managing MM. De-novo MM patients restored their renal function and achieved low-level FLC early on the treatment and become dialysis-independent. One patient with relapsed myeloma remained dialysis dependant. Conclusion Our study suggests that if myeloma nephropathy associated with light-chain disease, HCO-HD should be initiated as early as possible. At the same time a specific MM treatment should be initiated to gain control of the disease and salvage the kidneys in order to achieve dialysis-independency. Further trials to confirm our results are warranted. Key Words: Multiple myeloma, renal failure, High cut-off haemodialysis, chemotherapy, outcome.

  9. The optimum cut-off value to differentiate Echinococcus granulosus sensu stricto from other species of E. granulosus sensu lato using larval rostellar hook morphometry.

    Science.gov (United States)

    Soriano, S V; Pierangeli, N B; Pianciola, L A; Mazzeo, M; Lazzarini, L E; Debiaggi, M F; Bergagna, H F J; Basualdo, J A

    2015-01-01

    Cystic echinococcosis caused by Echinococcus granulosus sensu lato is one of the most important helminth zoonoses in the world; it affects both humans and livestock. The disease is endemic in Argentina and highly endemic in the province of Neuquén. Considerable genetic and phenotypic variation has been demonstrated in E. granulosus, and ten different genotypes (G1-G10) have been identified using molecular tools. Echinococcus granulosus sensu lato may be considered a species complex, comprised of E. granulosus sensu stricto (G1-G3), E. equinus (G4), E. ortleppi (G5) and E. canadensis (G6-G10). In endemic areas, the characterization of cystic echinococcosis molecular epidemiology is important in order to apply adequate control strategies. A cut-off value for larval large hook total length to distinguish E. granulosus sensu stricto isolates from those produced by other species of the complex was defined for the first time. Overall, 1780 larval hooks of 36 isolates obtained from sheep (n= 11, G1), goats (n= 10, G6), cattle (n= 5, G6) and pigs (n= 10, G7) were analysed. Validation against molecular genotyping as gold standard was carried out using the receiver operating characteristic (ROC) curve analysis. The optimum cut-off value was defined as 26.5 μm. The proposed method showed high sensitivity (97.8%) and specificity (91.1%). Since in most endemic regions the molecular epidemiology of echinococcosis includes the coexistence of the widely distributed E. granulosus sensu stricto G1 strain and other species of the complex, this technique could be useful as a quick and economical tool for epidemiological and surveillance field studies, when fertile cysts are present.

  10. D-dimer Test

    Science.gov (United States)

    ... or trauma Hospitalization or living in a nursing home Prolonged immobility—this can include long trips by plane, car, etc. or prolonged bed rest Use of birth control or hormone replacement therapy Broken bone, cast Pregnancy or recent childbirth Antiphospholipid syndrome ...

  11. CA-125 cut-off value as a predictor for complete interval debulking surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer

    Science.gov (United States)

    Sasaki, Yoshikazu; Shigemitsu, Aiko; Akasaka, Juria; Kanayama, Seiji; Kawaguchi, Ryuji; Kobayashi, Hiroshi

    2013-01-01

    Objective In the present study, we evaluated changes in CA-125 cut-off values predictive of complete interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) using receiver operating characteristic (ROC) analysis. Methods This retrospective single-institution study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer and a pre-NAC serum CA-125 level of greater than 40 U/mL who were treated with neoadjuvant platinum-based chemotherapy followed by IDS between 1994 and 2009. Logistic regression analysis was used to evaluate univariate and independent multivariate associations with the effect of clinical, pathological, and CA-125 parameters on complete IDS, and ROC analysis was used to determine potential cut-off values of CA-125 for prediction of the possibility of complete IDS. Results Seventy-five patients were identified. Complete IDS was achieved in 46 (61.3%) patients and non-complete IDS was observed 29 (38.7%). Median pre-NAC CA-125 level was 639 U/mL (range, 57 to 6,539 U/mL) in the complete IDS group and 1,427 U/mL (range, 45 to 10,989 U/mL) in the non-complete IDS group. Median pre-IDS CA-125 level was 15 U/mL (range, 2 to 60 U/mL) in the complete IDS group and 53 U/mL (range, 5 to 980 U/mL) in the non-complete IDS group (pCA-125 as an independent predictor. The odds ratio of non-complete IDS was 10.861 when the pre-IDS CA-125 level was greater than 20 U/mL. Conclusion The present data suggest that in the setting of IDS after platinum-based NAC for advanced ovarian cancer, a pre-IDS CA-125 level less than 20 U/mL is an independent predictor of complete IDS. PMID:23653831

  12. Usefulness of Clinical Prediction Rules, D-dimer, and Arterial Blood Gas Analysis to Predict Pulmonary Embolism in Cancer Patients

    Directory of Open Access Journals (Sweden)

    Shazia Awan

    2017-03-01

    Full Text Available Objectives: Pulmonary embolism (PE is seven times more common in cancer patients than non-cancer patients. Since the existing clinical prediction rules (CPRs were validated predominantly in a non-cancer population, we decided to look at the utility of arterial blood gas (ABG analysis and D-dimer in predicting PE in cancer patients. Methods: Electronic medical records were reviewed between December 2005 and November 2010. A total of 177 computed tomography pulmonary angiograms (CTPAs were performed. We selected 104 individuals based on completeness of laboratory and clinical data. Patients were divided into two groups, CTPA positive (patients with PE and CTPA negative (PE excluded. Wells score, Geneva score, and modified Geneva score were calculated for each patient. Primary outcomes of interest were the sensitivities, specificities, positive, and negative predictive values for all three CPRs. Results: Of the total of 104 individuals who had CTPAs, 33 (31.7% were positive for PE and 71 (68.3% were negative. There was no difference in basic demographics between the two groups. Laboratory parameters were compared and partial pressure of oxygen was significantly lower in patients with PE (68.1 mmHg vs. 71 mmHg, p = 0.030. Clinical prediction rules showed good sensitivities (88−100% and negative predictive values (93−100%. An alveolar-arterial (A-a gradient > 20 had 100% sensitivity and negative predictive values. Conclusions: CPRs and a low A-a gradient were useful in excluding PE in cancer patients. There is a need for prospective trials to validate these results.

  13. Relationship between Plasma D-Dimer Concentration and Three-Dimensional Ultrasound Placental Volume in Women at Risk for Placental Vascular Diseases: A Monocentric Prospective Study

    OpenAIRE

    Fanget, C?cile; Chauleur, C?line; Stadler, Amandine; Presles, Emilie; Varlet, Marie-No?lle; Gris, Jean-Christophe; Raia-Barjat, Tiphaine

    2016-01-01

    Introduction The aim of this study was to correlate placental volumes deduced from three-dimensional ultrasound and virtual organ computer-aided analysis (VOCAL) software with systemic concentrations of D-dimer and soluble endothelial protein C receptor (sEPCR). Methods This was a monocentric experimental prospective study conducted from October 2008 to July 2009. Forty consecutive patients at risk of placental vascular pathology (PVP) recurrence or occurrence were included. Placental volumes...

  14. Dual energy CT pulmonary blood volume assessment in acute pulmonary embolism - correlation with D-dimer level, right heart strain and clinical outcome

    International Nuclear Information System (INIS)

    Bauer, Ralf W.; Frellesen, Claudia; Schell, Boris; Lehnert, Thomas; Jacobi, Volkmar; Vogl, Thomas J.; Kerl, J.M.; Renker, Matthias; Ackermann, Hanns; Schoepf, U.J.

    2011-01-01

    To investigate the role of perfusion defect (PD) size on dual energy CT pulmonary blood volume assessment as predictor of right heart strain and patient outcome and its correlation with d-dimer levels in acute pulmonary embolism (PE). 53 patients with acute PE who underwent DECT pulmonary angiography were retrospectively analyzed. Pulmonary PD size caused by PE was measured on DE iodine maps and quantified absolutely (VolPD) and relatively to the total lung volume (RelPD). Signs of right heart strain (RHS) on CT were determined. Information on d-dimer levels and readmission for recurrent onset of PE and death was collected. D-dimer level was mildly (r = 0.43-0.47) correlated with PD size. Patients with RHS had significantly higher VolPD (215 vs. 73 ml) and RelPD (9.9 vs. 2.9%) than patients without RHS (p 5% RelPD, while no such events were found for patients with <5% RelPD. Pulmonary blood volume on DECT in acute PE correlates with RHS and appears to be a predictor of patient outcome in this pilot study. (orig.)

  15. Determination of D-Dimers in condition of emergency: the D-Di Liatest. Threshold value in elimination of pulmonary emboli (PE)

    International Nuclear Information System (INIS)

    Duet, M.; Soria, C.; Elkarrat, D.; Benelhadj, S.; Bailliard, O.; Kedra, A.W.; Drouet, L.; Mundler, O.

    1997-01-01

    Several studies have shown that a low rate of D-Dimers (products of fibrin decay) measured by Elisa technique can eliminate the diagnosis of thrombo-embolic disease. However, the conventional Elisa technique is not adapted to emergency conditions. A new agglutination test of latex microparticles (D-Di Liatest) has been developed by Diagnostica Stago with a sensitivity of 100 ng/ml. Our goal was to determine the threshold of PE exclusion. Ninety six patients suspected of PE were included. The pulmonary perfusion scintigraphy (PPS), as a reference examination the positivity of which has been confirmed by clinical follow-up, has been carried out in association with the determination of plasmatic rates of D-Dimers by the techniques Elisa and Liatest based on different antibodies. A table is given containing the D-Di threshold rates obtained by these techniques. In conclusion, our results showed that the rate of D-Dimers which eliminate a PE is ≤ 500 ng/ml by Elisa and ≤ 400 ng/ml by Liatest with a VPN of 100%. However, the PPS remains necessary in 77% of cases. This work stresses the necessity of clinical validations for the new biological tests

  16. Optimal cut-off of homeostasis model assessment of insulin resistance (HOMA-IR) for the diagnosis of metabolic syndrome: third national surveillance of risk factors of non-communicable diseases in Iran (SuRFNCD-2007).

    Science.gov (United States)

    Esteghamati, Alireza; Ashraf, Haleh; Khalilzadeh, Omid; Zandieh, Ali; Nakhjavani, Manouchehr; Rashidi, Armin; Haghazali, Mehrdad; Asgari, Fereshteh

    2010-04-07

    We have recently determined the optimal cut-off of the homeostatic model assessment of insulin resistance for the diagnosis of insulin resistance (IR) and metabolic syndrome (MetS) in non-diabetic residents of Tehran, the capital of Iran. The aim of the present study is to establish the optimal cut-off at the national level in the Iranian population with and without diabetes. Data of the third National Surveillance of Risk Factors of Non-Communicable Diseases, available for 3,071 adult Iranian individuals aging 25-64 years were analyzed. MetS was defined according to the Adult Treatment Panel III (ATPIII) and International Diabetes Federation (IDF) criteria. HOMA-IR cut-offs from the 50th to the 95th percentile were calculated and sensitivity, specificity, and positive likelihood ratio for MetS diagnosis were determined. The receiver operating characteristic (ROC) curves of HOMA-IR for MetS diagnosis were depicted, and the optimal cut-offs were determined by two different methods: Youden index, and the shortest distance from the top left corner of the curve. The area under the curve (AUC) (95%CI) was 0.650 (0.631-0.670) for IDF-defined MetS and 0.683 (0.664-0.703) with the ATPIII definition. The optimal HOMA-IR cut-off for the diagnosis of IDF- and ATPIII-defined MetS in non-diabetic individuals was 1.775 (sensitivity: 57.3%, specificity: 65.3%, with ATPIII; sensitivity: 55.9%, specificity: 64.7%, with IDF). The optimal cut-offs in diabetic individuals were 3.875 (sensitivity: 49.7%, specificity: 69.6%) and 4.325 (sensitivity: 45.4%, specificity: 69.0%) for ATPIII- and IDF-defined MetS, respectively. We determined the optimal HOMA-IR cut-off points for the diagnosis of MetS in the Iranian population with and without diabetes.

  17. Optimal cut-off of homeostasis model assessment of insulin resistance (HOMA-IR for the diagnosis of metabolic syndrome: third national surveillance of risk factors of non-communicable diseases in Iran (SuRFNCD-2007

    Directory of Open Access Journals (Sweden)

    Rashidi Armin

    2010-04-01

    Full Text Available Abstract Aim We have recently determined the optimal cut-off of the homeostatic model assessment of insulin resistance for the diagnosis of insulin resistance (IR and metabolic syndrome (MetS in non-diabetic residents of Tehran, the capital of Iran. The aim of the present study is to establish the optimal cut-off at the national level in the Iranian population with and without diabetes. Methods Data of the third National Surveillance of Risk Factors of Non-Communicable Diseases, available for 3,071 adult Iranian individuals aging 25-64 years were analyzed. MetS was defined according to the Adult Treatment Panel III (ATPIII and International Diabetes Federation (IDF criteria. HOMA-IR cut-offs from the 50th to the 95th percentile were calculated and sensitivity, specificity, and positive likelihood ratio for MetS diagnosis were determined. The receiver operating characteristic (ROC curves of HOMA-IR for MetS diagnosis were depicted, and the optimal cut-offs were determined by two different methods: Youden index, and the shortest distance from the top left corner of the curve. Results The area under the curve (AUC (95%CI was 0.650 (0.631-0.670 for IDF-defined MetS and 0.683 (0.664-0.703 with the ATPIII definition. The optimal HOMA-IR cut-off for the diagnosis of IDF- and ATPIII-defined MetS in non-diabetic individuals was 1.775 (sensitivity: 57.3%, specificity: 65.3%, with ATPIII; sensitivity: 55.9%, specificity: 64.7%, with IDF. The optimal cut-offs in diabetic individuals were 3.875 (sensitivity: 49.7%, specificity: 69.6% and 4.325 (sensitivity: 45.4%, specificity: 69.0% for ATPIII- and IDF-defined MetS, respectively. Conclusion We determined the optimal HOMA-IR cut-off points for the diagnosis of MetS in the Iranian population with and without diabetes.

  18. A cut-off in ocular chemesthesis from vapors of homologous alkylbenzenes and 2-ketones as revealed by concentration-detection functions

    International Nuclear Information System (INIS)

    Cometto-Muniz, J. Enrique; Abraham, Michael H.

    2008-01-01

    Studies of homologous series of environmental vapors have shown that their chemesthetic (i.e., sensory irritation) potency increases with carbon chain length (that is, their detection thresholds decrease) until they reach a homolog that fails to be detected, even at vapor saturation. All ensuing homologs cannot be detected either. In this investigation, we measured concentration-detection (i.e., psychometric) functions for ocular chemesthesis from homologous alkylbenzenes (pentyl, hexyl, and heptyl benzene) and 2-ketones (undecanone, dodecanone, and tridecanone). Using a three-alternative forced-choice procedure against air blanks, we tested a total of 18 to 24 subjects, about half of them females, average age 31 years, ranging from 18 to 56 years. Stimuli were generated and presented by a computer-controlled, vapor delivery device whose output was quantified by gas chromatography. Exposure time was 6 s and delivery flow 2.5 L/min. Within the context of present and previous findings, the outcome indicated that the functions for heptylbenzene and 2-tridecanone reached a plateau where further increases in concentration did not enhance detection. We conclude that: a) a cut-off point in ocular chemesthetic detection is reached along homologous alkylbenzenes and 2-ketones at the level of heptylbenzene and 2-tridecanone, respectively, and b) the observed effect rests on the homologs exceeding a critical molecular size (or dimension) rather than on them failing to achieve a high enough vapor concentration

  19. The Einsteinian T(3)-gauge approach and the stress tensor of the screw dislocation in the second order: avoiding the cut-off at the core

    International Nuclear Information System (INIS)

    Malyshev, C

    2007-01-01

    A translational gauge approach of the Einstein type is proposed for obtaining the stresses that are due to non-singular screw dislocation. The stress distribution of the second order around the screw dislocation is classically known for the hollow circular cylinder with traction-free external and internal boundaries. The inner boundary surrounds the dislocation's core, which is not captured by the conventional solution. The present gauge approach enables us to continue the classically known quadratic stresses inside the core. The gauge equation is chosen in the Hilbert-Einstein form, and it plays the role of non-conventional incompatibility law. The stress function method is used, and it leads to the modified stress potential given by two constituents: the conventional one, say, the 'background' and a short-ranged gauge contribution. The latter just causes additional stresses, which are localized. The asymptotic properties of the resulting stresses are studied. Since the gauge contributions are short-ranged, the background stress field dominates sufficiently far from the core. The outer cylinder's boundary is traction-free. At sufficiently moderate distances, the second-order stresses acquire regular continuation within the core region, and the cut-off at the core does not occur. Expressions for the asymptotically far stresses provide self-consistently new length scales dependent on the elastic parameters. These lengths could characterize an exteriority of the dislocation core region

  20. The Effect of Irrigation Cut-off in Flowering Stage and Foliar Application of Spermidine on Essential Oil Quantity and Quality of Three Ecotypes of Cumin

    Directory of Open Access Journals (Sweden)

    Sarah Bakhtari

    2017-03-01

    Full Text Available Introduction Cumin (Cuminum cyminum L. is an annual plant that commonly cultivated in arid and semiarid regions of Iran. The crop has a wide range of uses including medicinal, cosmetic and food industry. Cumin occupies about 26% of total area devoted to medicinal plants in Iran. However, cumin is seriously affected by the Fusarium wilt and blight diseases. The diseases usually increase under warm and wet conditions. Control of the diseases incidence is a crucial factor for cumin production. Limited control of the diseases is provided by seed pre-sowing with certain fungicides such as benlate. Soil fumigation with methyle bromide can provide a control measure against the disease but may be limited application value for large scale production systems in the open field. In addition, methyle bromide is considered an ozone-depleting compound and has potential risk on the living environment and human health. Considering the environmental limitations of chemical fungicides, it seems appropriate to search for a supplemental control strategy .It was demonstrated that peak of the diseases incidence is occurred at flowering stage and irrigation cut-off in this time may be reduced the diseases density. Materials and methods This experiment was conducted in a split-split-plot arrangement in randomized complete block design with three replications in research farm of Shahid Bahonar University of Kerman at 2014. The experimental treatments were irrigation (complete irrigation and cut-off the irrigation in flowering stage assigned to main plots, foliar application of spermidine (0, 1 and 2 Mm as subplot and cumin ecotypes (Kerman, Khorasan and Esfahan that was randomized in sub-subplot. The seedbed preparation was made based on common practices at the location. Plots size under the trial was 4 m×3 m so as to get 50 cm inter row spacing in six rows. The ideal density of the crops was considered as 120 plant.m-2. As soon as the seeds were sown, irrigation

  1. The Effect of Irrigation Cut-off in Flowering Stage and Foliar Application of Spermidine on Essential Oil Quantity and Quality of Three Ecotypes of Cumin

    Directory of Open Access Journals (Sweden)

    Sarah Bakhtari

    2017-08-01

    Full Text Available Introduction Cumin (Cuminum cyminum L. is an annual plant that commonly cultivated in arid and semiarid regions of Iran. The crop has a wide range of uses including medicinal, cosmetic and food industry. Cumin occupies about 26% of total area devoted to medicinal plants in Iran. However, cumin is seriously affected by the Fusarium wilt and blight diseases. The diseases usually increase under warm and wet conditions. Control of the diseases incidence is a crucial factor for cumin production. Limited control of the diseases is provided by seed pre-sowing with certain fungicides such as benlate. Soil fumigation with methyle bromide can provide a control measure against the disease but may be limited application value for large scale production systems in the open field. In addition, methyle bromide is considered an ozone-depleting compound and has potential risk on the living environment and human health. Considering the environmental limitations of chemical fungicides, it seems appropriate to search for a supplemental control strategy .It was demonstrated that peak of the diseases incidence is occurred at flowering stage and irrigation cut-off in this time may be reduced the diseases density. Materials and methods This experiment was conducted in a split-split-plot arrangement in randomized complete block design with three replications in research farm of Shahid Bahonar University of Kerman at 2014. The experimental treatments were irrigation (complete irrigation and cut-off the irrigation in flowering stage assigned to main plots, foliar application of spermidine (0, 1 and 2 Mm as subplot and cumin ecotypes (Kerman, Khorasan and Esfahan that was randomized in sub-subplot. The seedbed preparation was made based on common practices at the location. Plots size under the trial was 4 m×3 m so as to get 50 cm inter row spacing in six rows. The ideal density of the crops was considered as 120 plant.m-2. As soon as the seeds were sown, irrigation

  2. UV Filtering of Dye-Sensitized Solar Cells: The Effects of Varying the UV Cut-Off upon Cell Performance and Incident Photon-to-Electron Conversion Efficiency

    Directory of Open Access Journals (Sweden)

    Matthew Carnie

    2012-01-01

    Full Text Available With current technology, UV filters are essential to ensure long-term dye-sensitized solar cell (DSC stability. Blocking photons, however, will have an obvious effect on device performance and upon its incident photon-to-current conversion efficiency (IPCE. Filters have been applied to DSC devices with a range of cut-off wavelengths in order to assess how different levels of filtering affect the performance and IPCE of devices made with three different dyes, namely N719, Z907, and N749. It is shown that dyes that extend their IPCE further into the NIR region suffer lesser relative efficiency losses due to UV filtering than dyes with narrower action spectra. Furthermore, the results are encouraging to those working towards the industrialisation of DSC technology. From the results presented it can be estimated that filtering at a level intended to prevent direct band gap excitation of the TiO2 semiconductor should cause a relative drop in cell efficiency of no more than 10% in forward illuminated devices and no more than 2% in reverse illuminated devices.

  3. Suppressed oxygen extraction and degradation of LiNixMnyCozO2 cathodes at high charge cut-off voltages

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Jianming; Yan, Pengfei; Zhang, Jiandong; Engelhard, Mark H.; Zhu, Zihua; Polzin, Bryant J.; Trask, Steve; Xiao, Jie; Wang, Chongmin; Zhang, Jiguang

    2017-09-01

    The capacity degradation mechanism in lithium nickel-manganese-cobalt oxide (NMC) cathodes (LiNi1/3Mn1/3Co1/3O2 (NMC333) and LiNi0.4Mn0.4Co0.2O2 (NMC442)) during high-voltage (cut-off of 4.8 V) operation has been investigated. In contrast to NMC442, NMC333 exhibits rapid structural changes including severe micro-crack formation and phase transformation from a layered to a disordered rock-salt structure, as well as interfacial degradation during high-voltage cycling, leading to a rapid increase of the electrode resistance and fast capacity decline. The fundamental reason behind the poor structural and interfacial stability of NMC333 was found to be correlated to its high Co content and the significant overlap between the Co3+/4+ t(2g) and O2- 2p bands, resulting in oxygen removal and consequent structural changes at high voltages. In addition, oxidation of the electrolyte solvents by the extracted oxygen species generates acidic species, which then attack the electrode surface and form highly resistive LiF. These findings highlight that both the structural and interfacial stability should be taken into account when tailoring cathode materials for high voltage battery systems

  4. Evaluation of epidemiological cut-off values indicates that biocide resistant subpopulations are uncommon in natural isolates of clinically-relevant microorganisms.

    Directory of Open Access Journals (Sweden)

    Ian Morrissey

    Full Text Available To date there are no clear criteria to determine whether a microbe is susceptible to biocides or not. As a starting point for distinguishing between wild-type and resistant organisms, we set out to determine the minimal inhibitory concentration (MIC and minimal bactericidal concentration (MBC distributions for four common biocides; triclosan, benzalkonium chloride, chlorhexidine and sodium hypochlorite for 3319 clinical isolates, with a particular focus on Staphylococcus aureus (N = 1635 and Salmonella spp. (N = 901 but also including Escherichia coli (N = 368, Candida albicans (N = 200, Klebsiella pneumoniae (N = 60, Enterobacter spp. (N = 54, Enterococcus faecium (N = 53, and Enterococcus faecalis (N = 56. From these data epidemiological cut-off values (ECOFFs are proposed. As would be expected, MBCs were higher than MICs for all biocides. In most cases both values followed a normal distribution. Bimodal distributions, indicating the existence of biocide resistant subpopulations were observed for Enterobacter chlorhexidine susceptibility (both MICs and MBCs and the susceptibility to triclosan of Enterobacter (MBC, E. coli (MBC and MIC and S. aureus (MBC and MIC. There is a concern on the potential selection of antibiotic resistance by biocides. Our results indicate however that resistance to biocides and, hence any potential association with antibiotic resistance, is uncommon in natural populations of clinically relevant microorganisms.

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

    Science.gov (United States)

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

    2017-05-24

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

  6. Middle Term Results of Simple Open Hip Reduction of Irreducible DDH - What Is the Cut-off Age to Safely Perform It with Lower Complications?

    Science.gov (United States)

    Alexiev, V; Georgiev, H; Mileva, S

    2017-01-01

    PURPOSE OF THE STUDY When developmental dysplasia of the hip (DDH) is irreducible by conservative means, then surgical open hip reduction is the choice. When done before walking age simple open hip reduction (SOHR) is most often enough to stabilize the hip. We tested the hypothesis that simple open hip reduction gives enough stability even in severe Tönnis 4 grades of dislocation. We tried to find what is the cut-off age to safely perform SOHR with lower complications. MATERIAL AND METHODS From 193 open hip reductions (OHR) of irreducible DDH in 123 children for the period 1995-2010 year with X-ray follow up of at least 8 years and full documentation we investigated 75 SOHR. Mean age at follow-up was 13 years and 5 months for the whole group and 8 years and 3 months for the SOHR patients. Age at operation - 7 months to 7.5 years for all patients with OHR, with average OR age for SOHR - 18 months. The traditional surgical technique of open hip reduction was performed through lateral Murphy's approach but with sparing the attachment of the piriformis muscle with the underlying blood supply to the epiphysis during circumferential capsulotomy. We used McKay clinical criteria, radiological classifications of Tönnis, Severin, Herring-Mose and Kalamchi & MacEwen. RESULTS When analyzing the results, there came up a strong statistical correlation between bilaterality and Tönnis grade 4. The final CE angle of Wiberg was on average 28º. According to Severin classification: 74% were excellent and 10% good or 84 % successful results. But according to Herring-Mose sphericity scoring - 60% were good and 30% fair. Mose's fair is a potential cam-type femoro-acetabular impingement (FAI). Clinically according to McKay criteria - 10% excellent and 54% good, or 64% of the operated hips were clinically acceptable, which correlates more with the radiological results according to Mose than with Severin. Avascular necrosis (AVN) of the femoral head (FH) according to Kalamchi was: Type

  7. Alzheimer’s Disease Dementia as the Diagnosis Best Supported by the Cerebrospinal Fluid Biomarkers: Difference in Cut-Off Levels from Thai Experience

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    V. Senanarong

    2012-01-01

    Full Text Available Objectives. To determine how beta-amyloid 1-42 (Aβ 1-42, total tau (tTau, and phosphorylated tau (pTau levels in CSF behave in a cohort of Thai patients from the Memory Clinic in Bangkok, Thailand. Methods. During 2009–2011, twenty eight subjects from the memory clinic at Siriraj Hospital had CSF analysis for AD biomarkers. Aβ 1-42, tTau, and pTau (at amino acid 181 were measured in CSF by ELISA technique. Results. Mean of Thai mental state examination (TMSE of 28 Thai cohort was 16.48 (6.63. Fourteen had AD, ten had non-AD dementia, and four non-cases were those with subjective memory complaint (SMC without dementia. Mean CSF Aβ 1-42, tTau, ptau (181, and pTau/Aβ 1-42 in the AD group were 241.36 (60.14 pg/mL, 222.79 (212.24 pg/mL, 40.79 (27.84 pg/mL, and 0.18 (0.12 accordingly. Mean CSF Aβ 1-42, tTau, pTau (181, and pTau/Aβ 1-42 in the non-AD dementia group were 430.40 (125.18 pg/mL, 349.30 (692.16 pg/mL, 36.80 (14.90 pg/mL, and 0.09 (0.04 accordingly. Mean CSF Aβ 1-42, tTau, pTau (181, and pTau/Aβ 1-42 in the non-cases with SMC without dementia were 499.75 (93.44 pg/mL, 137.25 (62.74 pg/mL, 31.75 (17.48 pg/mL, and 0.06 (0.02. There is significant difference (P<0.05 among the 3 groups in CSF Aβ 1-42 and pTau/Aβ 1-42. We propose mean + 1.5 SD of CSF Aβ 1-42 in AD group (331.57 pg/mL to be the cut-off point in Thai subjects. Conclusion. There are significant different in CSF Aβ 1-42 and CSF p-tau/Aβ 1-42 among those with AD, non-AD dementia and non cases with SMC without dementia in Thai cohort. Cut-off point of CSF Aβ 1-42 of 331.57 pg/mL is suggested in Thai study.

  8. Burst of reactive oxygen species in pedicel-mediated fruit abscission after carbohydrate supply was cut off in longan (Dimocarpus longan)

    Science.gov (United States)

    Yang, Ziqin; Zhong, Xiumei; Fan, Yan; Wang, Huicong; Li, Jianguo; Huang, Xuming

    2015-01-01

    Cutting off carbohydrate supply to longan (Dimocarpus longan Lour.) fruit by girdling and defoliation or by detachment induced 100% abscission within a few days. We used these treatments to study the involvement of reactive oxygen species (ROS) in fruit abscission. Girdling plus defoliation decreased sugar concentrations in the fruit and pedicel and depleted starch grains in the chloroplasts in the cells of abscission zone. Prior to the occurrence of intensive fruit abscission, there was a burst in ROS in the pedicel, which peaked at 1 day after treatment (DAT), when H2O2 in the abscission zone was found to be chiefly located along the plasma membrane (PM). H2O2 was found exclusively in the cell walls 2 DAT, almost disappeared 3 DAT, and reappeared in the mitochondria and cell walls 4 DAT. Signs of cell death such as cytoplasm breakdown were apparent from 3 DAT. The burst of ROS coincided with a sharp increase in the activity of PM-bound NADPH oxidase in the pedicel. At the same time, activities of antioxidant enzymes including superoxide dismutase (SOD), catalase, and peroxidase (POD) were all increased by the treatment and maintained higher than those in the control. Accompanying the reduction in H2O2 abundance, there was a sharp decrease in PM-bound NADPH oxidase activity after 1 DAT in the treated fruit. H2O2 scavenger dimethylthiourea (DMTU, 1 g L–1) significantly inhibited fruit abscission in detached fruit clusters and suppressed the increase in cellulase activity in the abscission zone. These results suggest that fruit abscission induced by carbohydrate stress is mediated by ROS. Roles of ROS in regulating fruit abscission were discussed in relation to its subcellular distribution. PMID:26074931

  9. Cut-off values for serum matrix metalloproteinase-9: is there a threshold to predict renal involvement for Henoch-Schonlein purpura in children?

    Science.gov (United States)

    Qin, Yuan-Han; Zhou, Tian-Biao; Lei, Feng-Ying; Huang, Wei-Fang; Zhao, Yan-Jun; Lin, Fa-Quan; Su, Li-Na

    2011-01-01

    To clarify whether the level of matrix metalloproteinase-9 (MMP-9), tissue inhibitor matrix metalloproteinase-1 (TIMP-1) or the ratio of MMP-9/TIMP-1 was associated with the renal involvement in Henoch-Schonlein purpura (HSP); and to explore whether there existed early diagnostic measure for HSP nephritis (HSPN). Sixty-six patients with HSPN, 68 patients with HSP and 60 healthy children (control group) were enrolled into our study. Serum and urine samples before treatment were collected for detection. Compared with the HSP group and control group, serum MMP-9, TIMP-1 and ratio of MMP-9/TIMP-1 in the HSPN group were significantly higher (P<0.05 and P<0.01, respectively). Urine MMP-9, TIMP-1 and ratio of MMP-9/TIMP-1 in the HSPN group were obviously higher than those of the control group (P<0.05) and the HSP group (P<0.05). Receiver-operator curve (ROC) analysis was performed to obtain the area under the curve (AUC) and the AUC and its 95% confidence interval (CI) of serum MMP-9 were 0.97 and 0.95-0.99, respectively. The optimal cut-off point (sensitivity; specificity) of serum MMP-9 for diagnosing HSPN was 179.79 mg/L (0.96; 0.88). Levels of MMP-9, TIMP-1 and ratio of MMP-9/TIMP-1 in serum and urine were remarkably high in the patients with HSPN, but the serum MMP-9 was more sensitive. Serum MMP-9 may be associated with the occurrence and development of renal involvement in HSPN and become an important indicator for early diagnosis of HSPN. © 2011 The Authors. Nephrology © 2011 Asian Pacific Society of Nephrology.

  10. Cut off values of laser fluorescence for different storage methods at different time intervals in comparison to frozen condition: A 1 year in vitro study.

    Science.gov (United States)

    Kaul, Rudra; Kaul, Vibhuti; Farooq, Riyaz; Wazir, Nikhil Dev; Khateeb, Shafayat Ullah; Malik, Altaf H; Masoodi, Ajaz Amin

    2014-03-01

    The aim of the following study is to evaluate the change in laser fluorescence (LF) values for extracted teeth stored in different solutions over 1 year period, to give cut-off values for different storage media at different time intervals to get them at par with the in vivo conditions and to see which medium gives best results with the least change in LF values and while enhancing the validity of DIAGNOdent in research. Ninety extracted teeth selected, from a pool of frozen teeth, were divided into nine groups of 10 each. Specimens in Groups 1-8 were stored in 1% chloramine, 10% formalin, 10% buffered formalin, 0.02% thymol, 0.12% chlorhexidine, 3% sodium hypochlorite, a commercially available saliva substitute-Wet Mouth (ICPA Pharmaceuticals) and normal saline respectively at 4°C. The last group was stored under frozen condition at -20°C without contact with any storage solution. DIAGNOdent was used to measure the change the LF values at day 30, 45, 60, 160 and 365. The mean change in LF values in different storage mediums at different time intervals were compared using two-way ANOVA. At the end of 1 year, significant decrease in fluorescence (P < 0.05) was observed in Groups 1-8. Maximum drop in LF values occurred between day 1 and 30. Group 9 (frozen specimens) did not significantly change their fluorescence response. An inevitable change in LF takes place due to various storage media commonly used in dental research at different time intervals. The values obtained from our study can remove the bias caused by the storage media and the values of LF thus obtained can hence be conveniently extrapolated to the in vivo condition.

  11. Relationship between glycated hemoglobin and glucose concentrations in the adult Galician population: selection of optimal glycated hemoglobin cut-off points as a diagnostic tool of diabetes mellitus.

    Science.gov (United States)

    Botana López, Manuel Antonio; López Ratón, Mónica; Tomé, María Ausencia; Fernández Mariño, Alexis; Mato Mato, José Antonio; Rego Iraeta, Antonia; Pérez Fernández, Román; Cadarso Suárez, Carmen

    2012-10-01

    To analyze the relationship between glucose and glycated hemoglobin (HbA(1c)) in the adult Galician population, evaluate the use of HbA(1c) for the screening and diagnosis of diabetes, and calculate the diagnostic threshold required for this purpose. We analyzed data on 2848 subjects (aged 18-85 years) drawn from a study undertaken in 2004 to assess the prevalence of diabetes in Galicia. For study purposes, diabetes was defined using the criteria recommended in 2002. Participants were classified into four glucose-based groups. The relationship between glucose and HbA(1c) was described using linear regression models, generalized additive models and Spearman's correlation. Diagnostic capacity was assessed, and optimal HbA(1c) cut-off points were calculated as a diabetes marker using the receiver operating characteristic curve. Prevalence of pre-diabetes, unknown diabetes and known diabetes was 20.86, 3.37 and 4.39%, respectively. The correlations between HbA(1c) and fasting glucose were higher than those obtained for HbA(1c) and glycemia at 2h of the oral glucose overload (0.344 and 0.270, respectively). Taking glucose levels as the gold standard, a greater discriminatory capacity was obtained for HbA(1c) (area under de cruve: 0.839, 95% confidence intervals: 0.788-0.890). Based on the study criteria, the optimal minimum and maximum HbA(1c) values were 5.9% and 6.7%, respectively. HbA(1c) did not prove superior to glycemia for diagnosis of diabetes in the adult Galician population, and cannot therefore be used to replace the oral glucose tolerance test for screening and diagnosis purposes. Indeed, determination of glucose is essential to verify the diagnosis in the majority of cases. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.

  12. Specific cut-off points for waist circumference and waist-to-height ratio as predictors of cardiometabolic risk in Black subjects: a cross-sectional study in Benin and Haiti

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    EL Mabchour A

    2015-10-01

    Full Text Available Asma EL Mabchour,1 Hélène Delisle,1 Colette Vilgrain,2 Philippe Larco,2 Roger Sodjinou,3 Malek Batal1 1Transition Nutritionnelle (TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Development, Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada; 2Haitian Foundation for Diabetes and Cardiovascular Diseases (FHADIMAC, Port-au-Prince, Haiti; 3West Africa Health Organization (WAHO, Bobo-Dioulasso, Burkina Faso Purpose: Waist circumference (WC and waist-to-height ratio (WHtR are widely used as indicators of abdominal adiposity and the cut-off values have been validated primarily in Caucasians. In this study we identified the WC and WHtR cut-off points that best predicted cardiometabolic risk (CMR in groups of African (Benin and African ancestry (Haiti Black subjects. Methods: This cross-sectional study included 452 apparently healthy subjects from Cotonou (Benin and Port-au-Prince (Haiti, 217 women and 235 men from 25 to 60 years. CMR biomarkers were the metabolic syndrome components. Additional CMR biomarkers were a high atherogenicity index (total serum cholesterol/high density lipoprotein cholesterol ≥4 in women and ≥5 in men; insulin resistance set at the 75th percentile of the calculated Homeostasis Model Assessment index (HOMA-IR; and inflammation defined as high-sensitivity C-reactive protein (hsCRP concentrations between 3 and 10 mg/L. WC and WHtR were tested as predictors of two out of the three most prevalent CMR biomarkers. Receiver operating characteristic (ROC curves, Youden's index, and likelihood ratios were used to assess the performance of specific WC and WHtR cut-offs. Results: High atherogenicity index (59.5%, high blood pressure (23.2%, and insulin resistance (25% by definition were the most prevalent CMR biomarkers in the study groups. WC and WHtR were equally valid as predictors of CMR. Optimal WC cut-offs were 80 cm and 94 cm in men and women, respectively, which is exactly

  13. [Establishment of a cut-off value for the diagnosis of acute myocardial infarction using a new CK-MB activity measurement reagent containing anti-MtCK antibody].

    Science.gov (United States)

    Murakami, Mariko; Kodama, Mayumi; Yoshida, Risa; Asada, Takashi; Sano, Takahiro; Sano, Michitaka; Kamakura, Shiro; Nonogi, Hiroshi

    2011-07-01

    CK-MB is an important marker for the diagnosis of acute myocardial infarction (AMI). Since mitochondrial CK (MtCK) is universally present in the blood of healthy individuals, it is known to positively affect the measurement of CK-MB using the immunoinhibition method, causing false-positive results. We performed basic evaluation of ACCURAS AUTO CK-MB MtO, a new reagent containing anti-MtCK antibody that inhibits MtCK activity, and attempted to calculate a cut-off CK-MB level to diagnose AMI. The measurement was performed in samples submitted to the Clinical Laboratory of our center for the measurement of CK-MB. This method was confirmed to have satisfactory basic attributes concerning the reproducibility, linearity, lower detection limit, and effects of interfering substances. When 2886 samples were examined using this and conventional methods, the results of the two methods were correlated in some but not in others. In the samples that showed no correlation, MtCK was demonstrated by isozyme analysis using electrophoresis. The AUC calculated from the ROC curve in AMI patients was 0.912 with this method and 0.861 with the conventional method. The sensitivity and specificity of the new method were higher than those of the conventional method. The cut-off value determined by ROC analysis was 7.7 U/l using the new method and 13.6 U/l using the conventional method, causing an increase in false-positive results compared with the cut off value of 25 U/l widely used for the conventional method to date. However, the cut-off value for the new method that yielded a specificity comparable to 99.1%, which is the specificity of the conventional method using a cut-off value of 25 U/l, was 12 U/l. With a cut-off value of 12 U/l, the sensitivity was improved compared with that employing the conventional method, and both the sensitivity and specificity became comparable to those of the CK-MB mass method. This method is very useful for the accurate measurement of CK-MB activity.

  14. Von Willebrand Factor, ADAMTS13 and D-Dimer Are Correlated with Different Levels of Nephropathy in Type 1 Diabetes Mellitus.

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    Caroline Pereira Domingueti

    Full Text Available We have investigated whether von Willebrand factor, ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13, and D-Dimer were associated with different levels of renal function in patients with type 1 diabetes. Patients were classified according to level of renal function through estimated glomerular filtration rate: ≥90 and <130mL/min/1,73m2, n=52 (control group, ≥60 and <90mL/min/1,73m2, n=29 (mild renal dysfunction group, <60mL/min/1,73m2, n=28 (severe renal dysfunction group; and through urinary albumin excretion: normoalbuminuria, microalbuminuria and macroalbuminuria. Von Willebrand factor, ADAMTS13, and D-Dimer plasma levels were determined by enzyme-linked immunosorbent assay. ADAMTS13 activity was determined by fluorescence resonance energy transfer assay. Von Willebrand factor levels were increased in patients with mild (P=0.001 and severe (P<0.001 renal dysfunction as compared to the control group. ADAMTS13 levels were also increased in mild (P=0.029 and severe (P=0.002 renal dysfunction groups in comparison to the control group, while ADAMTS13 activity was increased only in the severe renal dysfunction group as compared to the control group (P=0.006. No significant differences were observed among the groups regarding von Willebrand factor/ADAMTS13 ratio. ADAMTS13 activity/ADAMTS13 levels ratio was reduced in patients with mild (P=0.013 and severe (P=0.015 renal dysfunction as compared to the control group. D-Dimer levels were increased in patients with mild (P=0.006 and severe (P<0.001 renal dysfunction as compared to the control group; it was also higher in patients with severe renal dysfunction as compared to the mild renal dysfunction group (P=0.019. Similar results were found for albuminuria classification. Increased von Willebrand factor, ADAMTS13, and D-Dimer levels and decreased ADAMTS13 activity/ADAMTS13 levels ratio are associated with renal dysfunction in patients with type 1 diabetes

  15. Optimal Cut-Offs of Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) to Identify Dysglycemia and Type 2 Diabetes Mellitus: A 15-Year Prospective Study in Chinese.

    Science.gov (United States)

    Lee, C H; Shih, A Z L; Woo, Y C; Fong, C H Y; Leung, O Y; Janus, E; Cheung, B M Y; Lam, K S L

    The optimal reference range of homeostasis model assessment of insulin resistance (HOMA-IR) in normal Chinese population has not been clearly defined. Here we address this issue using the Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS), a prospective population-based cohort study with long-term follow-up. In this study, normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM) were defined according to the 1998 World Health Organization criteria. Dysglycemia referred to IFG, IGT or T2DM. This study comprised two parts. Part one was a cross-sectional study involving 2,649 Hong Kong Chinese subjects, aged 25-74 years, at baseline CRISPS-1 (1995-1996). The optimal HOMA-IR cut-offs for dysglycemia and T2DM were determined by the receiver-operating characteristic (ROC) curve. Part two was a prospective study involving 872 subjects who had persistent NGT at CRISPS-4 (2010-2012) after 15 years of follow-up. At baseline, the optimal HOMA-IR cut-offs to identify dysglyceia and T2DM were 1.37 (AUC = 0.735; 95% confidence interval [CI] = 0.713-0.758; Sensitivity [Se] = 65.6%, Specificity [Sp] = 71.3%] and 1.97 (AUC = 0.807; 95% CI = 0.777-0.886; Se = 65.5%, Sp = 82.9%) respectively. These cut-offs, derived from the cross-sectional study at baseline, corresponded closely to the 75th (1.44) and 90th (2.03) percentiles, respectively, of the HOMA-IR reference range derived from the prospective study of subjects with persistent NGT. HOMA-IR cut-offs, of 1.4 and 2.0, which discriminated dysglycemia and T2DM respectively from NGT in Southern Chinese, can be usefully employed as references in clinical research involving the assessment of insulin resistance.

  16. Calculation of cut-off values based on the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Pemphigus Disease Area Index (PDAI) pemphigus scoring systems for defining moderate, significant and extensive types of pemphigus.

    Science.gov (United States)

    Boulard, C; Duvert Lehembre, S; Picard-Dahan, C; Kern, J S; Zambruno, G; Feliciani, C; Marinovic, B; Vabres, P; Borradori, L; Prost-Squarcioni, C; Labeille, B; Richard, M A; Ingen-Housz-Oro, S; Houivet, E; Werth, V P; Murrell, D F; Hertl, M; Benichou, J; Joly, P

    2016-07-01

    Two pemphigus severity scores, Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Pemphigus Disease Area Index (PDAI), have been proposed to provide an objective measure of disease activity. However, the use of these scores in clinical practice is limited by the absence of cut-off values that allow differentiation between moderate, significant and extensive types of pemphigus. To calculate cut-off values defining moderate, significant and extensive pemphigus based on the ABSIS and PDAI scores. In 31 dermatology departments in six countries, consecutive patients with newly diagnosed pemphigus were assessed for pemphigus severity, using ABSIS, PDAI, Physician's Global Assessment (PGA) and Dermatology Life Quality Index (DLQI) scores. Cut-off values defining moderate, significant and extensive subgroups were calculated based on the 25th and 75th percentiles of the ABSIS and PDAI scores. The median ABSIS, PDAI, PGA and DLQI scores of the three severity subgroups were compared in order to validate these subgroups. Ninety-six patients with pemphigus vulgaris (n = 77) or pemphigus foliaceus (n = 19) were included. The median PDAI activity and ABSIS total scores were 27·5 (range 3-84) and 34·8 points (range 0·5-90·5), respectively. The respective cut-off values corresponding to the first and third quartiles of the scores were 15 and 45 for the PDAI, and 17 and 53 for ABSIS. The moderate, significant and extensive subgroups were thus defined, and had distinguishing median ABSIS (P values of 15 and 45 for PDAI and 17 and 53 for ABSIS, to distinguish moderate, significant and extensive pemphigus forms. Identifying these pemphigus activity subgroups should help physicians to classify and manage patients with pemphigus. © 2016 British Association of Dermatologists.

  17. Application of the fracture risk assessment tool (FRAX(®)) and determination of suitable cut-off values during primary screening in specific health check-ups in Japan.

    Science.gov (United States)

    Nakatoh, Shinichi; Takemaru, Yuki

    2013-11-01

    Specific health check-ups, which do not include osteoporosis screening, are conducted more frequently than periodic osteoporosis screening in Japan. In this study, we investigated the usefulness of the fracture risk assessment tool (FRAX(®)) during specific health check-ups, evaluated the variations in its usefulness for 2 consecutive years, and determined FRAX(®) cut-off values for osteoporosis screening. FRAX(®) questionnaires were distributed to subjects who underwent specific health check-ups in 2009 and 2010 at Asahi-machi. Subjects who exhibited FRAX(®) cut-off values of ≥10 % were advised to be screened at a medical institution. Bone mineral densities (BMDs) were measured in 201 subjects in 2009 and 105 subjects in 2010 after specific health check-ups, and treatment was initiated for 79 subjects in 2009 and 24 subjects in 2010. The number of subjects examined and the rate of treatment initiation following specific health check-ups were higher than those in subjects following periodic osteoporosis screening in 2009. However, the number and the rate following specific health check-ups dropped in 2010. According to receiver operating characteristic curves analyses, the sensitivity and specificity of FRAX(®) to determine osteoporosis treatment were highest when the cut-off values were 8 % for men and 10.5 % for women. In conclusion, the combination of FRAX(®) and specific health check-ups was more useful than periodic osteoporosis screening to narrow down the subjects and to motivate them to seek follow-up. Cut-off values for specific health check-up using FRAX(®) should be approximately 8 % for men and 10.5 % for women.

  18. Modified Cut-Off Value of the Urine Protein-To-Creatinine Ratio Is Helpful for Identifying Patients at High Risk for Chronic Kidney Disease: Validation of the Revised Japanese Guideline.

    Science.gov (United States)

    Yamamoto, Hiroyuki; Yamamoto, Kyoko; Yoshida, Katsumi; Shindoh, Chiyohiko; Takeda, Kyoko; Monden, Masami; Izumo, Hiroko; Niinuma, Hiroyuki; Nishi, Yutaro; Niwa, Koichiro; Komatsu, Yasuhiro

    2015-11-01

    Chronic kidney disease (CKD) is a global public health issue, and strategies for its early detection and intervention are imperative. The latest Japanese CKD guideline recommends that patients without diabetes should be classified using the urine protein-to-creatinine ratio (PCR) instead of the urine albumin-to-creatinine ratio (ACR); however, no validation studies are available. This study aimed to validate the PCR-based CKD risk classification compared with the ACR-based classification and to explore more accurate classification methods. We analyzed two previously reported datasets that included diabetic and/or cardiovascular patients who were classified into early CKD stages. In total, 860 patients (131 diabetic patients and 729 cardiovascular patients, including 193 diabetic patients) were enrolled. We assessed the CKD risk classification of each patient according to the estimated glomerular filtration rate and the ACR-based or PCR-based classification. The use of the cut-off value recommended in the current guideline (PCR 0.15 g/g creatinine) resulted in risk misclassification rates of 26.0% and 16.6% for the two datasets. The misclassification was primarily caused by underestimation. Moderate to substantial agreement between each classification was achieved: Cohen's kappa, 0.56 (95% confidence interval, 0.45-0.69) and 0.72 (0.67-0.76) in each dataset, respectively. To improve the accuracy, we tested various candidate PCR cut-off values, showing that a PCR cut-off value of 0.08-0.10 g/g creatinine resulted in improvement in the misclassification rates and kappa values. Modification of the PCR cut-off value would improve its efficacy to identify high-risk populations who will benefit from early intervention.

  19. Antimicrobial Susceptibility of Flavobacterium psychrophilum from Chilean Salmon Farms and their Epidemiological Cut-off Values using Agar Dilution and Disk Diffusion Methods

    Directory of Open Access Journals (Sweden)

    Claudio D Miranda

    2016-11-01

    Full Text Available Flavobacterium psychrophilum is the most important bacterial pathogen for freshwater farmed salmonids in Chile. The aims of this study were to determine the susceptibility to antimicrobials used in fish farming of Chilean isolates and to calculate their epidemiological cut-off (COWT values. A number of 125 Chilean isolates of F. psychrophilum were isolated from reared salmonids presenting clinical symptoms indicative of flavobacteriosis and their identities were confirmed by 16S rRNA polymerase chain reaction. Susceptibility to antibacterials was tested on diluted Mueller-Hinton by using an agar dilution MIC method and a disk diffusion method. The COWT values calculated by Normalised Resistance Interpretation (NRI analysis allow isolates to be categorized either as wild-type fully susceptible (WT or as manifesting reduced susceptibility (NWT. When MIC data was used, NRI analysis calculated a COWT of ≤ 0.125 μg mL-1, ≤ 2 μg mL-1 and ≤ 0.5 μg mL-1 for amoxicillin, florfenicol and oxytetracycline, respectively. For the quinolones, the COWT were ≤1 μg mL-1, ≤ 0.5 μg mL-1 and ≤ 0.125 μg mL-1 for oxolinic acid, flumequine and enrofloxacin respectively. The disc diffusion data sets obtained in this work were extremely diverse and were spread over a wide range. For the quinolones there was a close agreement between the frequencies of NWT isolates calculated using MIC and disc data. For oxolinic acid, flumequine and enrofloxacin the frequencies were 45, 39 and 38% using MIC data, and 42, 41 and 44%, when disc data were used. There was less agreement with the other antimicrobials, because NWT frequencies obtained using MIC and disc data respectively, were 24% and 10% for amoxicillin, 8% and 2% for florfenicol and 70% and 64% for oxytetracycline. Considering that the MIC data was more precise than the disc diffusion data, MIC determination would be the preferred method for susceptibility testing for this species and the NWT frequencies

  20. Consistency and inconsistency in testing biomarkers in breast cancer. A GRELL study in cut-off variability in the Romance language countries.

    Science.gov (United States)

    Crocetti, Emanuele; Caldarella, Adele; Ferretti, Stefano; Ardanaz, Eva; Arveux, Patrick; Bara, Simona; Barrios, Enrique; Bento, Maria J; Bordoni, Andrea; Buzzoni, Carlotta; Candela, Giuseppina; Colombani, Françoise; Delafosse, Patricia; Federico, Massimo; Francart, Julie; Giacomin, Adriano; Grosclaude, Pascale; Guizard, Anne V; Izarzugaza, Isabel; Konzelmann, Isabelle; La Rosa, Francesco; Lapotre, Benedicte; Leone, Nathalie; Ligier, Karine; Mangone, Lucia; Marcos-Gragera, R; Martinez, Ruth; Michelena, Maria J; Michiara, Maria; Miranda, Ana; Molinié, Florence; Mugarza-Gomez, Conception; Paci, Eugenio; Piffer, Silvano; Puig-Vives, Montserrat; Sacchettini, Claudio; Sánchez, Maria J; Traina, Adele; Tretarre, Brigitte; Tumino, Rosario; Van Vaerenbergh, Elke; Velten, Michel; Woronoff, Anne S

    2013-08-01

    Biological markers are crucial factors in order to differentiate female breast cancers and to determine the right therapy. This study aims at evaluating whether testing for biomarkers for female breast cancer has similar frequency and characteristics across and within countries. Population-based cancer registries of the Association for cancer registration and epidemiology in Romance language countries (GRELL) were asked to complete a questionnaire on biomarkers testing. The data collected referred to invasive female breast cancer cases diagnosed between 2004 and 2009. The investigation focused on 1) the overexpression and amplification of the human epidermal growth factor receptor 2 oncogene (HER2); 2) the expression of oestrogen (ER) and progesterone (PgR) receptors; and 3) the proliferation index (PI). Weighted percentages, the heterogeneity among and within countries, and the correlation between responses and calendar years were evaluated. The study was based on 19,644 breast cancers. Overall, 85.9% of the cases were tested for HER2, 91.8% for both ER and PgR, and 74.1% for proliferative markers. For HER2 and ER-PgR, the frequency of testing increased from 2004 to 2009. Testing varied among countries (HER2 from 82.0% to 95.9%, ER-PgR from 89.3% to 98.9%, PI from 10% to 92%) and also within the same country (e.g. HER2 in Italy from 51% to 99%) as well as within single cancer registries. The most relevant differences were in the scores for positive/negative/not clearly defined HER2 (e.g. HER2 was defined positive if IHC 3+ in 21/33 registries), and in the cut-off of positive cells for ER/PgR (from >0% to >30%) and PI positivity (from >0% to >20%). Biological markers are widely tested in the Romance language countries; however, the parameters defining their positivity may vary, raising concerns about homogeneity in breast cancer classification and treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Determination of D-Dimers in condition of emergency: the D-Di Liatest. Threshold value in elimination of pulmonary emboli (PE); Determination en urgence des D-Dimeres: le liatest D-DI. Valeur seuil permettant d`eliminer une embolie pulmonaire (EP)

    Energy Technology Data Exchange (ETDEWEB)

    Duet, M. [Service de Medecine Nucleaire (France); Soria, C. [Service de Hematologie (France); Elkarrat, D. [Service de Urgences (France); Benelhadj, S. [Service de Medecine Nucleaire (France); Bailliard, O.; Kedra, A.W. [Service de Explorations Founctionnelles, Hopital Lariboisiere, Paris (France); Drouet, L. [Service de Hematologie (France); Mundler, O. [Service de Medecine Nucleaire (France)

    1997-12-31

    Several studies have shown that a low rate of D-Dimers (products of fibrin decay) measured by Elisa technique can eliminate the diagnosis of thrombo-embolic disease. However, the conventional Elisa technique is not adapted to emergency conditions. A new agglutination test of latex microparticles (D-Di Liatest) has been developed by Diagnostica Stago with a sensitivity of 100 ng/ml. Our goal was to determine the threshold of PE exclusion. Ninety six patients suspected of PE were included. The pulmonary perfusion scintigraphy (PPS), as a reference examination the positivity of which has been confirmed by clinical follow-up, has been carried out in association with the determination of plasmatic rates of D-Dimers by the techniques Elisa and Liatest based on different antibodies. A table is given containing the D-Di threshold rates obtained by these techniques. In conclusion, our results showed that the rate of D-Dimers which eliminate a PE is {<=} 500 ng/ml by Elisa and {<=} 400 ng/ml by Liatest with a VPN of 100%. However, the PPS remains necessary in 77% of cases. This work stresses the necessity of clinical validations for the new biological tests

  2. Optimal waist circumference cut-off points and ability of different metabolic syndrome criteria for predicting diabetes in Japanese men and women: Japan Epidemiology Collaboration on Occupational Health Study

    Directory of Open Access Journals (Sweden)

    Huanhuan Hu

    2016-03-01

    Full Text Available Abstract Background We sought to establish the optimal waist circumference (WC cut-off point for predicting diabetes mellitus (DM and to compare the predictive ability of the metabolic syndrome (MetS criteria of the Joint Interim Statement (JIS and the Japanese Committee of the Criteria for MetS (JCCMS for DM in Japanese. Methods Participants of the Japan Epidemiology Collaboration on Occupational Health Study, who were aged 20–69 years and free of DM at baseline (n = 54,980, were followed-up for a maximum of 6 years. Time-dependent receiver operating characteristic analysis was used to determine the optimal cut-off points of WC for predicting DM. Time-dependent sensitivity, specificity, and positive and negative predictive values for the prediction of DM were compared between the JIS and JCCMS MetS criteria. Results During 234,926 person-years of follow-up, 3180 individuals developed DM. Receiver operating characteristic analysis suggested that the most suitable cut-off point of WC for predicting incident DM was 85 cm for men and 80 cm for women. MetS was associated with 3–4 times increased hazard for developing DM in men and 7–9 times in women. Of the MetS criteria tested, the JIS criteria using our proposed WC cut-off points (85 cm for men and 80 cm for women had the highest sensitivity (54.5 % for men and 43.5 % for women for predicting DM. The sensitivity and specificity of the JCCMS MetS criteria were ~37.7 and 98.9 %, respectively. Conclusion Data from the present large cohort of workers suggest that WC cut-offs of 85 cm for men and 80 cm for women may be appropriate for predicting DM for Japanese. The JIS criteria can detect more people who later develop DM than does the JCCMS criteria.

  3. Optimal waist circumference cut-off points and ability of different metabolic syndrome criteria for predicting diabetes in Japanese men and women: Japan Epidemiology Collaboration on Occupational Health Study.

    Science.gov (United States)

    Hu, Huanhuan; Kurotani, Kayo; Sasaki, Naoko; Murakami, Taizo; Shimizu, Chii; Shimizu, Makiko; Nakagawa, Tohru; Honda, Toru; Yamamoto, Shuichiro; Okazaki, Hiroko; Nagahama, Satsue; Uehara, Akihiko; Yamamoto, Makoto; Tomita, Kentaro; Imai, Teppei; Nishihara, Akiko; Kochi, Takeshi; Eguchi, Masafumi; Miyamoto, Toshiaki; Hori, Ai; Kuwahara, Keisuke; Akter, Shamima; Kashino, Ikuko; Kabe, Isamu; Liu, Weiping; Mizoue, Tetsuya; Kunugita, Naoki; Dohi, Seitaro

    2016-03-03

    We sought to establish the optimal waist circumference (WC) cut-off point for predicting diabetes mellitus (DM) and to compare the predictive ability of the metabolic syndrome (MetS) criteria of the Joint Interim Statement (JIS) and the Japanese Committee of the Criteria for MetS (JCCMS) for DM in Japanese. Participants of the Japan Epidemiology Collaboration on Occupational Health Study, who were aged 20-69 years and free of DM at baseline (n = 54,980), were followed-up for a maximum of 6 years. Time-dependent receiver operating characteristic analysis was used to determine the optimal cut-off points of WC for predicting DM. Time-dependent sensitivity, specificity, and positive and negative predictive values for the prediction of DM were compared between the JIS and JCCMS MetS criteria. During 234,926 person-years of follow-up, 3180 individuals developed DM. Receiver operating characteristic analysis suggested that the most suitable cut-off point of WC for predicting incident DM was 85 cm for men and 80 cm for women. MetS was associated with 3-4 times increased hazard for developing DM in men and 7-9 times in women. Of the MetS criteria tested, the JIS criteria using our proposed WC cut-off points (85 cm for men and 80 cm for women) had the highest sensitivity (54.5 % for men and 43.5 % for women) for predicting DM. The sensitivity and specificity of the JCCMS MetS criteria were ~37.7 and 98.9 %, respectively. Data from the present large cohort of workers suggest that WC cut-offs of 85 cm for men and 80 cm for women may be appropriate for predicting DM for Japanese. The JIS criteria can detect more people who later develop DM than does the JCCMS criteria.

  4. Interleukin 6 Is a Stronger Predictor of Clinical Events Than High-Sensitivity C-Reactive Protein or D-Dimer During HIV Infection

    DEFF Research Database (Denmark)

    Borges, Alvaro Humberto Diniz; O'Connor, Jemma L; Phillips, Andrew N

    2016-01-01

    BACKGROUND: Interleukin 6 (IL-6), high-sensitivity C-reactive protein (hsCRP), and D-dimer levels are linked to adverse outcomes in human immunodeficiency virus (HIV) infection, but the strength of their associations with different clinical end points warrants investigation. METHODS: Participants...... receiving standard of care in 2 HIV trials with measured biomarker levels were followed to ascertain all-cause death, non-AIDS-related death, AIDS, cardiovascular disease (CVD), and non-AIDS-defining malignancies. Hazard ratios (HRs) and 95% confidence intervals (CIs) of each end point for quartiles and log......-dimer (P = .20) as a predictor for different end points. CONCLUSIONS: IL-6 is a stronger predictor of fatal events than of CVD and non-AIDS-defining malignancies. Adjuvant antiinflammatory and antithrombotic therapies should be tested in HIV-infected individuals....

  5. Which are the cut-off values of 2D-Shear Wave Elastography (2D-SWE) liver stiffness measurements predicting different stages of liver fibrosis, considering Transient Elastography (TE) as the reference method?

    Energy Technology Data Exchange (ETDEWEB)

    Sporea, Ioan, E-mail: isporea@umft.ro; Bota, Simona, E-mail: bota_simona1982@yahoo.com; Gradinaru-Taşcău, Oana, E-mail: bluonmyown@yahoo.com; Şirli, Roxana, E-mail: roxanasirli@gmail.com; Popescu, Alina, E-mail: alinamircea.popescu@gmail.com; Jurchiş, Ana, E-mail: ana.jurchis@yahoo.com

    2014-03-15

    Introduction: To identify liver stiffness (LS) cut-off values assessed by means of 2D-Shear Wave Elastography (2D-SWE) for predicting different stages of liver fibrosis, considering Transient Elastography (TE) as the reference method. Methods: Our prospective study included 383 consecutive subjects, with or without hepatopathies, in which LS was evaluated by means of TE and 2D-SWE. To discriminate between various stages of fibrosis by TE we used the following LS cut-offs (kPa): F1-6, F2-7.2, F3-9.6 and F4-14.5. Results: The rate of reliable LS measurements was similar for TE and 2D-SWE: 73.9% vs. 79.9%, p = 0.06. Older age and higher BMI were associated for both TE and 2D-SWE with the impossibility to obtain reliable LS measurements. Reliable LS measurements by both elastographic methods were obtained in 65.2% of patients. A significant correlation was found between TE and 2D-SWE measurements (r = 0.68). The best LS cut-off values assessed by 2D-SWE for predicting different stages of liver fibrosis were: F ≥ 1: >7.1 kPa (AUROC = 0.825); F ≥ 2: >7.8 kPa (AUROC = 0.859); F ≥ 3: >8 kPa (AUROC = 0.897) and for F = 4: >11.5 kPa (AUROC = 0.914). Conclusions: 2D-SWE is a reliable method for the non-invasive evaluation of liver fibrosis, considering TE as the reference method. The accuracy of 2D-SWE measurements increased with the severity of liver fibrosis.

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

    Science.gov (United States)

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

    2015-12-01

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

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

    Science.gov (United States)

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

    2009-10-01

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

  8. {sup 18}F-FDG PET/CT for detection of malignant peripheral nerve sheath tumours in neurofibromatosis type 1: tumour-to-liver ratio is superior to an SUV{sub max} cut-off

    Energy Technology Data Exchange (ETDEWEB)

    Salamon, Johannes [University Medical Centre Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); University Hospital Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Veldhoen, Simon [University Medical Centre Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); University Medical Centre Wuerzburg, Department of Diagnostic and Interventional Radiology, Wuerzburg (Germany); Apostolova, Ivayla [Otto-von-Guericke University, Department of Radiology and Nuclear Medicine, Magdeburg (Germany); Bannas, Peter; Yamamura, Jin; Herrmann, Jochen; Adam, Gerhard; Derlin, Thorsten [University Medical Centre Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Friedrich, Reinhard E. [University Medical Centre Hamburg-Eppendorf, Department of Oral and Maxillofacial Surgery, Hamburg (Germany); Mautner, Victor F. [University Medical Centre Hamburg-Eppendorf, Department of Neurology, Hamburg (Germany)

    2014-02-15

    To evaluate the usefulness of normalising intra-tumour tracer accumulation on {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to reference tissue uptake for characterisation of peripheral nerve sheath tumours (PNSTs) in neurofibromatosis type 1 (NF1) compared with the established maximum standardised uptake value (SUVmax) cut-off of >3.5. Forty-nine patients underwent FDG PET/CT. Intra-tumour tracer uptake (SUVmax) was normalised to three different reference tissues (tumour-to-liver, tumour-to-muscle and tumour-to-fat ratios). Receiver operating characteristic (ROC) analyses were used out to assess the diagnostic performance. Histopathology and follow-up served as the reference standard. Intra-tumour tracer uptake correlated significantly with liver uptake (r{sub s} = 0.58, P = 0.016). On ROC analysis, the optimum threshold for tumour-to-liver ratio was >2.6 (AUC = 0.9735). Both the SUVmax cut-off value of >3.5 and a tumour-to-liver ratio >2.6 provided a sensitivity of 100 %, but specificity was significantly higher for the latter (90.3 % vs 79.8 %; P = 0.013). In patients with NF1, quantitative {sup 18}F-FDG PET imaging may identify malignant change in neurofibromas with high accuracy. Specificity could be significantly increased by using the tumour-to-liver ratio. The authors recommend further evaluation of a tumour-to-liver ratio cut-off value of >2.6 for diagnostic intervention planning. (orig.)

  9. Can Cut-Off-Values for Tumor Size or Patient Age in Breast Ultrasound Reduce Unnecessary Biopsies or is it all About Bi-rads?- A Retrospective Analysis of 763 Biopsied T1-Sized Lesions.

    Science.gov (United States)

    Holzer-Fruehwald, Laura; Meissnitzer, Matthias; Weber, Michael; Holzer, Stephan; Hergan, Klaus; Weismann, Christian

    2017-06-01

    To assess whether it is possible to establish a size cut-off-value for sonographically visible breast lesions in a screening situation, under which it is justifiable to obviate a biopsy and to evaluate the grayscale characteristics of the identified lesions. Images of sonographically visible and biopsied breast lesions of 684 patients were retrospectively reviewed and assessed for the following parameters: size, shape, margin, lesion boundary, vascularity, patient's age, side of breast, histological result, and initial BI-RADS category. Statistical analyses (t-test for independent variables, ROC analyses, binary logistic regression models, cross-tabulations, positive/negative predictive values) were performed using IBM SPSS (Version 21.0). Of all 763 biopsied lesions, 223 (29.2%) showed a malignant histologic result, while 540 (70.8%) were benign. Although we did find a statistically significant correlation of malignancy and lesion size (p=0.031), it was not possible to define a cut-off value, under which it would be justifiable to obviate a biopsy in terms of sensitivity and specificity (AUC: 0.558) at any age. Lesions showing the characteristics of a round or oval shape, a sharp delineation and no echogenic rim (n=112) were benign with an NPV of 99.1%. It is not possible to define a cut-off value for size or age, under which a biopsy of a sonographically visible breast lesion can be obviated in the screening situation. The combination of the 3 grayscale characteristics, shape (round or oval), margin (circumscribed) and no echogenic-rim sign, showed an NPV of 99.1%. Therefore, it seems appropriate to classify such lesions as BI-RADS 2.

  10. Can Cut-Off-Values for Tumor Size or Patient Age in Breast Ultrasound Reduce Unnecessary Biopsies or is it all About Bi-rads?– A Retrospective Analysis of 763 Biopsied T1-Sized Lesions

    Science.gov (United States)

    Holzer-Fruehwald, Laura; Meissnitzer, Matthias; Weber, Michael; Holzer, Stephan; Hergan, Klaus; Weismann, Christian

    2017-01-01

    Aims and Objectives To assess whether it is possible to establish a size cut-off-value for sonographically visible breast lesions in a screening situation, under which it is justifiable to obviate a biopsy and to evaluate the grayscale characteristics of the identified lesions. Materials and Methods Images of sonographically visible and biopsied breast lesions of 684 patients were retrospectively reviewed and assessed for the following parameters: size, shape, margin, lesion boundary, vascularity, patient’s age, side of breast, histological result, and initial BI-RADS category. Statistical analyses (t-test for independent variables, ROC analyses, binary logistic regression models, cross-tabulations, positive/negative predictive values) were performed using IBM SPSS (Version 21.0). Results Of all 763 biopsied lesions, 223 (29.2%) showed a malignant histologic result, while 540 (70.8%) were benign. Although we did find a statistically significant correlation of malignancy and lesion size (p=0.031), it was not possible to define a cut-off value, under which it would be justifiable to obviate a biopsy in terms of sensitivity and specificity (AUC: 0.558) at any age. Lesions showing the characteristics of a round or oval shape, a sharp delineation and no echogenic rim (n=112) were benign with an NPV of 99.1%. Conclusion It is not possible to define a cut-off value for size or age, under which a biopsy of a sonographically visible breast lesion can be obviated in the screening situation. The combination of the 3 grayscale characteristics, shape (round or oval), margin (circumscribed) and no echogenic-rim sign, showed an NPV of 99.1%. Therefore, it seems appropriate to classify such lesions as BI-RADS 2. PMID:28879346

  11. The Brazilian hazard-based cut-off criteria for pesticide registration: a critical appraisal / Critérios de exclusão baseados em perigo adotados no Brasil para registro de pesticidas: Uma avalição crítica

    OpenAIRE

    Francisco José Roma Paumgartten

    2013-01-01

    Brazil, the world’s top consumer of agricultural pesticides, adopts a unique hazard-based cut-off approach to pesticide registration. Cut-off criteria for mutagenicity, carcinogenicity, teratogenicity, hormonal disturbances and damage to reproductive organs were introduced by the Pesticide Law enacted in 1989. As far as health is concerned, law enforcement is additionally regulated by rules issued by the federal health authority (National Agency for Health Surveillance – ANVISA). Contrasting ...

  12. Optimal Cut-Offs of Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) to Identify Dysglycemia and Type 2 Diabetes Mellitus: A 15-Year Prospective Study in Chinese

    Science.gov (United States)

    Lee, C. H.; Shih, A. Z. L.; Woo, Y. C.; Fong, C. H. Y.; Leung, O. Y.; Janus, E.; Cheung, B. M. Y.; Lam, K. S. L.

    2016-01-01

    Background The optimal reference range of homeostasis model assessment of insulin resistance (HOMA-IR) in normal Chinese population has not been clearly defined. Here we address this issue using the Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS), a prospective population-based cohort study with long-term follow-up. Material & Methods In this study, normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM) were defined according to the 1998 World Health Organization criteria. Dysglycemia referred to IFG, IGT or T2DM. This study comprised two parts. Part one was a cross-sectional study involving 2,649 Hong Kong Chinese subjects, aged 25–74 years, at baseline CRISPS-1 (1995–1996). The optimal HOMA-IR cut-offs for dysglycemia and T2DM were determined by the receiver-operating characteristic (ROC) curve. Part two was a prospective study involving 872 subjects who had persistent NGT at CRISPS-4 (2010–2012) after 15 years of follow-up. Results At baseline, the optimal HOMA-IR cut-offs to identify dysglyceia and T2DM were 1.37 (AUC = 0.735; 95% confidence interval [CI] = 0.713–0.758; Sensitivity [Se] = 65.6%, Specificity [Sp] = 71.3%] and 1.97 (AUC = 0.807; 95% CI = 0.777–0.886; Se = 65.5%, Sp = 82.9%) respectively. These cut-offs, derived from the cross-sectional study at baseline, corresponded closely to the 75th (1.44) and 90th (2.03) percentiles, respectively, of the HOMA-IR reference range derived from the prospective study of subjects with persistent NGT. Conclusions HOMA-IR cut-offs, of 1.4 and 2.0, which discriminated dysglycemia and T2DM respectively from NGT in Southern Chinese, can be usefully employed as references in clinical research involving the assessment of insulin resistance. PMID:27658115

  13. Extraction of the deciduous canine as an interceptive treatment in children with palatally displaced canines - part II: possible predictors of success and cut-off points for a spontaneous eruption.

    Science.gov (United States)

    Naoumova, Julia; Kürol, Jüri; Kjellberg, Heidrun

    2015-04-01

    To analyse factors affecting the success rate of palatally displaced canines (PDCs) and eruption time and to find cut-off points to predict when interceptive extraction is beneficial versus unnecessary. Sixty-seven patients, 40 girls, 27 boys (10-13 years) with uni- (45) or bilateral (22) PDCs, persisting deciduous canine and no previous orthodontic treatment were randomly allocated for extraction or non-extraction using the block randomization method. There were no dropped out after the randomization or during the trial. Clinical examination and cone beam computed tomography was performed at 0, 6, and 12 months. Blinded measurements were done on baseline images. Erupted PDCs had a significantly smaller mesioangular angle, shorter distance of canine cusp tip-dental arch plane, and larger distance of canine cusp tip-midline, and the patients were younger compared to the non-erupted group. Faster eruption was noted of PDCs in the extraction group. Spontaneous eruption was achieved without prior deciduous canine extraction with cut-off points: initial canine cusp tip-midline of 11mm, canine cusp tip-dental arch plane of 2.5mm, or a mesioangular angle of 103 degrees. PDCs with a less favourable position, i.e. an initial cusp tip-midline of 6mm, a canine cusp tip-dental arch plane of 5mm, or a mesioangular angle of 116 degrees, will need surgical exposure despite interceptive extraction of the deciduous canine. The canine cusp tip-midline had the best predictive measure for assessing the outcome. Decision on where to place the cut-off points may differ from one operator to another, therefore results from several studies are needed to get average cut-off points. Deciduous canine extraction is the variable that affects the spontaneous eruption of the canine most. Canine cusp tip-midline, canine cusp tip-dental arch plane, and mesioangular angle might be useful for distinguishing when an interceptive extraction of the deciduous canine is beneficial or when exposure of the

  14. Thickness-Independent Ultrasonic Imaging Applied to Abrasive Cut-Off Wheels: An Advanced Aerospace Materials Characterization Method for the Abrasives Industry. A NASA Lewis Research Center Technology Transfer Case History

    Science.gov (United States)

    Roth, Don J.; Farmer, Donald A.

    1998-01-01

    Abrasive cut-off wheels are at times unintentionally manufactured with nonuniformity that is difficult to identify and sufficiently characterize without time-consuming, destructive examination. One particular nonuniformity is a density variation condition occurring around the wheel circumference or along the radius, or both. This density variation, depending on its severity, can cause wheel warpage and wheel vibration resulting in unacceptable performance and perhaps premature failure of the wheel. Conventional nondestructive evaluation methods such as ultrasonic c-scan imaging and film radiography are inaccurate in their attempts at characterizing the density variation because a superimposing thickness variation exists as well in the wheel. In this article, the single transducer thickness-independent ultrasonic imaging method, developed specifically to allow more accurate characterization of aerospace components, is shown to precisely characterize the extent of the density variation in a cut-off wheel having a superimposing thickness variation. The method thereby has potential as an effective quality control tool in the abrasives industry for the wheel manufacturer.

  15. Comparison of image quality and radiation dose between prospectively ECG-triggered and retrospectively ECG-gated CT angiography: Establishing heart rate cut-off values in first-generation dual-source CT.

    Science.gov (United States)

    Ünal, Emre; Yıldız, A Elçin; Güler, Ezgi; Karcaaltıncaba, Muşturay; Akata, Deniz; Kılınçer, Abidin; Atlı, Eray; Topçuoğlu, Melih; Hazırolan, Tuncay

    2015-09-01

    To evaluate radiation dose and image quality of prospectively electrocardiography (ECG)-triggered and retrospectively ECG-gated coronary computed tomography (CT) angiography and to establish cut-off values of heart rates (HRs) for each technique in first-generation dual-source CT. A total of 200 consecutive patients with suspected coronary artery disease were accepted into the study. Patients were selected randomly for each technique (prospective triggering group n=99, mean age 55.85±10.74 and retrospective gating group n=101, mean age 53.38±11.58). Two independent radiologists scored coronary artery segments for image quality using a 5-point scale. Also, attenuation values of each coronary artery segment and dose-length product values were measured. For each technique, cut-off HR values were determined for the best image quality. Mean image quality scores and attenuation values were found to be higher in the prospective triggering group (pquality scores were ≤67 beats per minute (bpm) and ≤80 bpm for the prospective triggering and retrospective gating groups, respectively (pquality (pquality scores than retrospective ECG gating, particularly in patients who have an HR of less than 68 bpm. Also, a 73% radiation dose reduction can be achieved with prospective ECG triggering. In patients with higher heart rates, retrospective ECG gating is recommended.

  16. Test accuracy at different cut-offs when plasma concentrations of metabolic indicators are used to detect decreased fertility in dairy cows (Poster topic 01, Poster 27, p. 193)

    DEFF Research Database (Denmark)

    Lomander, H; Gustafsson, H; Svensson, C

    Negative energy balance is a known risk factor for decreased fertility in dairy cows. This study evaluates the accuracy of measuring plasma concentrations of two indicators of negative energy balance, non esterified fatty acids (NEFA) and β-hyrdroxy buturate (BHBA), when they are used to predict...... results and fertility parameters were investigated using logistic regressio n. For this analysis, cut-offs with Sp ~80% was used because a high Sp was considered of interest. This corresponded to a NEFA-cutoff at 400 µeqv./mL (Se≤0.44) and a BHBA-cut-off at 1.8 mM (Se ≤0.32). Sp was generally higher when...... the test was used in heifers compared to older cows. With a prevalence of ANEST of 28% PV+ were 0.25 and PV- nearly 0.90. With a DFAI prevalence of 35%, PV+ were indicate that overall test performance is low when metabolic indicators measured 0-21 days in milk...

  17. Direct Extraction of InP/GaAsSb/InP DHBT Equivalent-Circuit Elements From S-Parameters Measured at Cut-Off and Normal Bias Conditions

    DEFF Research Database (Denmark)

    Johansen, Tom Keinicke; Leblanc, Rémy; Poulain, Julien

    2016-01-01

    A unique direct parameter extraction method for the small-signal equivalent-circuit model of InP/GaAsSb/InP double heterojunction bipolar transistors (DHBTs) is presented. $S$-parameters measured at cut-off bias are used, at first, to extract the distribution factor $X_{0}$ for the base-collector......A unique direct parameter extraction method for the small-signal equivalent-circuit model of InP/GaAsSb/InP double heterojunction bipolar transistors (DHBTs) is presented. $S$-parameters measured at cut-off bias are used, at first, to extract the distribution factor $X_{0}$ for the base......-collector capacitance at zero collector current and the collector-to-emitter overlap capacitance $C_{ceo}$ present in InP DHBT devices. Low-frequency $S$-parameters measured at normal bias conditions then allows the extraction of the external access resistances $R_{bx}$, $R_{e}$, and $R_{cx}$ as well as the intrinsic...

  18. Is it acceptable to use coagulation plasma samples stored at room temperature and 4°C for 24 hours for additional prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin, and D-dimer testing?

    Science.gov (United States)

    Rimac, V; Coen Herak, D

    2017-10-01

    Coagulation laboratories are faced on daily basis with requests for additional testing in already analyzed fresh plasma samples. This prompted us to examine whether plasma samples stored at room temperature (RT), and 4°C for 24 hours can be accepted for additional prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen (Fbg), antithrombin (AT), and D-dimer testing. We measured PT, aPTT, Fbg in 50 and AT in 30 plasma samples with normal and pathological values, within 4 hours of blood collection (baseline results) and after 24-hours storage at RT (primary tubes), and 4°C (aliquots). D-dimer stability was investigated in 20 samples stored in primary tubes at 4°C. No statistically significant difference between baseline results and results in samples stored at RT and 4°C was observed for PT (P=.938), aPTT (P=.186), Fbg (P=.962), AT (P=.713), and D-dimers (P=.169). The highest median percentage changes were found for aPTT, being more pronounced for samples stored at 4°C (13.0%) than at RT (8.7%). Plasma samples stored both at RT and 4°C for 24 hours are acceptable for additional PT, Fbg, and AT testing. Plasma samples stored 24 hours in primary tubes at 4°C are suitable for D-dimer testing. © 2017 John Wiley & Sons Ltd.

  19. Age-Adjusted PSA Levels in Prostate Cancer Prediction: Updated Results of the Tyrol Prostate Cancer Early Detection Program.

    Science.gov (United States)

    Heidegger, Isabel; Fritz, Josef; Klocker, Helmut; Pichler, Renate; Bektic, Jasmin; Horninger, Wolfgang

    2015-01-01

    To reduce the number of unnecessary biopsies in patients with benign prostatic disease, however, without missing significant PCa the present study re-evaluates the age-dependent PSA cut-offs in the Tyrol Prostate Cancer (PCa) early detection program. The study population included 2225 patients who underwent prostate biopsy due to elevated PSA levels at our department. We divided our patient collective into four age groups: ≤49 years (n = 178), 50-59 years (n = 597), 60-69 years (n = 962) and ≥70 years (n = 488). We simulated different scenarios for PSA cut-off values between 1.25 and 6 ng/mL and fPSA% between 15 and 21% for all four age groups and calculated sensitivity, specificity, confidence intervals and predictive values. PCa was detected in 1218 men (54.7%). We found that in combination with free PSA ≤21% the following PSA cut-offs had the best cancer specificity: 1.75 ng/ml for men ≤49 years and 50-59 years, 2.25 ng/ml for men aged 60-69 years and 3.25 ng/ml for men ≥70 years. Using these adjusted PSA cut-off values all significant tumors are recognized in all age groups, yet the number of biopsies is reduced. Overall, one biopsy is avoided in 13 to 14 men (number needed to screen = 13.3, reduction of biopsies = 7.5%) when decision regarding biopsy is done according to the "new" cut-off values instead of the "old" ones. For the different age groups the number needed to screen to avoid one biopsy varied between 9.2 (≤49 years) and 17.4 (50-59 years). With "new", fine-tuned PSA cut-offs we detect all relevant PCa with a significant reduction of biopsies compared to the "old" cut-off values. Optimization of age-specific PSA cut-offs is one step towards a smarter strategy in the Tyrol PCa Early Detection Program.

  20. Population norms and cut-off-points for suboptimal health related quality of life in two generic measures for adolescents: the Spanish VSP-A and KINDL-R

    Directory of Open Access Journals (Sweden)

    Rajmil Luis

    2009-04-01

    Full Text Available Abstract Background Health-related quality of life (HRQL outcome measures are complex and for further application in clinical practice and health service research the meaning of their scorings should be studied in depth. The aim of this study was to increase the interpretability of the Spanish VSP-A and KINDL-R scores. Methods A representative sample of adolescents aged 12 to 18 years old was selected in Spain. The Spanish VSP-A and KINDL-R, two generic HRQL measures (range: 0–100, were self-administered along with other external anchor measures (Strengths and Difficulties Questionnaire, Oslo Social Support Scale and self-declaration of chronic conditions and sent by post. Percentiles of both HRQL questionnaires were obtained by gender, and age group and effect sizes (ES were calculated. Receiver Operating Characteristic curves and related sensitivity (SE and specificity (SP values were also computed. Results The Spanish VSP-A and KINDL-R were completed by 555 adolescents. A moderate ES was shown in Psychological well-being between younger and older girls (ES: 0.77 in the VSP-A and small ES in the KINDL (ES: 0.41 between these groups. A SE and SP value close to 0.70 was associated to a global HRQL score of 65 in the VSP-A and 70 in the KINDL-R, when compared to anchors measuring mental and psychosocial health. Adolescents with scores bellow these cut-off points showed a moderate probability of presenting more impairment in their HRQL. Conclusion The results of this study will be of help to interpret the VSP-A AND KINDL-R questionnaires by comparing with the general population and also provide cut-off points to define adolescents with health problems.

  1. Increase in 2–Long Terminal Repeat Circles and Decrease in D-dimer After Raltegravir Intensification in Patients With Treated HIV Infection: A Randomized, Placebo-Controlled Trial

    Science.gov (United States)

    Hatano, Hiroyu; Strain, Matthew C.; Scherzer, Rebecca; Bacchetti, Peter; Wentworth, Deborah; Hoh, Rebecca; Martin, Jeffrey N.; McCune, Joseph M.; Neaton, James D.; Tracy, Russell P.; Hsue, Priscilla Y.; Richman, Douglas D.; Deeks, Steven G.

    2013-01-01

    Background. The degree to which human immunodeficiency virus (HIV) continues to replicate during antiretroviral therapy (ART) is controversial. We conducted a randomized, double-blind, placebo-controlled study to assess whether raltegravir intensification reduces low-level viral replication, as defined by an increase in the level of 2–long terminal repeat (2-LTR) circles. Methods. Thirty-one subjects with an ART-suppressed plasma HIV RNA level of D-dimer level, compared to placebo (P = .045). Conclusions. Raltegravir intensification resulted in a rapid increase in the level of 2-LTR circles in a proportion of subjects, indicating that low-level viral replication persists in some individuals even after long-term ART. Intensification also reduced the D-dimer level, a coagulation biomarker that is predictive of morbidity and mortality among patients receiving treatment for HIV infection. PMID:23975885

  2. A Correlation of the Platelet Count with D-Dimer Levels as an Indicator for Component Therapy in Children with Dengue Hemorrhagic Fever.

    Science.gov (United States)

    Sridhar, Arthi; Sunil Kumar, B M; Rau, Aarathi; Rau, A T K

    2017-06-01

    Dengue Fever (DF) may evolve into two life threatening forms-Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). DHF is associated with increased vascular permeability and plasma leakage causing thrombocytopenia and loss of clotting factors into the third space and may result in bleeding initially due to thrombocytopenia and later due to disseminated intravascular coagulation (DIC), often as a terminal event. Prompt recognition and treatment of minor bleeds in DF children with incipient DIC with component therapy may be associated with improved survival while failure to do so is usually catastrophic. A sensitive marker for early DIC is the presence of D-dimer (DD) in the blood. To determine the correlation between the severity of thrombocytopenia and early DIC in children with DHF. The impact of additional factors like age and shock will also be evaluated. Case control prospective study of 60 DHF sero -positive children (1-15 years) with thrombocytopenia. After clinical evaluation they were divided into two equal groups based on the degree of thrombocytopenia (more than/less than 30,000/mm 3 ). PT/APTT and DD levels were estimated in all children of both groups and statistical correlation was done. There was no significant difference in the DD levels between the two groups. However, children in either group, presenting with clinical features of shock and thrombocytopenia had significantly higher DD levels. Empirical component therapy in children with DHF based purely on their low platelet counts may not be justified. However, in DHF children with thrombocytopenia and features of shock, aggressive component therapy may prevent subsequent bleeding and may be justified.

  3. Forensic differentiation between peripheral and menstrual blood in cases of alleged sexual assault-validating an immunochromatographic multiplex assay for simultaneous detection of human hemoglobin and D-dimer.

    Science.gov (United States)

    Holtkötter, Hannah; Dias Filho, Claudemir Rodrigues; Schwender, Kristina; Stadler, Christian; Vennemann, Marielle; Pacheco, Ana Claudia; Roca, Gabriela

    2018-05-01

    Sexual assault is a serious offense and identification of body fluids originating from sexual activity has been a crucial aspect of forensic investigations for a long time. While reliable tests for the detection of semen and saliva have been successfully implemented into forensic laboratories, the detection of other body fluids, such as vaginal or menstrual fluid, is more challenging. Especially, the discrimination between peripheral and menstrual blood can be highly relevant for police investigations because it provides potential evidence regarding the issue of consent. We report the forensic validation of an immunochromatographic test that allows for such discrimination in forensic stains, the SERATEC PMB test, and its performance on real casework samples. The PMB test is a duplex test combining human hemoglobin and D-dimer detection and was developed for the identification of blood and menstrual fluid, both at the crime scene and in the laboratory. The results of this study showed that the duplex D-dimer/hemoglobin assay reliably detects the presence of human hemoglobin and identifies samples containing menstrual fluid by detecting the presence of D-dimers. The method distinguished between menstrual and peripheral blood in a swab from a historical artifact and in real casework samples of alleged sexual assaults. Results show that the development of the new duplex test is a substantial progress towards analyzing and interpreting evidence from sexual assault cases.

  4. Accuracy of body fat percent and adiposity indicators cut off values to detect metabolic risk factors in a sample of Mexican adults.

    Science.gov (United States)

    Macias, Nayeli; Quezada, Amado D; Flores, Mario; Valencia, Mauro E; Denova-Gutiérrez, Edgar; Quiterio-Trenado, Manuel; Gallegos-Carrillo, Katia; Barquera, Simon; Salmerón, Jorge

    2014-04-10

    Although body fat percent (BF%) may be used for screening metabolic risk factors, its accuracy compared to BMI and waist circumference is unknown in a Mexican population. We compared the classification accuracy of BF%, BMI and WC for the detection of metabolic risk factors in a sample of Mexican adults; optimized cutoffs as well as sensitivity and specificity at commonly used BF% and BMI international cutoffs were estimated. We also estimated conditional BF% means at BMI international cutoffs. We performed a cross-sectional analysis of data on body composition, anthropometry and metabolic risk factors(high glucose, high triglycerides, low HDL cholesterol and hypertension) from 5,100 Mexican men and women. The association between BMI, WC and BF%was evaluated with linear regression models. The BF%, BMI and WC optimal cutoffs for the detection of metabolic risk factors were selected at the point where sensitivity was closest to specificity. Areas under the ROC Curve (AUC) were compared among classifiers using a non-parametric method. After adjustment for WC, a 1% increase in BMI was associated with a BF% rise of 0.05 percentage points (p.p.) in men (Pwomen (Pmen and 41.2±0.07 in women. Estimated BF% cutoffs for detection of metabolic risk factors were close to 30.0 in men and close to 44.0 in women. In men WC had higher AUC than BF% for the classification of all conditions whereas BMI had higher AUC than BF% for the classification of high triglycerides and hypertension. In womenBMI and WC had higher AUC than BF% for the classification of all metabolic risk factors. BMI and WC were more accurate than BF% for classifying the studied metabolic disorders. International BF% cutoffs had very low specificity and thus produced a high rate of false positives in both sexes.

  5. Health related quality of life and psychopathological distress in risk taking and self-harming adolescents with full-syndrome, subthreshold and without borderline personality disorder: rethinking the clinical cut-off?

    Science.gov (United States)

    Kaess, Michael; Fischer-Waldschmidt, Gloria; Resch, Franz; Koenig, Julian

    2017-01-01

    -syndrome BPD. Findings raise awareness on the importance of early detection and question the diagnostic validity and clinical utility of existing cut-offs. Findings support a lower diagnostic cut-off for adolescent BPD, to identify those at-risk at an early stage.

  6. Determination of an optimal response cut-off able to predict progression-free survival in patients with well-differentiated advanced pancreatic neuroendocrine tumours treated with sunitinib: an alternative to the current RECIST-defined response.

    Science.gov (United States)

    Lamarca, Angela; Barriuso, Jorge; Kulke, Matthew; Borbath, Ivan; Lenz, Heinz-Josef; Raoul, Jean Luc; Meropol, Neal J; Lombard-Bohas, Catherine; Posey, James; Faivre, Sandrine; Raymond, Eric; Valle, Juan W

    2018-01-01

    Sunitinib prolongs progression-free survival (PFS) in patients with advanced pancreatic neuroendocrine tumours (pNET). Response Evaluation Criteria in Solid Tumors (RECIST)-defined partial responses (PR; classically defined as ⩾30% size decrease from baseline) are infrequent. Individual data of pNET patients from the phase II [NCT00056693] and pivotal phase III [NCT00428597] trials of sunitinib were analysed in this investigator-initiated, post hoc study. The primary objective was to determine the optimal RECIST (v.1.0) response cut-off value to identify patients who were progression-free at 11 months (median PFS in phase III trial); and the most informative time-point (highest area under the curve (AUC) by receiver operating characteristic (ROC) analysis and logistic regression) for prediction of benefit (PFS) from sunitinib. Data for 237 patients (85 placebo; 152 sunitinib (n=66.50 mg '4-weeks on/2-weeks off' schedule; n=86 '37.5 mg continuous daily dosing (CDD)')) and 788 scans were analysed. The median PFS for sunitinib and placebo were 9.3 months (95% CI 7.6-12.2) and 5.4 months (95% CI 3.5-6.01), respectively (hazard ratio (HR) 0.43 (95% CI 0.29-0.62); P<0.001). A PR was seen in 19 patients (13%) on sunitinib; the median change in the sum of the lesions (vs baseline) was -12.8% (range -100 to +36.4). Month 7 was the most informative time-point (AUC 0.78 (95% CI 0.66-0.9); odds ratio 1.05 (95% CI 1.01-1.08), P=0.002). Reduction of 10% (vs baseline) achieved the highest sensitivity (50%) and specificity (82%), amongst cut-offs tested. A 10% reduction in marker lesions was associated with improved PFS in the whole sunitinib population (HR 0.55 (95 CI 0.3-0.9); P=0.04); mostly in patients on sunitinib CDD (HR 0.33 (95% CI 0.2-0.7); P=0.005). A 10% reduction in marker lesions (P=0.034) and sunitinib treatment (P=0.012) independently impacted on PFS (multivariable analysis). A 10% reduction within marker lesions identifies pNET patients benefiting from

  7. Acute small-bowel toxicity during neoadjuvant combined radiochemotherapy in locally advanced rectal cancer: determination of optimal dose-volume cut-off value predicting grade 2-3 diarrhoea.

    Science.gov (United States)

    Reis, Tina; Khazzaka, Edwin; Welzel, Grit; Wenz, Frederik; Hofheinz, Ralf-Dieter; Mai, Sabine

    2015-01-31

    Current therapeutic standard for locally advanced rectal cancer is the neoadjuvant radiochemotherapy with total mesorectal excision. Diarrhoea is the main acute side effect, induced by the dose to the small-bowel, frequently leading to a treatment modification. Aim of this study was to analyse the differences between the irradiated small-bowel volumes and the occurrence of acute diarrhea during combined radiochemotherapy for rectal cancer. 45 patients treated with a neoadjuvant radiochemotherapy (three-field box 50.4 Gy; Cetuximab, Capecitabine, Irinotecan) for locally advanced rectal cancer within a prospective phase I/II study were evaluated. Based on the dose-volume histograms, the small-bowel volumes receiving doses of 5, 10 … 45 Gy (V5, V10 …V45) were calculated and compared with the prospectively documented small- bowel toxicities. There was a statistically significant difference between irradiated small-bowel volumes and the severity of therapy related diarrhoea. The strongest validity concerning the risk of developing a grade 2-3 diarrhoea was seen at a dose level of 5 Gy (V 5) with a small-bowel volume of 291.94 cc. Patients with V 5 > 291.94 cc had significantly more often grade 2-3 diarrhoea, than patients with V5 below this cut-off value (82% vs. 29%; p bowel volume receiving 5 Gy should be limited to about 300 cc.

  8. Position and quality of the cut-off in the luminous intensity distribution of automobile headlamps; Lage und Qualitaet der Hell-Dunkel-Grenze in der Lichtverteilung von Kraftfahrzeug-Scheinwerfern

    Energy Technology Data Exchange (ETDEWEB)

    Pollack, W.

    1998-01-01

    The distribution of the dipped light of automobile headlights is generally designed to illuminate the roadway as well as possible. Dazzling of oncoming traffic participants has to be kept within bearable limits. To give an optimum light distribution a bright/dark border between the lower bright and the upper dark zone is demanded in the ECE regulations. The border is also used to conduct a proper allignment of the headlights. As the visual evaluation of the bright/dark border is prone to subjective fluctuations an objective process is being sought which determines both the sharpness and the position of the cut-off. In this article several processes are described and their utility investigated with reference to the precision of the visual alignment. (orig.) [Deutsch] Die Lichtverteilung des Abblendlichtes von Kfz-Scheinwerfern ist allgemein so ausgelegt, dass die Fahrbahn moeglichst gut beleuchtet wird. Die Blendung entgegenkommender Verkehrsteilnehmer muss dabei in ertraeglichen Grenzen gehalten werden. Fuer eine optimale Lichtverteilung wird in den ECE-Regelungen eine Hell-Dunkel-Grenze (HDG) zwischen dem unteren hellen und dem oberen dunklen Bereich gefordert. Die HDG dient zugleich der ordnungsgemaessssen Einstellung der Scheinwerfer. Da die visuelle Beurteilung der Hell-Dunkel-Grenze subjektiven Schwanken unterliegt, wird nach einem objektiven Verfahren gesucht, das sowohl die Schaerfe als auch die Lage der Hell-Dunkel-Grenze bestimmt. In diesem Beitrag werden einige Verfahren beschrieben und deren Brauchbarkeit in Anlehnung an die Genauigkeit der visuellen Einstellung untersucht. (orig.)

  9. 27 The DiPEP (Diagnosis of PE in Pregnancy) study: can clinical assessment, d-dimer or chest x-ray be used to select pregnant or postpartum women with suspected PE for diagnostic imaging?

    Science.gov (United States)

    Goodacre, Steve; Horspool, Kimberley; Nelson-Piercy, Catherine; Knight, Marian; Shephard, Neil; Lecky, Fiona; Thomas, Steven; Hunt, Beverley; Fuller, Gordon

    2017-12-01

    To determine whether clinical features (in the form of a clinical decision rule) or d-dimer can be used to select pregnant or postpartum women with suspected PE for diagnostic imaging. Observational cohort study augmented with additional cases. Consultant-led maternity units participating in the UK Obstetric Surveillance System (UKOSS) and emergency departments and maternity units at eleven prospectively recruiting sites. 198 pregnant or postpartum women with diagnosed PE identified through UKOSS and 324 pregnant or postpartum women with suspected PE from prospectively recruiting sites. Data were collected relating to clinical features, elements of clinical decision rules, d-dimer measurements, diagnostic imaging, treatment for PE and adverse outcomes. Women were classified as having or not having PE on the basis of diagnostic imaging, treatment and subsequent adverse outcomes. Primary analysis was limited to women with conclusive diagnostic imaging. Secondary analyses included women with clinically diagnosed or ruled out PE. The primary analysis included 181 women with PE and 259 without. Most clinical features showed no association with PE. The only exceptions were number of previous pregnancies over 24 weeks (p=0.017), no varicose veins (p=0.045), no recent long haul travel (p=0.006), recent surgery including caesarean section (p=0.001), increased temperature (p=0.003), low oxygen saturation (px-ray abnormality (p=0.01) and other chest x-ray abnormality (p=0.001).Clinical decision rules had areas under the receiver-operator characteristic curve ranging from 0.577 to 0.732. No clinically useful threshold for decision-making was identified for any rule. The sensitivities and specificities of d-dimer were 88.4% and 8.8% using the standard laboratory threshold and 69.8% and 32.8% using a pregnancy-specific threshold. Clinical decision rules, d-dimer and chest x-ray should not be used to select pregnant or postpartum women with suspected PE for diagnostic imaging.

  10. Comparison of VerifyNow-P2Y12 test and Flow Cytometry for monitoring individual platelet response to clopidogrel. What is the cut-off value for identifying patients who are low responders to clopidogrel therapy?

    Directory of Open Access Journals (Sweden)

    Castelli Alfredo

    2009-05-01

    Full Text Available Abstract Background Dual anti-platelet therapy with aspirin and a thienopyridine (DAT is used to prevent stent thrombosis after percutaneous coronary intervention (PCI. Low response to clopidogrel therapy (LR occurs, but laboratory tests have a controversial role in the identification of this condition. Methods We studied LR in patients with stable angina undergoing elective PCI, all on DAT for at least 7 days, by comparing: 1 Flow cytometry (FC to measure platelet membrane expression of P-selectin (CD62P and PAC-1 binding following double stimulation with ADP and collagen type I either in the presence of prostaglandin (PG E1; 2 VerifyNow-P2Y12 test, in which results are reported as absolute P2Y12-Reaction-Units (PRU or % of inhibition (% inhibition. Results Thirty controls and 52 patients were analyzed. The median percentage of platelets exhibiting CD62P expression and PAC-1 binding by FC evaluation after stimulation in the presence of PG E1 was 25.4% (IQR: 21.4–33.1% and 3.5% (1.7–9.4%, respectively. Only 6 patients receiving DAT (11.5% had both values above the 1st quartile of controls, and were defined as LR. Evaluation of the same patients with the VerifyNow-P2Y12 test revealed that the area under the receiver-operating-characteristic (ROC curve was 0.94 (95% CI: 0.84–0.98, p 213 PRU gave the maximum accuracy for the detection of patients defined as having LR by FC. Conclusion In conclusion our findings show that a cut-off value of ≤ 15% inhibition or > 213 PRU in the VerifyNow-P2Y12 test may provide the best accuracy for the identification of patients with LR.

  11. Suppressed oxygen extraction and degradation of LiNixMnyCozO2 cathodes at high charge cut-off voltages

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Jianming; Yan, Pengfei; Zhang, Jiandong; Engelhard, Mark H.; Zhu, Zihua; Polzin, Bryant J.; Trask, Steve; Xiao, Jie; Wang, Chongmin; Zhang, Jiguang

    2017-09-01

    The capacity degradation mechanism in lithium nickel–manganese–cobalt oxide (NMC) cathodes (LiNi1/3Mn1/3Co1/3O2 (NMC333) and LiNi0.4Mn0.4Co0.2O2 (NMC442)) during high-voltage (cut-off of 4.8 V) operation has been investigated. In contrast to NMC442, NMC333 exhibits rapid structural changes including severe micro-crack formation and phase transformation from a layered to a disordered rock-salt structure, as well as interfacial degradation during high-voltage cycling, leading to a rapid increase of the electrode resistance and fast capacity decline. The fundamental reason behind the poor structural and interfacial stability of NMC333 was found to be correlated to its high Co content and the significant overlap between the Co3+/4+ t2g and O2- 2p bands, resulting in oxygen removal and consequent structural changes at high voltages. In addition, oxidation of the electrolyte solvents by the extracted oxygen species generates acidic species, which then attack the electrode surface and form highly resistive LiF. These findings highlight that both the structural and interfacial stability should be taken into account when tailoring cathode materials for high voltage battery systems.

  12. Comparison of PCT, CRP, D-Dimer, Lactate, TNF-α, IL-1β, IL-6 and lL-10 in Development of Systemic Inflammatory Response Syndrome and Sepsis on Patients with Isolated Head Trauma and Polytrauma

    Directory of Open Access Journals (Sweden)

    Emine Dağlı

    2012-12-01

    Full Text Available Objective: In this study, it was aimed to compare the relationship between Glasgow Coma Scale (GKS, ISS values, PCT, CRP, D-Dimer, laktat, TNF-α, IL-1β, IL-6, IL-10 in patients with polytrauma and isolated head trauma in conjunction with SIRS and sepsis. Material and Method: Total of 68 patients (32 polytrauma, 36 isolated head trauma aged between 18-65 years were enrolled in the study. For 7 days of follow up, the biochemical parameters were analysed on the days 0, 1, 3, 5, 7 and the ISS, GCS score and growth rates of SIRS and sepsis were recorded. Results: It was demonstrated that for patients with isolated head trauma, SIRS (80.6%, sepsis (38.9% and mortality values (71.4% were higher and there is a statistically important linear and inverse relationship between ISS and GCS values (p<0.05. During sepsis and SIRS phases, CRP elevated in both groups, whereas PCT only in the polytrauma group. D-Dimer values were investigated high in both groups, but atypically decreased on day 3 in isolated head trauma group. Lactate, TNF-α and, IL-1β were within reference values, IL-6 and IL-10 values were elevated in both groups but were higher in the polytrauma group. Conclusion: Although multiple variations were detected in serum markers of pro-inflamatory and acute phase proteins, we thought that these are inadequate in predicting mortality and complications such as SIRS and sepsis.

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

    Science.gov (United States)

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

    2016-09-20

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

  14. [The impact of the dosing, a 12-week physical training on the concentration of NT-proBNP and D-Dimer in patients with heart failure and impaired functional capacity in VII-X decade of life].

    Science.gov (United States)

    Andrzejczak-Karbowska, Magdalena; Irzmański, Robert

    2016-07-29

    Chronic heart failure (CHF), despite the preventive measures taken is the most common problem of modern cardiology. The aging of the body predisposes to the development of PNS, because qualitative changes taking place in the heart of the patient in the elderly are similar to those occurring among patients with heart failure. A growing problem of eldery patients becomes a deterioration of physical fitness leading to the reduction of activity and sedentary lifestyle. There is no doubt that increasing physical activity in the elderly should aim not only to restore the patient to a previous level of functioning, but also improve their physical resources to a higher level of efficiency and to facilitate independent functioning in everyday life. The aim of the study was to analyze the assessment of 12-week controlled physical training on the concentration of NT-proBNP and D-Dimer in patients with heart failure and impaired functional capacity in VII-X decade of life. The study included a group of 72 patients, elderly men and women (within a mean age of 81,6 ± 6,4) with stable heart failure. The plasma concentration of B-type natriuretic peptide and D-Dimer was measured in each and every subject. The subjects were also asked to perform a Timed Up and Go Test (TUG) and the normal gait speed was analyzed over a 6 meter distance. 12-weeks cardiac rehabilitation process, improved the functional capacity of patients which is proved by reduction in duration of the TUG. Analysis of the results showed a correlation between the results of the test TUG and speed of gait. In the group of patients who underwent rehabilitation, a decrease in the concentration of plasma NT-proBNP and D-Dimer were observed. The low-intensity physical training increases functional capacity which is shown to shorten the duration of the TUG test and affects the modulation of neuroendocrine and concentration of NT-proBNP in patients with CHF, regardless of gender.

  15. [Structural adjustment, cultural adjustment?].

    Science.gov (United States)

    Dujardin, B; Dujardin, M; Hermans, I

    2003-12-01

    Over the last two decades, multiple studies have been conducted and many articles published about Structural Adjustment Programmes (SAPs). These studies mainly describe the characteristics of SAPs and analyse their economic consequences as well as their effects upon a variety of sectors: health, education, agriculture and environment. However, very few focus on the sociological and cultural effects of SAPs. Following a summary of SAP's content and characteristics, the paper briefly discusses the historical course of SAPs and the different critiques which have been made. The cultural consequences of SAPs are introduced and are described on four different levels: political, community, familial, and individual. These levels are analysed through examples from the literature and individual testimonies from people in the Southern Hemisphere. The paper concludes that SAPs, alongside economic globalisation processes, are responsible for an acute breakdown of social and cultural structures in societies in the South. It should be a priority, not only to better understand the situation and its determining factors, but also to intervene and act with strategies that support and reinvest in the social and cultural sectors, which is vital in order to allow for individuals and communities in the South to strengthen their autonomy and identify.

  16. The Brazilian hazard-based cut-off criteria for pesticide registration: a critical appraisal / Critérios de exclusão baseados em perigo adotados no Brasil para registro de pesticidas: Uma avalição crítica

    Directory of Open Access Journals (Sweden)

    Francisco José Roma Paumgartten

    2013-02-01

    Full Text Available Brazil, the world’s top consumer of agricultural pesticides, adopts a unique hazard-based cut-off approach to pesticide registration. Cut-off criteria for mutagenicity, carcinogenicity, teratogenicity, hormonal disturbances and damage to reproductive organs were introduced by the Pesticide Law enacted in 1989. As far as health is concerned, law enforcement is additionally regulated by rules issued by the federal health authority (National Agency for Health Surveillance – ANVISA. Contrasting to the European Union’s hazard-based cut-off criteria for pesticides, Brazilian rules do not make an exception for “negligible” exposures. Moreover, Brazilian regulations have shortcomings (e.g. no reference to relevance of Mode of Action to humans that make cut-off criteria difficult to be put into effect. The deficiencies of regulations and difficulties to consistently apply the hazard-based cut-off criteria are appraised in this article. Adoption of a risk assessment approach or cut-off criteria based on classification into the Globally Harmonized System’s hazard categories 1A and 1B is suggested. Resumo O Brasil, líder mundial do consumo de agro-químicos, adota uma singular abordagem para registro de agrotóxicos que é baseada em critérios de exclusão quanto à periculosidade. Critérios de exclusão para mutagenicidade, carcinogenicidade, teratogenicidade, distúrbios hormonais e dano a órgãos reprodutivos foram introduzidos pela Lei de Agrotóxicos promulgada em 1989. Em relação à saúde, a aplicação da lei é também regulada por portarias publicadas pela autoridade sanitária federal (Agência Nacional de Vigilância Sanitária – ANVISA. Em contraste com os critérios de exclusão baseados na periculosidade que a União Européia usa para agrotóxicos, a regulamentação brasileira não faz exceção para exposições insignificantes. Além disso, a regulamentação brasileira apresenta deficiências (e.g., não faz men

  17. Prognostic value of Ki67 and p53 in patients with estrogen receptor-positive and human epidermal growth factor receptor 2-negative breast cancer: Validation of the cut-off value of the Ki67 labeling index as a predictive factor.

    Science.gov (United States)

    Ohara, Masahiro; Matsuura, Kazuo; Akimoto, Etsushi; Noma, Midori; Doi, Mihoko; Nishizaka, Takashi; Kagawa, Naoki; Itamoto, Toshiyuki

    2016-04-01

    The aim of this study was to evaluate the significance of the Ki67 labeling index and p53 status as prognostic and predictive indicators of operable estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Among 697 consecutive patients with primary breast cancer who underwent curative surgery between 2002 and 2013, 308 patients with ER-positive and HER2-negative breast cancer were assessed. The results of the multivariate Cox analysis demonstrated that a high Ki67 labeling index was significantly associated with a short recurrence-free interval (RFI) (p=0.004) and was marginally associated with a worse overall survival (p=0.074). A positive p53 status was not associated with worse outcomes. To validate the cut-off values of the Ki67 labeling index for identifying patients who may benefit from additional chemotherapy, prognostic factors were investigated in breast cancer patients treated postoperatively with endocrine therapy alone. Analysis of receiver operating characteristic curves demonstrated that a Ki67 labeling index cut-off of 20.0% was optimal for predicting recurrence among patients who did not receive adjuvant chemotherapy. The 5-year RFIs for patients with Ki67 Ki67 labeling index (≥20%) was significantly associated with large tumors (pKi67 labeling index ≥20%, lymph node metastasis and progesterone receptor negativity were significant worse prognostic factors for RFI (p=0.0333, 0.0116 and 0.0573, respectively). The Ki67 labeling index was found to be a useful prognostic factor in patients with ER-positive and HER2-negative breast cancer and the cut-off values of the Ki67 labeling index for making a decision regarding adjuvant treatment were validated.

  18. Convexity Adjustments

    DEFF Research Database (Denmark)

    M. Gaspar, Raquel; Murgoci, Agatha

    2010-01-01

    A convexity adjustment (or convexity correction) in fixed income markets arises when one uses prices of standard (plain vanilla) products plus an adjustment to price nonstandard products. We explain the basic and appealing idea behind the use of convexity adjustments and focus on the situations...

  19. Determining the Optimum Cut-Off Grades in Sulfide Copper Deposits / Określanie Optymalnej Wartości Odcięcia Zawartości Procentowej Pierwiastka Użytecznego W Złożach Siarczku Miedzi

    Science.gov (United States)

    Rahimi, Esmaeil; Oraee, Kazem; Shafahi, Zia Aldin; Ghasemzadeh, Hasan

    2015-03-01

    Optimum cut-off grades determination in mining life affects production planning and ultimate pit limit and it is also important from social, economical and environmental aspects. Calculation of optimum cut-off grades has been less considered for mines containing various mineral processing methods. In this paper, an optimization technique is applied to obtain optimum cut-off grades for both concentration and heap leaching processes. In this technique, production costs and different recoveries of heap leaching method directed into modeling different annual cash flows in copper mines. Considering the governing constraints, the Lagrange multiplier method is practiced to optimize the cut-off grades in which the objective function is supposed to maximize Net Present Value. The results indicate the effect of heap leaching process on the optimum cut-off grades of primary and secondary sulfide deposits. Określanie optymalnego poziomu odcięcia dla zawartości procentowej pierwiastka użytecznego ma poważny wpływ na planowanie produkcji, określanie ostatecznych limitów zasobów złoża; jest to także ważna kwestia z punktu widzenia kwestii społecznych, ekonomicznych i środowiskowych. Obliczanie optymalnego poziomu odcięcia dla zawartości procentowej pierwiastka użytecznego nie było zwykle szeroko rozważane w przypadku kopalni prowadzących ciągły system przeróbki. W pracy tej przedstawiono technikę optymalizacji określania poziomu zawartości procentowej pierwiastka użytecznego z uwzględnieniem zarówno procesów koncentracji jak i ługowania. W metodzie uwzględniono koszty produkcji i różne wskaźniki odzysku rudy, wielkości te wykorzystane zostały do modelowania rocznych przepływów gotówki w kopalniach miedzi. Uwzględniając narzucone ograniczenia, zastosowano metodę mnożników Lagrange'a w celu optymalizacji określania poziomu zawartości procentowej pierwiastka użytecznego, gdzie przyjętą funkcją celu jest maksymalizacja wartości bie

  20. Chiropractic Adjustment

    Science.gov (United States)

    ... Results Chiropractic adjustment can be effective in treating low back pain, although much of the research done shows only a modest benefit — similar to the results of more conventional treatments. Some studies suggest that spinal manipulation also may ...

  1. Chiropractic Adjustment

    Science.gov (United States)

    ... How you prepare No special preparation is required before a chiropractic adjustment. Chiropractic treatment may require a series of visits to your chiropractor. Ask your care provider about the frequency of visits and be ...

  2. Influence of different body mass index cut-off values in assessing the nutritional status of adolescents in a household survey Influência de distintos valores críticos do índice de massa corporal na avaliação do estado nutricional de adolescentes em inquérito domiciliar

    Directory of Open Access Journals (Sweden)

    Fabio da Silva Gomes

    2009-08-01

    Full Text Available The purpose of this study was to evaluate the anthropometric nutritional status of the adolescent population of Niterói, Rio de Janeiro State, Brazil, and the influence of changes in the adopted body mass index (BMI cut-offs in the nutritional status assessment of the adolescent population. A population-based survey conducted in 2003 obtained data from a probabilistic sample of 1,734 households and 523 adolescents. The multiple proportions test and prevalence ratios were used to analyze differences between estimates obtained from different BMI cut-offs. Changes in cut-off values from the old to the new recommendation of the World Health Organization (WHO resulted in a significant increase in overweight prevalence among total, male and female adolescent population (25%, 27% and 23%, respectively (p Este artigo tem por objetivo avaliar o estado nutricional antropométrico da população adolescente residente em Niterói, Rio de Janeiro, Brasil, bem como a influência das mudanças nos valores críticos de índice de massa corporal (IMC na avaliação do estado nutricional dessa população. Uma pesquisa amostral probabilística de base populacional conduzida em 2003 obteve dados de 1.734 domicílios e 523 adolescentes. Testes para múltiplas proporções e razões de prevalência foram utilizados para analisar as diferenças entre estimativas obtidas segundo distintos valores críticos de IMC. Mudanças nos pontos de corte da antiga para a atual recomendação da Organização Mundial da Saúde (OMS resultaram em aumentos significativos nas prevalências de sobrepeso entre o total de adolescentes, meninos e meninas (25%, 27% e 23%, respectivamente (p < 0,05. A proposta da International Obesity Task Force resultou em uma redução significativa de 29% e 39% na prevalência de baixo-IMC-para-idade entre o total de adolescentes e meninos, respectivamente, quando comparada à recomendação atual da OMS (p < 0,05. Foi evidenciado que uma simples

  3. Imaging of deep venous thrombosis in patients using a radiolabelled anti-D-dimer Fab' fragment (99mTc-DI-DD3B6/22-80B3): results of a phase I trial.

    Science.gov (United States)

    Macfarlane, David; Socrates, Angelides; Eisenberg, Paul; Larcos, George; Roach, Paul; Gerometta, Michael; Smart, Richard; Tsui, Wendy; Scott, Andrew M

    2009-02-01

    (99m)Tc-DI-DD3B6/22-80B3 (ThromboView, hereafter abbreviated to (99m)Tc-DI-80B3 Fab') is a radiolabelled humanised monoclonal Fab' fragment with affinity and specificity for D-dimer domains of cross-linked fibrin. Detection of thromboembolic events has been demonstrated in canine models. The study objectives were evaluation of safety and characterisation of biodistribution, immunogenicity and pharmacokinetic profile of increasing doses of (99m)Tc-DI-80B3 Fab' in subjects with acute lower-limb DVT. Twenty-six patients with acute lower limb DVT were enrolled. Of these, 21 received a single intravenous dose of 0.5 mg (n = 6), 1.0 mg (n = 9) or 2 mg (n = 6) (99m)Tc-DI-80B3 Fab'. Blood and urine samples and gamma camera images were collected to 24 h after administration for pharmacokinetic and dosimetry analysis. Vital signs, electrocardiography, hematological and biochemical data and human anti-human antibody (HAHA) levels were monitored for up to 30 days following administration. Patients were assigned to either planar or single photon emission computed tomographic (SPECT) imaging of the thorax at 4 h following injection. Thirty-five adverse events were reported in 15 of the 21 subjects. Those deemed possibly related to administration of (99m)Tc-DI-80B3 Fab' included mild hypertension, mild elevation of LD (lactate dehydrogenase) and moderate elevation of ALT (alanine transaminase). HAHA assays remained negative. Pharmacokinetics and organ dosimetry were comparable to prior normal volunteer data. Localisation of Thromboview to sites of known thrombus was evident as early as 30 min post-injection. In subjects with acute DVT, (99m)Tc-DI-80B3 Fab' was well tolerated with favourable characteristics for the detection of acute venous thrombosis.

  4. Imaging of deep venous thrombosis in patients using a radiolabelled anti-D-dimer Fab' fragment ({sup 99m}Tc-DI-DD3B6/22-80B3): results of a phase I trial

    Energy Technology Data Exchange (ETDEWEB)

    Macfarlane, David [University of Queensland, School of Medicine, Brisbane (Australia); Socrates, Angelides; Larcos, George [University of Sydney, Department of Medicine, Sydney (Australia)]|[Westmead Hospital, Department of Nuclear Medicine and Ultrasound, Westmead (Australia)]|[Westmead Hospital, Centre for Biomedical Imaging and Research, Westmead (Australia); Eisenberg, Paul [Amgen Inc, Thousand Oaks, CA (United States); Roach, Paul [University of Sydney, Department of Medicine, Sydney (Australia)]|[Royal North Shore Hospital, Nuclear Medicine, St. Leonards (Australia); Gerometta, Michael [Agen Biomedical Pty Ltd, Brisbane (Australia); Smart, Richard; Tsui, Wendy [St. George Hospital, Nuclear Medicine Department, Sydney (Australia)]|[University of New South Wales, Department of Medicine, Sydney (Australia); Scott, Andrew M. [Austin Hospital, Centre for PET, Melbourne (Australia)]|[Ludwig Institute, Melbourne (Australia)

    2009-02-15

    {sup 99m}Tc-DI-DD3B6/22-80B3 (ThromboView registered, hereafter abbreviated to {sup 99m}Tc-DI-80B3 Fab') is a radiolabelled humanised monoclonal Fab' fragment with affinity and specificity for D-dimer domains of cross-linked fibrin. Detection of thromboembolic events has been demonstrated in canine models. The study objectives were evaluation of safety and characterisation of biodistribution, immunogenicity and pharmacokinetic profile of increasing doses of {sup 99m}Tc-DI-80B3 Fab' in subjects with acute lower-limb DVT. Twenty-six patients with acute lower limb DVT were enrolled. Of these, 21 received a single intravenous dose of 0.5 mg (n = 6), 1.0 mg (n = 9) or 2 mg (n = 6) {sup 99m}Tc-DI-80B3 Fab'. Blood and urine samples and gamma camera images were collected to 24 h after administration for pharmacokinetic and dosimetry analysis. Vital signs, electrocardiography, hematological and biochemical data and human anti-human antibody (HAHA) levels were monitored for up to 30 days following administration. Patients were assigned to either planar or single photon emission computed tomographic (SPECT) imaging of the thorax at 4 h following injection. Thirty-five adverse events were reported in 15 of the 21 subjects. Those deemed possibly related to administration of {sup 99m}Tc-DI-80B3 Fab' included mild hypertension, mild elevation of LD (lactate dehydrogenase) and moderate elevation of ALT (alanine transaminase). HAHA assays remained negative. Pharmacokinetics and organ dosimetry were comparable to prior normal volunteer data. Localisation of Thromboview registered to sites of known thrombus was evident as early as 30 min post-injection. In subjects with acute DVT, {sup 99m}Tc-DI-80B3 Fab' was well tolerated with favourable characteristics for the detection of acute venous thrombosis. (orig.)

  5. Imaging of deep venous thrombosis in patients using a radiolabelled anti-D-dimer Fab' fragment (99mTc-DI-DD3B6/22-80B3): results of a phase I trial

    International Nuclear Information System (INIS)

    Macfarlane, David; Socrates, Angelides; Larcos, George; Eisenberg, Paul; Roach, Paul; Gerometta, Michael; Smart, Richard; Tsui, Wendy; Scott, Andrew M.

    2009-01-01

    99m Tc-DI-DD3B6/22-80B3 (ThromboView registered, hereafter abbreviated to 99m Tc-DI-80B3 Fab') is a radiolabelled humanised monoclonal Fab' fragment with affinity and specificity for D-dimer domains of cross-linked fibrin. Detection of thromboembolic events has been demonstrated in canine models. The study objectives were evaluation of safety and characterisation of biodistribution, immunogenicity and pharmacokinetic profile of increasing doses of 99m Tc-DI-80B3 Fab' in subjects with acute lower-limb DVT. Twenty-six patients with acute lower limb DVT were enrolled. Of these, 21 received a single intravenous dose of 0.5 mg (n = 6), 1.0 mg (n = 9) or 2 mg (n = 6) 99m Tc-DI-80B3 Fab'. Blood and urine samples and gamma camera images were collected to 24 h after administration for pharmacokinetic and dosimetry analysis. Vital signs, electrocardiography, hematological and biochemical data and human anti-human antibody (HAHA) levels were monitored for up to 30 days following administration. Patients were assigned to either planar or single photon emission computed tomographic (SPECT) imaging of the thorax at 4 h following injection. Thirty-five adverse events were reported in 15 of the 21 subjects. Those deemed possibly related to administration of 99m Tc-DI-80B3 Fab' included mild hypertension, mild elevation of LD (lactate dehydrogenase) and moderate elevation of ALT (alanine transaminase). HAHA assays remained negative. Pharmacokinetics and organ dosimetry were comparable to prior normal volunteer data. Localisation of Thromboview registered to sites of known thrombus was evident as early as 30 min post-injection. In subjects with acute DVT, 99m Tc-DI-80B3 Fab' was well tolerated with favourable characteristics for the detection of acute venous thrombosis. (orig.)

  6. Elevated plasma D-dimer and hypersensitive C-reactive protein levels may indicate aortic disorders Níveis plasmáticos elevados do dímero D e da proteína C reativa hipersensíveis podem indicar desordens aórticas

    OpenAIRE

    Shi-Min Yuan; Yong-Hui Shi; Jun-Jun Wang; Fang-Qi Lü; Song Gao

    2011-01-01

    OBJECTIVE: D-dimer and C-reactive protein are of diagnostic and predictive values in patients have thrombotic tendency, such as vascular thrombosis, coronary artery disease and aortic dissection. However, the comparative study in these biomarkers between the patients with acute aortic dissection and coronary artery disease has not been sufficiently elucidated. METHODS: Consecutive surgical patients for acute type A aortic dissection (20 patients), aortic aneurysm (nine patients) or coronary a...

  7. Rendimento da pupunheira em função da densidade de plantio, diâmetro de corte e manejo dos perfilhos no Vale do São Francisco Effect of density, cut-off diameter classes and shoot number on production and yield of irrigated plant peach palm at San Francisco River Valley

    Directory of Open Access Journals (Sweden)

    José Egidio Flori

    2004-02-01

    Full Text Available Com o objetivo de avaliar o rendimento de palmito de pupunheira irrigada em função da densidade de plantio, diâmetro de corte do estipe e o manejo dos perfilhos, instalou-se um experimento na Estação Experimental de Bebedouro da Embrapa Semi-Árido, Petrolina, PE. O delineamento utilizado foi de blocos ao acaso em parcelas subdivididas, sendo as parcelas constituídas por dois espaçamentos (2,0 x 1,0 m - E1 e 2,0 x 2,0 m - E2 e as subparcelas em arranjo fatorial 2 x 2, compreendendo dois manejos de perfilhos e duas classes de diâmetros de corte. As colheitas foram feitas a partir de 16 meses até os 69 meses após o plantio e realizadas com intervalos consecutivos de mais ou menos três meses. Pelos resultados, evidenciaram-se efeitos significativos para espaçamento, manejo de perfilhos e classe de diâmetro de corte. Não foram constatadas interações entre os tratamentos. Houve efeito significativo de espaçamento sobre o rendimento, diâmetro de corte, comprimento e peso médio do palmito. O rendimento e o peso do palmito da pupunheira foram de 545 e 434 kg ha-1 ano-1 e 147 g e 180 g nos espaçamentos E1 e E2, respectivamente. O diâmetro de corte afetou a altura da planta e peso médio do palmito. O manejo de perfilho afetou o rendimento e o peso médio do palmito, com 532 e 446 kg ha-1 e 177 e 149 g de palmito, respectivamente, no manejo de quatro e todos os perfilhos por planta. Pelos resultados, infere-se, como orientação técnica para os produtores de áreas irrigadas do Submédio São Francisco, o cultivo da pupunha no espaçamento de 2 m x 1 m, o manejo de quatro perfilhos por planta e o corte da planta com diâmetro variando de 10 a 12 cm, a 30 cm do nível do solo.The objective of this experiment was to evaluate the effect of planting density, cut-off diameter classes and shoot number on heart of palm production on irrigated peach palm. The experimental layout was a randomized split-plot design with a factorial arrangement

  8. Correlation of rheumatoid arthritis activity indexes (Disease Activity Score 28 measured with ESR and CRP, Simplified Disease Activity Index and Clinical Disease Activity Index) and agreement of disease activity states with various cut-off points in a Northeastern Brazilian population.

    Science.gov (United States)

    Medeiros, Marta Maria das Chagas; de Oliveira, Brenda Maria Gurgel Barreto; de Cerqueira, João Victor Medeiros; Quixadá, Raquel Telles de Souza; de Oliveira, Ídila Mont'Alverne Xavier

    2015-01-01

    The Disease Activity Score 28 (DAS28) and its versions have been used to measure rheumatoid arthritis (RA) activity, but there is no consensus about which one is the best. Determine the correlation among indexes (DAS28 ESR, DAS28 CRP, SDAI and CDAI) and evaluate agreement of activity strata using different cutoff points. Rheumatoid arthritis patients were cross-sectionally evaluated with data collection to calculate the DAS28 (ESR and CRP), SDAI and CDAI, using different cut-offs for defining remission, mild, moderate and high activity. Pearson correlations were calculated for continuous measures and agreement (kappa test) for the strata (remission, mild, moderate and high activity). Of 111 patients included, 108 were women, age 55.6 years, 11-year disease duration. DAS28 (ESR) was significantly higher than DAS28 (CRP) (4.0 vs. 3.5; p<0.001) and the values remained higher after stratification by age, gender, disease duration, rheumatoid factor and HAQ. Correlations among indexes ranged from 0.84 to 0.99, with better correlation between SDAI and CDAI. Agreements among activity strata ranged from 46.8% to 95.8%. DAS28 (CRP) with cut-off point for the remission of 2.3 underestimated disease activity by 45.8% compared with DAS28 (ESR). SDAI and CDAI showed agreement of 95.8%. The four indexes were associated with disease duration and HAQ. Although the activity indexes show good correlation, they show discrepancies in activity strata, thus requiring more researches to define a better index and better cutoff points. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

  9. Salary adjustments

    CERN Multimedia

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, following elements do not increase: a) Family Allowance, Child Allowance and Infant Allowance (Annex R A 3). b) Reimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be implemented, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and the rounding effects. Human Resources Department Tel. 73566

  10. Salary adjustments

    CERN Multimedia

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, the following elements do not increase: a)\tFamily Allowance, Child Allowance and Infant Allowance (Annex R A 3); b)\tReimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be applied, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and rounding effects. Human Resources Department Tel. 73566

  11. Shaft adjuster

    Science.gov (United States)

    Harry, Herbert H.

    1989-01-01

    Apparatus and method for the adjustment and alignment of shafts in high power devices. A plurality of adjacent rotatable angled cylinders are positioned between a base and the shaft to be aligned which when rotated introduce an axial offset. The apparatus is electrically conductive and constructed of a structurally rigid material. The angled cylinders allow the shaft such as the center conductor in a pulse line machine to be offset in any desired alignment position within the range of the apparatus.

  12. A prospective randomized trial of aspirin-clopidogrel combination therapy and dose-adjusted warfarin on indices of thrombogenesis and platelet activation in atrial fibrillation.

    Science.gov (United States)

    Kamath, Sridhar; Blann, Andrew D; Chin, Bernard S P; Lip, Gregory Y H

    2002-08-07

    This study was designed to investigate whether or not combination aspirin-clopidogrel therapy would reduce markers of thrombogenesis and platelet activation in atrial fibrillation (AF), in a manner similar to warfarin. Dose-adjusted warfarin is beneficial as thromboprophylaxis in AF, but potentially serious side effects and regular monitoring leave room for alternative therapies. METHODS; We randomized 70 patients with nonvalvular AF who were not on any antithrombotic therapy to either dose-adjusted warfarin (international normalized ratio 2 to 3) (Group I) or combination therapy with aspirin 75 mg and clopidogrel 75 mg (Group II). Plasma indices of thrombogenesis (fibrin D-dimer, prothrombin fragment 1+2) and platelet activation (beta-thromboglobulin [TG] and soluble P-selectin) were quantified, along with platelet aggregation responses to standard agonists, at baseline (pretreatment) and at six weeks posttreatment. RESULTS; Pretreatment levels of fibrin D-dimer (p = 0.001), beta-TG (p = 0.01) and soluble P-selectin (p = 0.03) were raised in patients with AF, whereas plasma prothrombin fragment 1+2 levels and platelet aggregation were not significantly different compared with controls. Dose-adjusted warfarin reduced plasma levels of fibrin D-dimer, prothrombin fragment 1+2 and beta-thromboglobulin levels at six weeks (all p failed to reduce plasma indices of thrombogenesis and platelet activation in AF, although some aspects of ex vivo platelet aggregation were altered. Anticoagulation with warfarin may be superior to combination aspirin-clopidogrel therapy as thromboprophylaxis in AF.

  13. Screening for cognitive dysfunction in ALS: validation of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) using age and education adjusted normative data.

    Science.gov (United States)

    Pinto-Grau, Marta; Burke, Tom; Lonergan, Katie; McHugh, Caroline; Mays, Iain; Madden, Caoifa; Vajda, Alice; Heverin, Mark; Elamin, Marwa; Hardiman, Orla; Pender, Niall

    2017-02-01

    Cognitive and behavioural changes are an important aspect in Amyotrophic Lateral Sclerosis (ALS). The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) briefly assesses these changes in ALS. To validate the ECAS against a standardised neuropsychological battery and assess its sensitivity and specificity using age and education adjusted cut-off scores. 30 incident ALS cases were assessed on both, ECAS and neuropsychological battery. Age and education adjusted cut-off scores were created from a sample of 82 healthy controls. ECAS composite scores (Total, ALS Specific and Non-Specific) were highly correlated with battery composite scores. High correlations were also observed between ECAS and full battery cognitive domains and subtests. The ECAS Total, ALS Specific and Non-Specific scores were highly sensitive to cognitive impairment. ECAS ALS-Specific cognitive domains also evidenced high sensitivity. Individual subtest sensitivity was medium to low, suggesting that caution should be used when interpreting these scores. Low positive predictive values indicated the presence of false positives. Psychometric properties of the ECAS using age and education adjusted norms indicate that the ECAS, when used as an overall measure of cognitive decline, is highly sensitive. Further comprehensive assessment is required for patients that present as impaired on the ECAS.

  14. Psychological Adjustment of Siblings of Children with Autism Spectrum Disorder in Hong Kong.

    Science.gov (United States)

    Chan, J Yn; Lai, K Yc

    2016-12-01

    Findings about the psychological adjustment of siblings of children with autism spectrum disorder have been inconsistent in western literature and little is known among non-western societies. This study explored the psychological adjustment of siblings of children with autism spectrum disorder in Hong Kong. A total of 116 families with siblings of children with autism spectrum disorders co-morbid with learning disability were included in the study. Parents completed questionnaires about sibling emotional and behavioural adjustment, and their own mental well-being, quality of life, and family functioning. Siblings completed a questionnaire on their relationship with the autistic proband. Parent ratings did not reveal any significant negative impact on the emotional and behavioural adjustment of the typically developing siblings of children with autism spectrum disorder, but there were concerns about their peer relationships and weak prosocial behaviours. When cut-off scores were used to screen for risk of mental health problems, a quarter of the siblings warranted further assessment. Parents' quality of life and family functioning were significant predictors of sibling adjustment. In managing children with autism spectrum disorder, it is necessary to bear in mind the adjustment of their siblings, especially their peer relationships and prosocial behaviour. Adopting a holistic approach to address the psychosocial needs of the parents can facilitate sibling adjustment.

  15. Avaliação do dímero D (D-Di na doença hipertensiva específica da gravidez (DHEG D-dimer plasma levels assessment in preeclampsia

    Directory of Open Access Journals (Sweden)

    Luci Maria Sant'Ana Dusse

    2003-09-01

    Full Text Available A doença hipertensiva específica da gravidez (DHEG, na sua forma pura, caracteriza-se pelo aparecimento, em grávida normotensa, após a vigésima semana de gestação, da tríade sintomática: hipertensão, proteinúria e edema. A DHEG está associada a vasoconstrição generalizada, anormalidades da coagulação e deposição de fibrina na microcirculação da placenta. A fibrina compromete a perfusão adequada da placenta, contribuindo para a prematuridade, o baixo peso fetal e a mortalidade neonatal. Os dímeros D (D-Di constituem os menores fragmentos dos produtos de degradação da fibrina (pdf e são produzidos após a lise, pela plasmina, da ligação cruzada da fibrina. Níveis plasmáticos aumentados de D-Di indicam tanto uma exacerbação da formação de fibrina como um aumento da ação da plasmina. O presente trabalho teve por objetivo avaliar e comparar os níveis plasmáticos de D-Di, obtido por Elisa (Stago em gestantes-controle (n = 26, gestantes com DHEG nas formas leve e moderada (n = 23 e gestantes com DHEG na forma grave (n = 20, visando a investigar a possível utilização desse marcador laboratorial para diagnóstico e/ou prognóstico da doença. As médias e os desvios padrões obtidos para os três grupos avaliados foram 1.146,6 ± 311,2; 1.060,3 ± 259,2 e 1.497,8 ± 435,3ng/ml, respectivamente. A análise estatística das médias dos resultados obtidos revelou um aumento significativo de D-Di plasmático no grupo com DHEG grave, comparando-se aos grupos com DHEG leve/moderada (p Preeclampsia is associated to a generalized vasoconstriction, clot abnormalities and fibrin deposition within placenta microcirculation. The presence of fibrin hampers the placenta perfusion contributing to prematurity, fetal low weight and neonates' mortality. D-Dimers (D-Di are the products of degradation of cross-linked fibrin by plasmin. Increased plasma levels of D-Di may indicate either an exacerbated fibrin formation or an increase

  16. Man-induced channel adjustment in Tennessee streams

    Science.gov (United States)

    Robbins, C.H.; Simon, Andrew

    1983-01-01

    Channel modifications in Tennessee, particularly in the western part, have led to large-scale instabilities in the channelized rivers and may have contributed to several bridge failures. These modifications, together with land-use practices, led to downcutting, headward erosion, downstream aggradation, accelerated scour, and bank instabilities. Changes in gradient by channel straightening caused more severe channel response than did dredging or clearing. Large-scale changes continue to occur in all the channelized rivers: the Obion River, its forks, and the South Fork Forked Deer River. However, the non-channelized Hatchie River in west Tennessee not only withstood the natural stresses imposed by the wet years of 1973 to 1975 but continues to exhibit characteristics of stability. Water-surface slope, the primary dependent variable, proved to be a sensitive and descriptive parameter useful in determining channel adjustment. Adjustments to man-induced increases in channel-slope are described by inverse exponential functions of the basic form S=ae(-b(t)); where ' S ' is some function describing channel-slope, ' t ' is the number of years since completion of channel work, and ' a ' and ' b ' are coefficients. Response times for the attainment of ' equilibrium ' channel slopes are a function of the magnitude and extent of the imposed modifications. The adjusted profile gradients attained by the streams following channelization are similar to the predisturbed profile gradients, where no alteration to channel length was made. Where the channels were straightened by constructing cut-offs, thus shortening channel length, then slope adjustments (reduction) proceed past the predisturbed profile gradients, to new profiles with lower gradients. (USGS)

  17. Adjusting CA19-9 values to predict malignancy in obstructive jaundice: Influence of bilirubin and C-reactive protein

    Science.gov (United States)

    La Greca, Gaetano; Sofia, Maria; Lombardo, Rosario; Latteri, Saverio; Ricotta, Agostino; Puleo, Stefano; Russello, Domenico

    2012-01-01

    AIM: To find a possible relationship between inflammation and CA19-9 tumor marker by analyzing data from patients with benign jaundice (BJ) and malignant jaundice (MJ). METHODS: All patients admitted for obstructive jaundice, in the period 2005-2009, were prospectively enrolled in the study, obtaining a total of 102 patients. On admission, all patients underwent complete standard blood test examinations including C-reactive protein (CRP), bilirubin, CA19-9. Patients were considered eligible for the study when they presented obstructive jaundice confirmed by instrumental examinations and increased serum bilirubin levels (total bilirubin > 2.0 mg/dL). The standard cut-off level for CA19-9 was 32 U/mL, whereas for CRP this was 1.5 mg/L. The CA19-9 level was adjusted by dividing it by the value of serum bilirubin or by the CRP value. The patients were divided into 2 groups, MJ and BJ, and after the adjustment a comparison between the 2 groups of patients was performed. Sensitivity, specificity and positive predictive values were calculated before and after the adjustment. RESULTS: Of the 102 patients, 51 were affected by BJ and 51 by MJ. Pathologic CA19-9 levels were found in 71.7% of the patients. In the group of 51 BJ patients there were 29 (56.9%) males and 22 (43.1%) females with a median age of 66 years (range 24-96 years), whereas in the MJ group there were 24 (47%) males and 27 (53%) females, with a mean age of 70 years (range 30-92 years). Pathologic CA19-9 serum level was found in 82.3% of MJ. CRP levels were pathologic in 66.6% of the patients with BJ and in 49% with MJ. Bilirubin and CA19-9 average levels were significantly higher in MJ compared with BJ (P = 0.000 and P = 0.02), while the CRP level was significantly higher in BJ (P = 0.000). Considering a CA19-9 cut-off level of 32 U/mL, 82.3% in the MJ group and 54.9% in the BJ group were positive for CA19-9 (P = 0.002). A CA19-9 cut-off of 100 U/mL increases the difference between the two groups: 35.3% in

  18. Modified thyroplasty for unilateral vocal fold paralysis using an adjustable titanium implant.

    Science.gov (United States)

    Wen, Wu; Sun, Guangbin; Sun, Bifeng; Liu, Chang; Zhang, Mingxing

    2015-03-01

    This study aimed to describe a new titanium thyroplasty implant that can be adjusted with a screw. Six Beagle dogs were randomly divided into experimental and control groups (n = 3). The titanium screw was implanted in the experimental group after the left recurrent laryngeal nerve was cut off under general anaesthesia. This procedure caused arytenoid cartilage internal shift, allowing the vocal cord to locate at the median and the glottis to close during phonation. No other operation was conducted in the control group. Each group, respectively, underwent video laryngoscopy, CT scan and histopathology before and after operation. After 4 months of follow-up, the video laryngoscopy results showed that the left arytenoid cartilage in the experimental group underwent internal adduct and shift, whereas the left vocal cords in the control group located at the paramedian position and exhibited fissure during phonation. CT scan results showed that the adjustable titanium screw was in proper position. Postoperative pathological examination showed that, in addition to early local inflammation, the laryngeal muscle may atrophy. The adjustable titanium screw requires a simple operation and can be significantly adjusted. The effect of the operation can be immediately observed without rejection. Therefore, this method is an efficient treatment for unilateral vocal cord paralysis.

  19. Height-adjusted percentiles evaluated central obesity in children and adolescents more effectively than just waist circumference.

    Science.gov (United States)

    Hosseini, Mostafa; Kelishadi, Roya; Yousefifard, Mahmoud; Qorbani, Mostafa; Bazargani, Behnaz; Heshmat, Ramin; Motlagh, Mohammad Esmail; Mirminachi, Babak; Ataei, Neamatollah

    2017-01-01

    We compared the prevalence of obesity based on both waist circumference for height and body mass index (BMI) in Iranian children and adolescents. Data on 13 120 children with a mean age of 12.45 ± 3.36 years (50.8% male) from the fourth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease study were included. Measured waist circumference values were modelled according to age, gender and height percentiles. The prevalence of obesity was estimated using the 90th percentiles for both unadjusted and height-adjusted waist circumferences and compared with the World Health Organization BMI cut-offs. They were analysed further for short, average and tall children. Waist circumference values increased steadily with age. For short and average height children, the prevalence of obesity was higher when height-adjusted waist circumference was used. For taller children, the prevalence of obesity using height-adjusted waist circumference and BMI was similar, but lower than the prevalence based on measurements unadjusted for height. Height-adjusted waist circumference and BMI identified different children as having obesity, with overlaps of 69.47% for boys and 68.42% for girls. Just using waist circumference underestimated obesity in some Iranian children and measurements should be adjusted for height. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  20. Un caso de baja segregada en niveles altos en el sur de Sudamérica: descripción del ciclo de vida y su relación con la precipitación A case of high level cut-off cyclonic vortex over southern South America: description of the life cycle and its relation to precipitation

    Directory of Open Access Journals (Sweden)

    Alejandro Anibal Godoy

    2011-09-01

    Full Text Available En este trabajo se analiza el ciclo de vida de una baja segregada que afectó el sur de Sudamérica entre el 26 de Marzo y el 2 de Abril del 2007 y se explora la relación existente entre las diferentes etapas de este sistema y la precipitación ocurrida sobre la franja central de Argentina. Además se evalúa si otros procesos coadyuvaron para la ocurrencia de la misma. Las características más relevantes de este sistema son su larga duración y el lento desplazamiento, ya que entre el inicio y el fin de su vida se desplaza sólo 780 km, manteniéndose estacionario, durante las etapas de segregación y madurez, por más de 56 hs frente a la costa central chilena. Esta última característica favorece la formación de un sistema de baja presión sobre el noroeste de Argentina y la persistencia de una corriente en chorro en capas bajas del norte que se extiende desde el centro de Bolivia hasta norte argentino. La masa de aire con características tropicales conducida por esta configuración y la convergencia en niveles bajos favorecieron el desarrollo convectivo. La precipitación acumulada durante estas etapas, en algunas regiones del sur del litoral argentino, superó los 300 mm, produciendo extensas inundaciones en la región. Durante la etapa de decaimiento (96 hs de duración, el sistema se debilita a medida que se desplaza hacia el este y las precipitaciones afectaron las provincias del centro-oeste de Argentina donde la lluvia en 48 horas duplicó el promedio mensual de marzo.This paper describes the life cycle of a high level cut-off cyclonic vortex that affected southern South America between 26 March and 2 April 2007, and explores the relationship between the evolution stages of the system and the rainfall over central Argentina. The possibility of other processes contributing to rainfall is also analyzed. The most relevant characteristics of this system were its length and slow displacement: from its development to decay it moved only

  1. Determinação de escore e nota de corte do módulo de asma do International Study of Asthma and Allergies in Childhood para discriminação de adultos asmáticos em estudos epidemiológicos Determining the score and cut-off point that would identify asthmatic adults in epidemiological studies using the asthma module of the International Study of Asthma and Allergies in Childhood questionnaire

    Directory of Open Access Journals (Sweden)

    Elayne de Fátima Maçãira

    2005-12-01

    Full Text Available OBJETIVO: Validar o questionário padronizado escrito do International Study of Asthma and Allergies in Childhood, módulo sobre asma, para pesquisa de prevalência de asma, estabelecendo seu escore e a nota de corte para discriminação de adultos asmáticos. MÉTODOS: Entrevistamos pacientes ambulatoriais adultos, 40 asmáticos e 38 controles, pareados por sexo e idade, utilizando o módulo de asma do International Study of Asthma and Allergies in Childhood, composto por oito aspectos dicotômicos de asma. Determinamos o escore e a nota de corte para discriminação de asmáticos, definindo sua sensibilidade, especificidade e índice de Youden. Validamos o método em contraposição ao diagnóstico clínico e funcional. A reprodutibilidade das questões individuais foi testada por meio de reentrevistas de metade dos pacientes após algumas semanas. RESULTADOS: O escore variou de 0 a 14 pontos. Um escore = 5 pontos permitiu discriminar pacientes asmáticos (sensibilidade = 93%, especificidade = 100% e índice de Youden = 0,93. A maioria das questões apresentou boa reprodutibilidade, observada em reentrevista após 48,2 ± 11,1 dias (Kappa e Kappa ponderado variando de 0,43 a 1,00 para as questões individuais. CONCLUSÃO: A validação de uma nota de corte permite uma interpretação alternativa às informações fornecidas pelo módulo de asma do International Study of Asthma and Allergies in Childhood, levando em conta o conjunto das informações e não somente as respostas individuais de cada questão em estudos de prevalência de asma em adultos.OBJECTIVE: To validate, for use in asthma prevalence studies, the asthma module of the standardized written questionnaire developed for use in the International Study of Asthma and Allergies in Childhood, establishing the score and cut-off point that would identify asthmatic adults. METHODS: We interviewed 78 adult outpatients (40 adult asthmatics and 38 age-matched and gender-matched controls

  2. Annual Adjustment Factors

    Data.gov (United States)

    Department of Housing and Urban Development — The Department of Housing and Urban Development establishes the rent adjustment factors - called Annual Adjustment Factors (AAFs) - on the basis of Consumer Price...

  3. Evaluation of D-dimer serum levels among patients with chronic urticaria, psoriasis and urticarial vasculitis Avaliação dos níveis séricos de D-dímeros entre doentes com urticária crônica, psoríase e urticária vasculite

    Directory of Open Access Journals (Sweden)

    Paulo Ricardo Criado

    2013-06-01

    Full Text Available BACKGROUND: It has been demonstrated that neutrophils, eosinophils and monocytes, under appropriated stimulus, may express tissue factor and therefore, activate the extrinsic pathway of coagulation. We performed a transversal and case-control study of patients with chronic urticaria and patients with psoriasis, in our outpatient clinic to evaluate the production of D-dimer. OBJECTIVE: To evaluate D-dimer serum levels in patients with chronic urticaria and its possible correlation with disease activity. PATIENTS AND METHODS: The study was conducted from October 2010 until March 2011. We selected 37 consecutive patients from our Allergy Unit and Psoriasis Unit, and divided them into three groups for statistical analysis: (i 12 patients with active chronic urticaria (CU; (ii 10 patients with chronic urticaria under remission and (iii 15 patients with psoriasis (a disease with skin inflammatory infiltrate constituted by neutrophils, lymphocytes and monocytes. Another five patients with urticarial vasculitis were allocated in our study, but not included in statistical analysis. The serum levels of D-dimer were measured by Enzyme Linked Fluorescent Assay (ELFA, and the result units were given in ng/ml FEU. RESULTS: Patients with active chronic urticaria had the highest serum levels of D-dimer (p FUNDAMENTOS: Tem sido demonstrado que os neutrófilos, eosinófilos e monócitos, sob estímulo apropriado, podem expressar fator tecidual e, portanto, ativar a via extrínseca da coagulação. Realizamos um estudo transversal e caso-controle de pacientes com urticária crônica e pacientes com psoríase em nosso ambulatório para avaliar a produção de dímero-D. OBJETIVO: Avaliar níveis de dímero-D em pacientes com urticária crônica e sua possível correlação com a atividade da doença. PACIENTES E MÉTODOS: O estudo foi conduzido de outubro de 2010 até março de 2011. Nós selecionamos 37 pacientes consecutivos da Unidade de Alergia e Unidade de

  4. ADJUSTABLE CHIP HOLDER

    DEFF Research Database (Denmark)

    2009-01-01

    An adjustable microchip holder for holding a microchip is provided having a plurality of displaceable interconnection pads for connecting the connection holes of a microchip with one or more external devices or equipment. The adjustable microchip holder can fit different sizes of microchips with ...

  5. Adjustment of macroeconomic imbalances

    Directory of Open Access Journals (Sweden)

    Georgeta Barbulescu

    2013-03-01

    Full Text Available The global financial and economic crisis was the factor that triggered the adjustment of macroeconomic imbalances accumulated in Romania. The current account deficit and budget deficit were two major structural imbalances that have created a high vulnerability for the economy and explained the extent of economic contraction in Romania during the economic crisis. This article identifies the main causes that lead to the need for fiscal adjustment both in the EU and in Romania, as well as main effects of adjustments in respect of their experience in recent years. The article deals with this topic, because the current topical debate in the field of fiscal adjustments implemented both in the EU and our country, and their need for economic activity aimed at economic recovery.

  6. Price adjustment clauses : report.

    Science.gov (United States)

    2012-10-01

    Price adjustment mechanisms exist to account for fluctuations in commodity or labor prices and have : been used for highway construction in 47 states. They are useful in stabilizing bid prices in times of : economic uncertainty and preventing default...

  7. Adjustable continence balloons

    DEFF Research Database (Denmark)

    Kjær, Line; Fode, Mikkel; Nørgaard, Nis

    2012-01-01

    . Fourteen patients (12%) ended up with an artificial sphincter or a urethral sling. Sixty patients (63%) experienced no discomfort and 58 (61%) reported being dry or markedly improved. Overall, 50 patients (53%) reported being very or predominantly satisfied. Conclusions. Adjustable continence balloons seem...

  8. Sustainable urban regime adjustments

    DEFF Research Database (Denmark)

    Quitzau, Maj-Britt; Jensen, Jens Stissing; Elle, Morten

    2013-01-01

    The endogenous agency that urban governments increasingly portray by making conscious and planned efforts to adjust the regimes they operate within is currently not well captured in transition studies. There is a need to acknowledge the ambiguity of regime enactment at the urban scale. This direc...

  9. Psychological Adjustment and Homosexuality.

    Science.gov (United States)

    Gonsiorek, John C.

    In this paper, the diverse literature bearing on the topic of homosexuality and psychological adjustment is critically reviewed and synthesized. The first chapter discusses the most crucial methodological issue in this area, the problem of sampling. The kinds of samples used to date are critically examined, and some suggestions for improved…

  10. The origins of the slurry trench cut-off and a review of cement-bentonite cut-off walls in the UK

    International Nuclear Information System (INIS)

    Jefferis, S.A.

    1997-01-01

    On the occasion of the first International Containment Technology Conference it is appropriate to look back to the origins of containment walls as well as forward to the new technologies that we may need for the complex chemical and physical environments in which containment may be employed in the future. This paper looks at the development of slurry trench technology from the first concepts in 1938, the first field trials in 1945 and on to the cement-bentonite walls used in the UK today and the issues associated with defining appropriate materials performance

  11. Automatic temperature adjustment apparatus

    Science.gov (United States)

    Chaplin, James E.

    1985-01-01

    An apparatus for increasing the efficiency of a conventional central space heating system is disclosed. The temperature of a fluid heating medium is adjusted based on a measurement of the external temperature, and a system parameter. The system parameter is periodically modified based on a closed loop process that monitors the operation of the heating system. This closed loop process provides a heating medium temperature value that is very near the optimum for energy efficiency.

  12. Quantification of microangiopathic lesions in brain parenchyma and age-adjusted mean scores for the diagnostic separation of normal from pathological values in senile dementia

    International Nuclear Information System (INIS)

    Hentschel, F.; Kreis, M.; Damian, M.; Krumm, B.; Froelich, F.

    2005-01-01

    Purpose: to quantify microangiopathic lesions in the cerebral white matter and to develop age-corrected cut-off values for separating normal from dementia-related pathological lesions. Materials and methods: in a memory clinic, 338 patients were investigated neuropsychiatrically by a psychological test battery and by MRI. Using a FLAIR sequence and a newly developed rating scale, white matter lesions (WMLs) were quantified with respect to localization, number and intensity, and these ratings were condensed into a score. The WML scores were correlated with the mini-mental state examination (MMSE) and clinical dementia rating (CDR) score in dementia patients. A non-linear smoothing procedure was used to calculate age-related mean values and confidence intervals, separate for cognitively intact subjects and dementia patients. Results: the WML scores correlated highly significantly with age in cognitively intact subjects and with psychometric scores in dementia patients. Age-adjusted WML scores of cognitively intact subjects were significantly different from those of dementia patients with respect to the whole brain as well as to the frontal lobe. Mean value and confidence intervals adjusted for age significantly separated dementia patients from cognitively intact subjects over an age range of 54 through 84 years. Conclusion: a rating scale for the quantification of WML was validated and age-adjusted mean values with their confidence intervals for a diagnostically relevant age range were developed. This allows an easy to handle, fast and reliable diagnosis of the vascular component in senile dementia. (orig.)

  13. Convexity Adjustments for ATS Models

    DEFF Research Database (Denmark)

    Murgoci, Agatha; Gaspar, Raquel M.

    . As a result we classify convexity adjustments into forward adjustments and swaps adjustments. We, then, focus on affine term structure (ATS) models and, in this context, conjecture convexity adjustments should be related of affine functionals. In the case of forward adjustments, we show how to obtain exact...... formulas. Concretely for LIBOR in arrears (LIA) contracts, we derive the system of Riccatti ODE-s one needs to compute to obtain the exact adjustment. Based upon the ideas of Schrager and Pelsser (2006) we are also able to derive general swap adjustments useful, in particular, when dealing with constant...

  14. Downhole adjustable bent assemblies

    International Nuclear Information System (INIS)

    Askew, W.E.

    1992-01-01

    This patent describes downhole adjustable apparatus for creating a bend angle in order to affect the inclination of a drilled borehole. It comprises an upper tubular member having an upper portion and a lower portion; lower tubular member having an upper portion and a lower portion; one of the portions being received within the other for relative rotational movement about an axis that is inclined with respect to the the longitudinal axes of the members, whereby in a first rotational position the longitudinal axes have one geometrical relationship, and in a second rotational position the longitudinal axes have a second, different geometrical relationship

  15. Primary length standard adjustment

    Science.gov (United States)

    Ševčík, Robert; Guttenová, Jana

    2007-04-01

    This paper deals with problems and techniques connected with primary length standard adjusting, which includes disassembling of the device and by use of the secondary laser with collimated beam and diffraction laws successively reassembling of the laser. In the reassembling process the device was enhanced with substituting the thermal grease cooling of cold finger by copper socket cooler. This improved external cooling system enables more effective cooling of molecular iodine in the cell, which allows better pressure stability of iodine vapor and easier readjustment of the system.

  16. Adjustment disorder: current perspectives

    Directory of Open Access Journals (Sweden)

    Zelviene P

    2018-01-01

    Full Text Available Paulina Zelviene, Evaldas Kazlauskas Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania Abstract: Adjustment disorder (AjD is among the most often diagnosed mental disorders in clinical practice. This paper reviews current status of AjD research and discusses scientific and clinical issues associated with AjD. AjD has been included in diagnostic classifications for over 50 years. Still, the diagnostic criteria for AjD remain vague and cause difficulties to mental health professionals. Controversies in definition resulted in the lack of reliable and valid measures of AjD. Epidemiological data on prevalence of AjD is scarce and not reliable because prevalence data are biased by the diagnostic algorithm, which is usually developed for each study, as no established diagnostic standards for AjD are available. Considerable changes in the field of AjD could follow after the release of the 11th edition of International Classification of Diseases (ICD-11. A new AjD symptom profile was introduced in ICD-11 with 2 main symptoms as follows: 1 preoccupation and 2 failure to adapt. However, differences between the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and ICD-11 AjD diagnostic criteria could result in diverse research findings in the future. The best treatment approach for AjD remains unclear, and further treatment studies are needed to provide AjD treatment guidelines to clinicians. Keywords: adjustment disorder, review, diagnosis, prevalence, treatment, DSM, ICD

  17. Continuously adjustable Pulfrich spectacles

    Science.gov (United States)

    Jacobs, Ken; Karpf, Ron

    2011-03-01

    A number of Pulfrich 3-D movies and TV shows have been produced, but the standard implementation has inherent drawbacks. The movie and TV industries have correctly concluded that the standard Pulfrich 3-D implementation is not a useful 3-D technique. Continuously Adjustable Pulfrich Spectacles (CAPS) is a new implementation of the Pulfrich effect that allows any scene containing movement in a standard 2-D movie, which are most scenes, to be optionally viewed in 3-D using inexpensive viewing specs. Recent scientific results in the fields of human perception, optoelectronics, video compression and video format conversion are translated into a new implementation of Pulfrich 3- D. CAPS uses these results to continuously adjust to the movie so that the viewing spectacles always conform to the optical density that optimizes the Pulfrich stereoscopic illusion. CAPS instantly provides 3-D immersion to any moving scene in any 2-D movie. Without the glasses, the movie will appear as a normal 2-D image. CAPS work on any viewing device, and with any distribution medium. CAPS is appropriate for viewing Internet streamed movies in 3-D.

  18. Metric adjusted skew information

    DEFF Research Database (Denmark)

    Hansen, Frank

    2008-01-01

    establish a connection between the geometrical formulation of quantum statistics as proposed by Chentsov and Morozova and measures of quantum information as introduced by Wigner and Yanase and extended in this article. We show that the set of normalized Morozova-Chentsov functions describing the possible......We extend the concept of Wigner-Yanase-Dyson skew information to something we call "metric adjusted skew information" (of a state with respect to a conserved observable). This "skew information" is intended to be a non-negative quantity bounded by the variance (of an observable in a state......) that vanishes for observables commuting with the state. We show that the skew information is a convex function on the manifold of states. It also satisfies other requirements, proposed by Wigner and Yanase, for an effective measure-of-information content of a state relative to a conserved observable. We...

  19. Adjusting to the Emergent

    DEFF Research Database (Denmark)

    Revsbæk, Line

    In her doctoral thesis Line Revsbæk explores newcomer innovation related to organizational entry processes in a changing organization. She introduces process philosophy and complexity theory to research on organizational socialization and newcomer innovation. The study challenges assumptions...... of ‘adjusting to the emergent’. Newcomer innovation is portrayed as carrying a variety of possible significations, such as unintentional innovation effects of newcomer’s proactive self-socializing behavior; an inspirational basis for designing innovation-generating employee induction; ‘resonant instances......’ of newcomers enacting the organizational emergent. The study throws light on the informal socialization in work-related interactions between newcomers and veterans and reveals professional relational histories, as well as the relationship between veteran coworker and hiring manager, to be important aspects...

  20. Application of body mass index adjusted for fat mass (BMIfat) obtained by bioelectrical impedance in adults.

    Science.gov (United States)

    Mialich, Mirele Savegnago; Martinez, Edson Zangiacomi; Jordão Junior, Alceu Afonso

    2014-08-01

    Body mass index (BMI) has been one of the methods most frequently used for diagnose obesity, but it isn't consider body composition. This study intends to apply one new adiposity index, the BMI adjusted for fat mass (BMIfat) developed by Mialich et al. (2011), in a adult Brazilian sample. A cross-sectional study with 501 individuals of both genders (366 women, 135 men) aged 17 to 38 years and mean age was 20.4 ± 2.8 years, mean weight 63.0 ± 13.5 kg, mean height 166.9 ± 9.0 cm, and BMI 22.4 ± 3.4 kg/m2. High and satisfactory R2 values were obtained, i.e., 91.1%, 91.9% and 88.8% for the sample as a whole and for men and women, respectively. Considering this BMIfat were developed new ranges, as follows: 1.35 to 1.65 (nutritional risk for malnutrition), > 1.65 and ≤2.0 (normal weight) and > 2.0 (obesity). The BMIfat had a more accurate capacity of detecting obese individuals (0.980. 0.993, 0.974) considering the sample as a whole and women and men, respectively, compared to the traditional BMI (0.932, 0.956, 0.95). Were also defined new cut-off points for the traditional BMI for the classification of obesity, i.e.: 25.24 kg/m2 and 28.38 kg/m2 for men and women, respectively. The BMIfat was applied for the present population and can be adopted in clinical practice. Further studies are needed to determine its application to different ethnic groups and to compare this index to others previously described in the scientific literature. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  1. Adolescent Mothers' Adjustment to Parenting.

    Science.gov (United States)

    Samuels, Valerie Jarvis; And Others

    1994-01-01

    Examined adolescent mothers' adjustment to parenting, self-esteem, social support, and perceptions of baby. Subjects (n=52) responded to questionnaires at two time periods approximately six months apart. Mothers with higher self-esteem at Time 1 had better adjustment at Time 2. Adjustment was predicted by Time 2 variables; contact with baby's…

  2. LC Filter Design for Wide Band Gap Device Based Adjustable Speed Drives

    DEFF Research Database (Denmark)

    Vadstrup, Casper; Wang, Xiongfei; Blaabjerg, Frede

    2014-01-01

    the LC filter with a higher cut off frequency and without damping resistors. The selection of inductance and capacitance is chosen based on capacitor voltage ripple and current ripple. The filter adds a base load to the inverter, which increases the inverter losses. It is shown how the modulation index...

  3. Metric-adjusted skew information

    DEFF Research Database (Denmark)

    Liang, Cai; Hansen, Frank

    2010-01-01

    We give a truly elementary proof of the convexity of metric-adjusted skew information following an idea of Effros. We extend earlier results of weak forms of superadditivity to general metric-adjusted skew information. Recently, Luo and Zhang introduced the notion of semi-quantum states...... on a bipartite system and proved superadditivity of the Wigner-Yanase-Dyson skew informations for such states. We extend this result to the general metric-adjusted skew information. We finally show that a recently introduced extension to parameter values 1 information is a special case...... of (unbounded) metric-adjusted skew information....

  4. Separation-survivability - the elusive moral cut-off point? | de ...

    African Journals Online (AJOL)

    moderate' stance on termination – that notwithstanding possessing some moral significance, other arguments may trump this up to the point of separationsurvivability. This seriously problematises 'partial birth' abortion, and the utilitarian argument on ...

  5. The 1913 Cut-off Date for Restitution of Dispossessed Land in South ...

    African Journals Online (AJOL)

    sulaiman.adebowale

    2006-08-29

    Aug 29, 2006 ... good reasons for South African law to support claims of aboriginal title.11. It is in the light of the above ... dispossessed through a conscious process of corruption and fraud before. 1913 and which are capable of ..... election in Zimbabwe and reflects the regime's recognition that disaffection. 10.Yanou.pmd.

  6. 76 FR 33161 - Installation and Use of Engine Cut-off Switches on Recreational Vessels

    Science.gov (United States)

    2011-06-08

    ... filing. If you submit them by mail and would like to know that they reached the Facility, please enclose... vessel hits a large wake, turns too sharply, or collides with another vessel or object in the water. When...

  7. Cutting Off the Head of the Snake: Applying and Assessing Leadership Attack in Military Conflict

    Science.gov (United States)

    2013-04-26

    extermination. This, in turn, would drive war to the absolute. He observes, however, that this is not often not the case. “In war, many roads lead to...sophisticated theory that supposes it possible for a particularly ingenious method of inflicting minor direct damage on the enemy’s forces to lead to major...as described by General Schwarzkopf after the war: The closest we came, we had a report that there was a very large convoy moving down a road one

  8. Let's Cut Out the Cut-Off Score in the Identification of the Gifted.

    Science.gov (United States)

    Kirschenbaum, Robert J.

    1983-01-01

    The use of IQ scores as criteria for entry into gifted programs is criticized. Difficulties in test interpretation are noted, as are factors biasing the performance of culturally different students. The author cites flaws with intelligence, achievement, and creativity tests and suggests that locally designed and normal methods are preferable. (CL)

  9. Transverse momentum cut-off hypothesis in high energy scattering in perturbation theory

    Science.gov (United States)

    Banerjee, H.; Sengupta, M.

    1980-06-01

    The hypothesis that transverse components of loop momenta are limited in high energy scattering is shown to imply that enhanced contributions from singular scaling in Feynman parameter space analysis should all cancel. Cancellation of singular scaling contributions is verified at the next to the leading-log level in the sixth order for fermion-fermion scattering in a Yang-Mills theory with SU( N)-gauge symmetry.

  10. Analytical continuation of the fermion determinant with a finite cut-off

    Science.gov (United States)

    Döring, F.; Schüren, C.; Ruiz Arriola, E.; Watabe, T.; Goeke, K.

    1996-02-01

    We consider the solitonic sector of the SU(2) Nambu-Jona-Lasinio model with vector mesons. We prove that none of the previously proposed procedures to handle the fermion determinant reproduces the perturbative expansion in the vector coupling constant. Hence they are either not consistent with the way the parameters of the model are fixed in the meson sector or they violate Lorentz invariance of the vacuum. We propose a new prescription at the operator level both in the proper-time and the Pauli-Villars regularization. Our method is in accordance with perturbation theory, explicitly preserves vector gauge invariance and allows for a consistent treatment of the meson and the soliton sector. The convergence radius of the perturbative expansion is also studied. We also show how direct calculations in Minkowski space might be performed.

  11. Analytical continuation of the fermion determinant with a finite cut-off

    International Nuclear Information System (INIS)

    Doering, F.; Watabe, T.; Goeke, K.

    1996-01-01

    We consider the solitonic sector of the SU(2) Nambu-Jona-Lasinio model with vector mesons. We prove that none of the previously proposed procedures to handle the fermion determinant reproduces the perturbative expansion in the vector coupling constant. Hence they are either not consistent with the way the parameters of the model are fixed in the meson sector or they violate Lorentz invariance of the vacuum. We propose a new prescription at the operator level both in the proper-time and the Pauli-Villars regularization. Our method is in accordance with perturbation theory, explicitly preserves vector gauge invariance and allows for a consistent treatment of the meson and the soliton sector. The convergence radius of the perturbative expansion is also studied. We also show how direct calculations in Minkowski space might be performed. (orig.)

  12. On the discovery of the Greisen–Zatzepin–Kuzmin cut-off

    Indian Academy of Sciences (India)

    Statistical inference; Bayesian confidence level; cosmic rays. PACS Nos 02.50.Tt; 02.60.Ed; 98.70.Sa. 1. Introduction. According to the usual practice, the '5 sigma' confidence level (the chance prob- ability of occurrence of about 1:10000000) is the level of discovery in physics (an observation of something which by chance ...

  13. Cutting off Cardiologists: The Disappeared in “Puro corazón” by Luisa Valenzuela

    Directory of Open Access Journals (Sweden)

    Diane E. Marting

    2015-01-01

    Full Text Available Luisa Valenzuela’s neglected short story “Puro corazón” ('All Heart' uses surreal imagery and plot to write about the increasing violence in Buenos Aires during the time immediately prior to the Dirty War ( la Guerra Sucia . By mimicking a police report, Valenzuela’s story manages to reproduce the experience of censorship and repression that denied the fate of the disappeared. This article shows how the story forges ludic connections between the human body (especially hearts, blood, and cardiologists, the censorship and repression in the early 1970s in Argentina, and the discourse that marked the official response to los desaparecidos , the disappeared.

  14. Low cut-off values increase diagnostic performance of protein S assays

    NARCIS (Netherlands)

    Mulder, Rene; ten Kate, Min Ki; Kluin-Nelemans, Hanneke C.; Mulder, Andre B.

    Conflicting data have been reported on the accuracy of protein S (PS) assays for detection of hereditary PS deficiency. In this study we assessed the diagnostic performance of two total PS antigen assays, four free PS assays and three PS activity assays in a group of 28 heterozygous carriers of

  15. A retrospective study of dogs with atypical hypoadrenocorticism: a diagnostic cut-off or continuum?

    Science.gov (United States)

    Furrow, E.; Merkel, L. K.; Armstrong, P. J.

    2017-01-01

    Objectives To describe the clinicopathologic findings and outcome in dogs with atypical hypoadrenocorticism (Group 1) and dogs with suspected atypical hypoadrenocorticism whose post-adrenocorticotropic hormone stimulation cortisol concentrations were greater than 55 nmol/L but below the laboratory reference interval (Group 2). Methods Medical records were searched to identify dogs diagnosed with hypoadrenocorticism between January 2004 and June 2014. Dogs were excluded if their Na:K ratio was less than 27 or if they had received prior therapy that could interfere with adrenocorticotropic hormone stimulation testing. Results Forty dogs were included in Group 1 and nine dogs in Group 2. In Group 1, the most common biochemical abnormalities were hypoalbuminaemia (87%) and hypocholesterolaemia (76%). Of 35 dogs in Group 1 with follow-up biochemistry results, five (14%) developed electrolyte abnormalities at 2 to 51 months post diagnosis. Of seven dogs in Group 2 with follow-up, glucocorticoid therapy was discontinued in two dogs without return of clinical signs, four dogs were subsequently diagnosed with inflammatory bowel disease and one dog continued to have clinical signs despite glucocorticoid treatment. Clinical Significance Dogs with gastrointestinal signs and hypoalbuminaemia and, or, hypocholesterolaemia should be evaluated for atypical hypoadrenocorticism. Follow-up electrolyte monitoring is recommended because some will develop electrolyte abnormalities. Although dogs in Group 2 had a clinical presentation compatible with atypical hypoadrenocorticism, the diagnosis appears unlikely based on review of follow-up data. Dogs with equivocal adrenocorticotropic hormone stimulation results should be evaluated for other underlying diseases such as inflammatory bowel disease. The use of endogenous adrenocorticotropic hormone measurements in these dogs warrants investigation. PMID:28247992

  16. Hemodialysis Using High Cut Off Filters in Light Chain Cast Nephropathy.

    Science.gov (United States)

    Buus, Niels Henrik; Rantanen, Jesper Moesgaard; Krag, Søren Palmelund; Andersen, Niels Frost; Jensen, Jens Dam

    2015-01-01

    Hemodialysis using high cutoff (HCO) filters possibly improves renal function in diseases with light chain (LC) overproduction and acute kidney injury. We established the effect of HCO dialysis on renal outcome in consecutive patients with malignant monoclonal gammopathies and LC cast nephropathy. LC concentration was measured before and after each dialysis session in 10 patients receiving HCO dialysis and bortezomib-based chemotherapy, and their renal function was monitored by plasma creatinine. The number of HCO sessions ranged from 4 to 34 (mean 13). Six patients recovered kidney function, 3 regained partial function while 1 patient continued chronic dialysis. Patients with the largest reductions in LC during HCO treatments had the lowest creatinine at 6 and 9 months of follow-up. For comparison, only 2 out of 10 patients in a historic control group recovered kidney function. HCO dialysis combined with bortezomib results in good renal recovery with kidney function being dependent on the degree of LC lowering. © 2015 S. Karger AG, Basel.

  17. Receiver Operating Characteristic (ROC) to Determine Cut-Off Points of Biomarkers in Lung Cancer Patients

    OpenAIRE

    Weiss, Heidi L.; Niwas, Santosh; Grizzle, William E.; Piyathilake, Chandrika

    2004-01-01

    The role of biomarkers in disease prognosis continues to be an important investigation in many cancer studies. In order for these biomarkers to have practical application in clinical decision making regarding patient treatment and follow-up, it is common to dichotomize patients into those with low vs. high expression levels. In this study, receiver operating characteristic (ROC) curves, area under the curve (AUC) of the ROC, sensitivity, specificity, as well as likelihood ratios were calculat...

  18. On the discovery of the Greisen–Zatzepin–Kuzmin cut-off

    Indian Academy of Sciences (India)

    index of ∼2.8 forming the 'ankle'. The possibility of another change of the CR composition at the ankle is the sub- ject of extensive experimental studies. If there is a proton-dominated extragalactic cosmic ray flux, then, according to the works of Greisen [4], and Zatsepin and. Kuzmin [5] (GZK) published in 1966 just after the ...

  19. Overcoming the Cut-Off Charge Transfer Bandgaps at the PbS Quantum Dot Interface

    KAUST Repository

    El-Ballouli, Ala'a O.

    2015-11-17

    Light harvesting from large size of semiconductor PbS quantum dots (QDs) with a bandgap of less than 1 eV is one of the greatest challenges precluding the development of PbS QD-based solar cells because the interfacial charge transfer (CT) from such QDs to the most commonly used electron acceptor materials is very inefficient, if it occurs at all. Thus, an alternative electron-accepting unit with a new driving force for CT is urgently needed to harvest the light from large-sized PbS QDs. Here, a cationic porphyrin is utilized as a new electron acceptor unit with unique features that bring the donor–acceptor components into close molecular proximity, allowing ultrafast and efficient electron transfer for QDs of all sizes, as inferred from the drastic photoluminescence quenching and the ultrafast formation of the porphyrin anionic species. The time-resolved results clearly demonstrate the possibility of modulating the electron transfer process between PbS QDs and porphyrin moieties not only by the size quantization effect but also by the interfacial electrostatic interaction between the positively charged porphyrin and the negatively charged QDs. This approach provides a new pathway for engineering QD-based solar cells that make the best use of the diverse photons making up the Sun\\'s broad irradiance spectrum.

  20. IAEA perspective on verification measures relevant to a fissile material production cut-off treaty (FMCT)

    Energy Technology Data Exchange (ETDEWEB)

    Shea, T.E. [IAEA, Vienna (Austria)

    1998-07-01

    In my presentation, I have drawn on IAEA safeguards experience and in the attached Annexes, I have included the methods currently approved for safeguarding enrichment and reprocessing facilities. These provisions are continuing to evolve and new methods are being developed that could also have an impact on the verification measures adopted for the FMCT. With the Additional Protocol as specified in INFCIRC/540, IAEA safeguards will provide comprehensive coverage in relation to fissile material production in those non-nuclear weapon states that adopt the protocol. The elements of the strengthened safeguards system have now been set, and over the next few years, useful experience will be gained in the verification methods and the procedural arrangements for bringing them into effect. That experience will no doubt be important in defining the verification provisions of the FMCT. I noted earlier that verification under the FMCT will depend upon the scope of the Treaty, the maximum time intervals tolerable between a violation and its detection, the importance of detecting violations in relation to the magnitude of the violations and the degree of certainty desired in detecting treaty violations - or conversely, in assuring the absence of violations. The cost of verification will depend on acceptance by states of the treaty, especially nuclear weapon states and threshold states. Within those states, the costs will be driven by the number of separate sites to be inspected, the nature of the nuclear operations located at those sites, the present status of the facilities involved and future plans for those facilities and for peaceful facilities which produce - or could produce - fissile materials. The cost will also depend on the use of efficient verification concepts by the verification authority, including integrated sensor networks and remote monitoring, and on the deployment arrangements adopted. When the negotiations commence, these issues and many more will need to be examined and resolved. If progress towards nuclear disarmament is to continue, then the capability for manufacturing additional weapons must be stopped. The FMCT is thus an essential step towards disarmament. This seminar, and others pertaining to the FMCT, provide a means to begin the serious thinking required before the negotiations commence. The IAEA was requested in the UN General Assembly Resolution to provide assistance during those negotiations and I believe the IAEA will gladly support any steps that facilitate progress towards the early completion of an effectively verifiable ban on the production of fissile materials for use in nuclear weapons.

  1. Perfectionsism, Coping, and Emotional Adjustment.

    Science.gov (United States)

    Rice, Kenneth G.; Lapsley, Daniel K.

    2001-01-01

    Undergraduates (N=204) completed three scales of the student adaptation to college questionnaire. Measures of coping and emotional adjustment revealed differences among the three groups of students labeled adaptive, maladaptive, and non-perfectionists. Perfectionism and coping predicted emotional adjustment but coping as a moderator or mediator in…

  2. Spousal Adjustment to Myocardial Infarction.

    Science.gov (United States)

    Ziglar, Elisa J.

    This paper reviews the literature on the stresses and coping strategies of spouses of patients with myocardial infarction (MI). It attempts to identify specific problem areas of adjustment for the spouse and to explore the effects of spousal adjustment on patient recovery. Chapter one provides an overview of the importance in examining the…

  3. Inverse correlation between morning plasma cortisol levels and MMPI psychasthenia and depression scale scores in victims of mobbing with adjustment disorders.

    Science.gov (United States)

    Rocco, Antonio; Martocchia, Antonio; Frugoni, Patrizia; Baldini, Rossella; Sani, Gabriele; Di Simone Di Giuseppe, Barbara; Vairano, Andrea; Girardi, Paolo; Monaco, Edoardo; Tatarelli, Roberto; Falaschi, Paolo

    2007-10-01

    Evidence in the literature suggests stress-related changes of hypothalamus-pituitary-adrenal (HPA) axis in mobbing. We investigated the association between HPA activity and psychological profiles in mobbing, using a multidisciplinary approach. Forty-eight victims of mobbing were evaluated by a working group of the Departments of Occupational Medicine, Psychiatry and Internal Medicine. After an informed consent, a detailed occupational history, a psychiatric interview with Minnesota Multiphasic Personality Inventory 2 (MMPI-2) administration and a blood sample (8:00 AM) for the determination of basal adrenocorticotropin (ACTH), cortisol and dehydroepiandrosterone sulphate (DHEAS) plasma levels were collected. Twenty-six patients received an overnight dexamethasone (dex) test. Mean ACTH, cortisol and DHEAS levels were within normal ranges. The dex-test response was normal, with a significant hormone suppression (ACTH pmobbing with adjustment disorders was observed. A larger group of patients is necessary to identify and validate a cut-off cortisol level that may become an innovative biological parameter for the diagnosis and follow-up in victims of mobbing.

  4. Time-adjusted variable resistor

    Science.gov (United States)

    Heyser, R. C.

    1972-01-01

    Timing mechanism was developed effecting extremely precisioned highly resistant fixed resistor. Switches shunt all or portion of resistor; effective resistance is varied over time interval by adjusting switch closure rate.

  5. Normal Stress or Adjustment Disorder?

    Science.gov (United States)

    ... disorder is a type of stress-related mental illness that can affect your feelings, thoughts and behaviors. Signs and symptoms of an adjustment disorder can include: Anxiety Poor school or work performance Relationship problems Sadness ...

  6. Electronic gaming and psychosocial adjustment.

    Science.gov (United States)

    Przybylski, Andrew K

    2014-09-01

    The rise of electronic games has driven both concerns and hopes regarding their potential to influence young people. Existing research identifies a series of isolated positive and negative effects, yet no research to date has examined the balance of these potential effects in a representative sample of children and adolescents. The objective of this study was to explore how time spent playing electronic games accounts for significant variation in positive and negative psychosocial adjustment using a representative cohort of children aged 10 to 15 years. A large sample of children and adolescents aged 10 to 15 years completed assessments of psychosocial adjustment and reported typical daily hours spent playing electronic games. Relations between different levels of engagement and indicators of positive and negative psychosocial adjustment were examined, controlling for participant age and gender and weighted for population representativeness. Low levels (3 hours daily) of game engagement was linked to key indicators of psychosocial adjustment. Low engagement was associated with higher life satisfaction and prosocial behavior and lower externalizing and internalizing problems, whereas the opposite was found for high levels of play. No effects were observed for moderate play levels when compared with non-players. The links between different levels of electronic game engagement and psychosocial adjustment were small (Games consistently but not robustly associated with children's adjustment in both positive and negative ways, findings that inform policy-making as well as future avenues for research in the area. Copyright © 2014 by the American Academy of Pediatrics.

  7. Self-adjusting assembly jig

    Science.gov (United States)

    Haaser, M. J.

    1973-01-01

    Jig adjusts for thermal expansion and contraction to hold parts being joined under constant pressure and in correct alignment during entire joining operation. Jig is simple and easy to use, durable and maintenance free. Several methods may be used to join parts of many sizes and shapes.

  8. Kinematic adjustments to seismic recordings

    Energy Technology Data Exchange (ETDEWEB)

    Telegin, A.N.; Levii, N.V.; Volovik, U.M.

    1981-01-01

    The introduction of kinematic adjustments by adding the displaced blocks is studied theoretically and in test seismograms. The advantage to this method resulting from the weight variation in the trace is demonstrated together with its kinematic drawback. A variation on the displaced block addition method that does not involve realignment of the travel time curves and that has improved amplitude characteristics is proposed.

  9. Adjustable chain trees for proteins

    DEFF Research Database (Denmark)

    Winter, Pawel; Fonseca, Rasmus

    2012-01-01

    A chain tree is a data structure for changing protein conformations. It enables very fast detection of clashes and free energy potential calculations. A modified version of chain trees that adjust themselves to the changing conformations of folding proteins is introduced. This results in much...

  10. Adjustment or updating of models

    Indian Academy of Sciences (India)

    Department of Mechanical Engineering, Imperial College of Science, .... It is first necessary to decide upon the level of accuracy, or correctness which is sought from the adjustment of the initial model, and this will be heavily influenced by the eventual application of the ..... reviewing the degree of success attained.

  11. Use of GRACE determined secular gravity rates for glacial isostatic adjustment studies in North-America

    Science.gov (United States)

    van der Wal, Wouter; Wu, Patrick; Sideris, Michael G.; Shum, C. K.

    2008-10-01

    Monthly geopotential spherical harmonic coefficients from the GRACE satellite mission are used to determine their usefulness and limitations for studying glacial isostatic adjustment (GIA) in North-America. Secular gravity rates are estimated by unweighted least-squares estimation using release 4 coefficients from August 2002 to August 2007 provided by the Center for Space Research (CSR), University of Texas. Smoothing is required to suppress short wavelength noise, in addition to filtering to diminish geographically correlated errors, as shown in previous studies. Optimal cut-off degrees and orders are determined for the destriping filter to maximize the signal to noise ratio. The halfwidth of the Gaussian filter is shown to significantly affect the sensitivity of the GRACE data (with respect to upper mantle viscosity and ice loading history). Therefore, the halfwidth should be selected based on the desired sensitivity. It is shown that increase in water storage in an area south west of Hudson Bay, from the summer of 2003 to the summer of 2006, contributes up to half of the maximum estimated gravity rate. Hydrology models differ in the predictions of the secular change in water storage, therefore even 4-year trend estimates are influenced by the uncertainty in water storage changes. Land ice melting in Greenland and Alaska has a non-negligible contribution, up to one-fourth of the maximum gravity rate. The estimated secular gravity rate shows two distinct peaks that can possibly be due to two domes in the former Pleistocene ice cover: west and south east of Hudson Bay. With a limited number of models, a better fit is obtained with models that use the ICE-3G model compared to the ICE-5G model. However, the uncertainty in interannual variations in hydrology models is too large to constrain the ice loading history with the current data span. For future work in which GRACE will be used to constrain ice loading history and the Earth's radial viscosity profile, it is

  12. Birth-Order Complementarity and Marital Adjustment.

    Science.gov (United States)

    Vos, Cornelia J. Vanderkooy; Hayden, Delbert J.

    1985-01-01

    Tested the influence of birth-order complementarity on marital adjustment among 327 married women using the Spanier Dyadic Adjustment Scale (1976). Birth-order complementarity was found to be unassociated with marital adjustment. (Author/BL)

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

    NARCIS (Netherlands)

    Eisenhofer, G.; Lattke, P.; Herberg, M.; Siegert, G.; Qin, N.; Darr, R.; Hoyer, J.; Villringer, A.; Prejbisz, A.; Januszewicz, A.; Remaley, A.; Martucci, V.; Pacak, K.; Ross, H.A.; Sweep, F.C.; Lenders, J.W.M.

    2013-01-01

    BACKGROUND: Measurements of plasma normetanephrine and metanephrine provide a useful diagnostic test for phaeochromocytoma, but this depends on appropriate reference intervals. Upper cut-offs set too high compromise diagnostic sensitivity, whereas set too low, false-positives are a problem. This

  14. 12 CFR 1780.80 - Inflation adjustments.

    Science.gov (United States)

    2010-01-01

    ... DEVELOPMENT RULES OF PRACTICE AND PROCEDURE RULES OF PRACTICE AND PROCEDURE Civil Money Penalty Inflation Adjustments § 1780.80 Inflation adjustments. The maximum amount of each civil money penalty within OFHEO's jurisdiction is adjusted in accordance with the Federal Civil Penalties Inflation Adjustment Act of 1990, as...

  15. 12 CFR 19.240 - Inflation adjustments.

    Science.gov (United States)

    2010-01-01

    ... PROCEDURE Civil Money Penalty Inflation Adjustments § 19.240 Inflation adjustments. (a) The maximum amount of each civil money penalty within the OCC's jurisdiction is adjusted in accordance with the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note) as follows: ER10NO08.001 (b) The...

  16. Adjustable extender for instrument module

    International Nuclear Information System (INIS)

    Sevec, J.B.; Stein, A.D.

    1975-01-01

    A blank extender module used to mount an instrument module in front of its console for repair or test purposes has been equipped with a rotatable mount and means for locking the mount at various angles of rotation for easy accessibility. The rotatable mount includes a horizontal conduit supported by bearings within the blank module. The conduit is spring-biased in a retracted position within the blank module and in this position a small gear mounted on the conduit periphery is locked by a fixed pawl. The conduit and instrument mount can be pulled into an extended position with the gear clearing the pawl to permit rotation and adjustment of the instrument

  17. Ovarian Suspension With Adjustable Sutures: An Easy and Helpful Technique for Facilitating Laparoendoscopic Single-Site Gynecologic Surgery.

    Science.gov (United States)

    Chen, Kuo-Hu; Chen, Li-Ru; Seow, Kok-Min

    2015-01-01

    To describe a method of ovarian suspension with adjustable sutures (OSAS) for facilitating laparoendoscopic single-site gynecologic surgery (LESS) and to investigate the effect of OSAS on LESS. Prospective cohort study (Canadian Task Force classification: II-2). University teaching hospital. One hundred seventy-eight patients with benign 5- to 15-cm cystic ovarian tumors who underwent LESS with OSAS (suspension group, n = 90) and without OSAS (control group, n = 88). For patients who underwent OSAS (suspension group), 1 end of double-head straight needles with a polypropylene suture was inserted into the pelvic cavity through the abdominal skin to penetrate the cyst or ovarian parenchyma and puncture outside the abdominal skin. After cutting off the needles, both sides of the remaining suture were held together by a clamp, without knotting, so that the manipulator could "lift," "loosen," or "fix" the stitches to adjust the tension. The average time to create OSAS was 2.9 min. For the suspension and control groups, the average blood loss was 81.4 and 131.8 mL (p < .001), and the operative time was 42.0 and 61.3 min (p < .001), respectively. There were no significant differences in the incidence of complications (5.6% vs 9.1%; p = .365), but there were significant differences in conversions to standard non-single-site laparoscopy (5.6% vs 15.9%; p = .025) and laparotomy (1.1% vs 6.8%; p = .040). Logistic regression analysis revealed that the ratios of conversion to standard non-single-site laparoscopy (odds ratio [OR], 0.126; 95% confidence interval [CI], 0.311-0.508) and laparotomy (OR, 0.032; 95% CI, 0.002-0.479) were much lower in the suspension group; the risk of complications was comparable (OR, 0.346; 95% CI, 0.085-1.403). OSAS is an easy, safe, and feasible method that offers advantages during LESS. Although routine use of OSAS is not necessary, OSAS can be considered during LESS to facilitate the surgery. Copyright © 2015 AAGL. Published by Elsevier Inc. All

  18. Adjustable link for kinematic mounting systems

    Science.gov (United States)

    Hale, L.C.

    1997-07-01

    An adjustable link for kinematic mounting systems is disclosed. The adjustable link is a low-cost, passive device that provides backlash-free adjustment along its single constraint direction and flexural freedom in all other directions. The adjustable link comprises two spheres, two sockets in which the spheres are adjustable retain, and a connection link threadly connected at each end to the spheres, to provide a single direction of restraint and to adjust the length or distance between the sockets. Six such adjustable links provide for six degrees of freedom for mounting an instrument on a support. The adjustable link has applications in any machine or instrument requiring precision adjustment in six degrees of freedom, isolation from deformations of the supporting platform, and/or additional structural damping. The damping is accomplished by using a hollow connection link that contains an inner rod and a viscoelastic separation layer between the two. 3 figs.

  19. Laparoscopic Adjustable Gastric Banding: Predictive Factors for Weight Loss and Band Removal After More than 10 Years' Follow-Up in a Single University Unit.

    Science.gov (United States)

    Tammaro, Pasquale; Hansel, Boris; Police, Andrea; Kousouri, Marina; Magnan, Christophe; Marmuse, Jean Pierre; Arapis, Konstantinos

    2017-08-01

    Weight loss and overall outcomes following laparoscopic adjustable gastric banding (LAGB) are more variable than with other bariatric procedures. Our aim was to investigate the predictive value of certain parameters in a cohort of 794 patients with 10 years' minimum follow-up after LAGB. We retrospectively reviewed the records of 794 patients undergoing LAGB performed by the authors between April 1996 and December 2004. We collected patients' data on weight loss and band-related complications and performed logistic regression modelling and calculated Kaplan-Meier curves for band preservation. The follow-up rate at 10 years was 90.4%. The mean follow-up duration was 15.1 years (range, 120-228 months). Overall band removal with or without conversion or replacement was required in 304 (38.2%) patients. The mean survival time of the band was 148.4 months (95% confidence interval: 138.3-167.4), and there was no difference in the rate of removal by operative technique (p = 0.7). The highest rate of band removal occurred in female patients (p = 0.05), those with BMI > 50 kg/m 2 (p = 0.005) and in those success rate was significantly lower in patients with initial BMI > 50 kg/m 2 . Conversely, differences in success rate were not statistically significant for age (using 50 years as the cut-off), technique or sex. Higher rates of removal occurred in women, younger patients and those with BMI > 50 kg/m 2 . Regardless of these criteria, the rate of band removal for complications rose over time. Patients should be informed of the high risk of the need for band removal long-term.

  20. Assessing Marital Adjustment and Satisfaction: A Review.

    Science.gov (United States)

    Burnett, Paul

    1987-01-01

    Evaluated five instruments of marital adjustment and satisfaction: Marital Adjustment Test, Dyadic Adjustment Scale, Marital Satisfaction Index, Marital Satisfaction Scale, and the Kansas Marital Satisfaction Scale. Discusses studies evaluating psychometric properties of each instrument. Recommends the Marital Satisfaction Index for assessing…

  1. 7 CFR 2201.30 - Adjustments.

    Science.gov (United States)

    2010-01-01

    ... adjustment does not adversely affect the interest of the Federal Government in the Assets or Collateral of... 7 Agriculture 15 2010-01-01 2010-01-01 false Adjustments. 2201.30 Section 2201.30 Agriculture... TELEVISION LOAN GUARANTEE PROGRAM-PROGRAM REGULATIONS Loan Guarantees § 2201.30 Adjustments. (a) The Board...

  2. 7 CFR 1744.64 - Budget adjustment.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false Budget adjustment. 1744.64 Section 1744.64... Disbursement of Funds § 1744.64 Budget adjustment. (a) If more funds are required than are available in a budget account, the borrower may request RUS's approval of a budget adjustment to use funds from another...

  3. Do fair value adjustments influence dividend policy?

    NARCIS (Netherlands)

    Goncharov, I.; van Triest, S.

    2011-01-01

    We examine the impact of positive fair value adjustments on dividend policy. If fair value adjustments are transitory in nature and managers are able to assess their implications for future earnings, fair value adjustments in net income is expected to have no distribution consequences. However,

  4. Control of Adjustable Compliant Actuators

    Directory of Open Access Journals (Sweden)

    Berno J.E. Misgeld

    2014-05-01

    Full Text Available Adjustable compliance or variable stiffness actuators comprise an additional element to elastically decouple the actuator from the load and are increasingly applied to human-centered robotic systems. The advantages of such actuators are of paramount importance in rehabilitation robotics, where requirements demand safe interaction between the therapy system and the patient. Compliant actuator systems enable the minimization of large contact forces arising, for example, from muscular spasticity and have the ability to periodically store and release energy in cyclic movements. In order to overcome the loss of bandwidth introduced by the elastic element and to guarantee a higher range in force/torque generation, new actuator designs consider variable or nonlinear stiffness elements, respectively. These components cannot only be adapted to the walking speed or the patient condition, but also entail additional challenges for feedback control. This paper introduces a novel design method for an impedance-based controller that fulfills the control objectives and compares the performance and robustness to a classical cascaded control approach. The new procedure is developed using a non-standard positive-real Η2 controller design and is applied to a loop-shaping approach. Robust norm optimal controllers are designed with regard to the passivity of the actuator load-impedance transfer function and the servo control problem. Classical cascaded and positive-real Η2 controller designs are validated and compared in simulations and in a test bench using a passive elastic element of varying stiffness.

  5. Potential adjustments to climate change

    International Nuclear Information System (INIS)

    Arthur, L.M.

    1990-01-01

    There are three basic approaches to the problem of climate change: prevention through reduction of greenhouse gas emissions, repair of damages by offsetting the effects of the gases, or learning to live with the climatic changes. Delaying greenhouse warming does not seem possible, at least not without substantial, unsupportable costs. A number of strategies to counter the effects of increasing concentrations of greenhouse gases have been proposed, but few have been given serious attention. Alternatives include additions of particulate matter to the atmosphere, altering land use to change the earth's reflectivity, cultivating carbon-eating organisms in the ocean, and injecting sulfur dioxide into the stratosphere to absorb visible sunlight. A contrasting response to the aggravated greenhouse effect is to require the world to adjust. Before potential adaptation strategies can be identified, regional and sectoral impacts of climate change must be understood, but few studies to date are convincing. It is suggested that the best response may be to delay any action on climatic warming, except in those cases where action can be justified on the basis of immediate or non-climate related benfits. 10 refs

  6. Adjustable magnification anamorphic beam expander

    Science.gov (United States)

    Escobar, S. R.

    1990-08-01

    A visible laser diode package is proposed to substitute a Krpton-Ion laser for alignment purposes. The proposed system uses 5 Melles Griot AR coated stock lenses. Tests performed to the optics reveal some undesirable properties, such as, astigmatism and spherical aberration; however, the interference pattern and star test reveals what seems to be a good quality wavefront. The interference fringes seem to be very good, but there still is a small presence of a comalike aberration at the fringes extreme. The star test revealed the system to be about 3 times diffraction limited. The system has yet to be tested in an alignment situation. As for now, it is ready to be tested with some minor alignment adjustments necessary for a good wavefront quality. A safety memo was written for testing the prototype system at the alignment lab. The initial laser diode system alignment method suggested, uses a reverse alignment procedure. In this procedure, the expected output (30 mm diameter beam) is input into the system output and alignment is performed by moving the components until the desired system input is found; an elliptical beam with 1 mm in the horizontal axis and 4 mm in the vertical axis. Once this reverse alignment procedure is completed the laser diode is placed at the system input. Fine alignment is done with the help of shear plate interference patterns in both, the 1 mm axis and 4 mm axis. The proposed final opto-mechanical packaging of this system is formed with squared adapter plates that are connected by means of four support rods where the center of the plate becomes the optical axis. These components are commercially available and provide high mechanical stability.

  7. Efficient Adjustable Reflectivity Smart Window

    Energy Technology Data Exchange (ETDEWEB)

    D. Morgan Tench

    2005-12-01

    This project addressed the key technical issues for development of an efficient smart window based on reversible electrochemical transfer of silver between a mirror electrode and a localized counter electrode. Effort to provide uniform switching over large areas focused on use of a resistive transparent electrode innerlayer to increase the interelectrode resistance. An effective edge seal was developed in collaboration with adhesive suppliers and an electrochromic device manufacturer. Work to provide a manufacturable counter electrode focused on fabricating a dot matrix electrode without photolithography by electrodeposition of Pt nuclei on inherent active sites on a transparent oxide conductor. An alternative counter electrode based on a conducting polymer and an ionic liquid electrolyte was also investigated. Work in all of these areas was successful. Sputtered large-bandgap oxide innerlayers sandwiched between conductive indium tin oxide (ITO) layers were shown to provide sufficient cross-layer resistance (>300 ohm/cm{sup 2}) without significantly affecting the electrochemical properties of the ITO overlayer. Two edge seal epoxies, one procured from an epoxy manufacturer and one provided by an electrochromic device manufacturer in finished seals, were shown to be effective barriers against oxygen intrusion up to 80 C. The optimum density of nuclei for the dot matrix counter electrode was attained without use of photolithography by electrodeposition from a commercial alkaline platinum plating bath. Silver loss issues for cells with dot matrix electrodes were successfully addressed by purifying the electrolyte and adjusting the cell cycling parameters. More than 30K cycles