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Sample records for criterion predict patient

  1. Application of Weibull Criterion to failure prediction in compsites

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    Cain, W. D.; Knight, Jr., C. E.

    1981-04-20

    Fiber-reinforced composite materials are being widely used in engineered structures. This report examines how the general form of the Weibull Criterion, including the evaluation of the parameters and the scaling of the parameter values, can be used for the prediction of component failure.

  2. A study to investigate the relationship between difficult intubation and prediction criterion of difficult intubation in patients with obstructive sleep apnea syndrome

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    Omer Kurtipek

    2012-01-01

    Full Text Available Background and Aim: Obstructive sleep apnea (OSA syndrome is predisposed to the development of upper airway obstruction during sleep, and it poses considerable problem for anesthetic management. Difficult intubation (DI is an important problem for management of anesthesia. In this clinical research, we aim to investigate the relationship between DI and prediction criteria of DI in cases with OSA. Materials and Methods: We studied 40 [OSA (Group O, n = 20 and non-OSA, (Group C, n = 20] ASA I-II, adult patients scheduled tonsillectomy under general anesthesia. Same anesthetic protocol was used in two groups. Intubation difficulties were assessed by Mallampati grading, Wilson sum score, Laryngoscopic grading (Cormack and Lehane, a line joining the angle of the mouth and tragus of the ear with the horizontal, sternomental distance, and tyromental distance. Demographic properties, time-dependent hemodynamic variables, doses of reversal agent, anesthesia and operation times, and recovery parameters were recorded. Results: Significant difference was detected between groups in terms of BMI, Mallampati grading, Wilson weight scores, Laryngoscopic grading, sternomental distance, tyromental distance, doses of reversal agent, and recovery parameters. Conclusion: OSA patient′s DI ratio is higher than that of non-OSA patients. BMI Mallampati grading, Wilson weight scores, Laryngoscopic grading, sternomental distance, and tyromental distance evaluation might be predictors for DI in patients with OSA.

  3. Negative-Margin Criterion for Impact-Response Prediction

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    Anderson, Denton

    2006-01-01

    Some space missions require a nuclear-power source to generate electrical power to meet mission objectives. At present, the nuclear-power source is an assembly of modular heat sources called the general purpose heat source (GPHS) modules. Each module comprises graphite shells designed to protect iridium-alloy clads which serve as the primary containment shells for the radioactive, heat-producing material. In the course of launching the space vehicle to perform its mission the nuclear heat source may be exposed to severe accident environments. One particular environment is a primary impact event where individual GPHS modules impact hard surfaces at speeds in the range of 50 meters per second or more. Tests have shown that some clads may be breached in particularly severe impacts and release a small fraction of their contents. This paper presents an empirical model for predicting essential ingredients for assessing the risk associated with primary impact events. The ingredients include: clad failure probability, release fraction of clad contents, characterization of the released material in terms of particle-size distribution and a means to estimate uncertainty in the prediction process. The empirical model focuses on the deformation of the clads and their capability to withstand deformation without breaching, measured by ductility. The basic criterion used to estimate all ingredients is called ``negative margin''. The procedure for estimating risk factors entails calculation of clad distortion by, e.g. hydrocode simulation, and high-strain-rate ductility of the iridium alloy. Negative margin is a linear combination of distortion and ductility. Regression equations derived from test data are used to calculate the clad failure probability and the fractional activity release as functions of negative margin. The mass-based particle-size distribution is calculated as a function of release fraction. Cumulative uncertainty in this computing process is evaluated using

  4. A Case for Transforming the Criterion of a Predictive Validity Study

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    Patterson, Brian F.; Kobrin, Jennifer L.

    2011-01-01

    This study presents a case for applying a transformation (Box and Cox, 1964) of the criterion used in predictive validity studies. The goals of the transformation were to better meet the assumptions of the linear regression model and to reduce the residual variance of fitted (i.e., predicted) values. Using data for the 2008 cohort of first-time,…

  5. Predicting ethnic and racial discrimination: a meta-analysis of IAT criterion studies.

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    Oswald, Frederick L; Mitchell, Gregory; Blanton, Hart; Jaccard, James; Tetlock, Philip E

    2013-08-01

    This article reports a meta-analysis of studies examining the predictive validity of the Implicit Association Test (IAT) and explicit measures of bias for a wide range of criterion measures of discrimination. The meta-analysis estimates the heterogeneity of effects within and across 2 domains of intergroup bias (interracial and interethnic), 6 criterion categories (interpersonal behavior, person perception, policy preference, microbehavior, response time, and brain activity), 2 versions of the IAT (stereotype and attitude IATs), 3 strategies for measuring explicit bias (feeling thermometers, multi-item explicit measures such as the Modern Racism Scale, and ad hoc measures of intergroup attitudes and stereotypes), and 4 criterion-scoring methods (computed majority-minority difference scores, relative majority-minority ratings, minority-only ratings, and majority-only ratings). IATs were poor predictors of every criterion category other than brain activity, and the IATs performed no better than simple explicit measures. These results have important implications for the construct validity of IATs, for competing theories of prejudice and attitude-behavior relations, and for measuring and modeling prejudice and discrimination.

  6. Discussion on Usability of the Niyama Criterion for Porosity Predicting in Cast Iron Castings

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    Ignaszak Z.

    2017-09-01

    Full Text Available The paper refers to previous publications of the author, focused on criteria of casting feeding, including the thermal criterion proposed by Niyama. On the basis of this criterion, present in the post-processing of practically all the simulation codes, danger of casting compactness (in the sense of soundness in form of a microporosity, caused by the shrinkage phenomena, is predicted. The vast majority of publications in this field concerns shrinkage and feeding phenomena in the cast steel castings – these are the alloys, in which parallel expansion phenomenon does not occur as in the cast irons (graphite crystallization. The paper, basing on the simulation-experimental studies, presents problems of usability of a classic, definition-based approach to the Niyama criterion for the cast iron castings, especially of greater massiveness, for prediction of presence of zones of dispersed porosity, with relation to predictions of the shrinkage type defects. The graphite expansion and its influence on shrinkage compensation during solidification of eutectic is also discussed.

  7. Statistical learning theory for high dimensional prediction: Application to criterion-keyed scale development.

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    Chapman, Benjamin P; Weiss, Alexander; Duberstein, Paul R

    2016-12-01

    Statistical learning theory (SLT) is the statistical formulation of machine learning theory, a body of analytic methods common in "big data" problems. Regression-based SLT algorithms seek to maximize predictive accuracy for some outcome, given a large pool of potential predictors, without overfitting the sample. Research goals in psychology may sometimes call for high dimensional regression. One example is criterion-keyed scale construction, where a scale with maximal predictive validity must be built from a large item pool. Using this as a working example, we first introduce a core principle of SLT methods: minimization of expected prediction error (EPE). Minimizing EPE is fundamentally different than maximizing the within-sample likelihood, and hinges on building a predictive model of sufficient complexity to predict the outcome well, without undue complexity leading to overfitting. We describe how such models are built and refined via cross-validation. We then illustrate how 3 common SLT algorithms-supervised principal components, regularization, and boosting-can be used to construct a criterion-keyed scale predicting all-cause mortality, using a large personality item pool within a population cohort. Each algorithm illustrates a different approach to minimizing EPE. Finally, we consider broader applications of SLT predictive algorithms, both as supportive analytic tools for conventional methods, and as primary analytic tools in discovery phase research. We conclude that despite their differences from the classic null-hypothesis testing approach-or perhaps because of them-SLT methods may hold value as a statistically rigorous approach to exploratory regression. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  8. Fracture prediction of hole expansion forming using forming limit stress criterion

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    Hakoyama, Tomoyuki; Nakano, Hayato; Kuwabara, Toshihiko

    2017-10-01

    The fracture prediction of a hole expansion forming for a cold rolled steel sheet is investigated using the concept of forming limit stress criterion. Multiaxial tube expansion tests (MTET) (T. Kuwabara and F. Sugawara, 2014), in which linear paths in the first quadrant of the stress space are applied to tubular specimens, are performed to measure the contours of plastic work and the directions of the plastic strain rates of the test material. The anisotropic parameters and the exponent of the Yld2000-2d yield function (F. Barlat et al., 2003) are optimized to approximate the material test data. Marciniak-Kuczynski type forming limit analyses (Z. Marciniak and K. Kuczynski, 1967) are performed to determine the forming limit stress surface (FLSS) in a stress space. It is concluded that the FLSS calculated using an appropriate material model calibrated using the MTET is effective in predicting the necking timing in the hole expansion forming of the test material.

  9. The zero ischemia index (ZII): a novel criterion for predicting complexity and outcomes of off-clamp partial nephrectomy.

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    Li, Yaohui; Zhou, Lin; Bian, Tingchang; Xiang, Zhuoyi; Xu, Yeqing; Zhu, Yanjun; Hu, Xiaoyi; Jiang, Shuai; Guo, Jianming; Wang, Hang

    2017-07-01

    Although several anatomical classification systems that aimed to standardize the description of renal tumors were previously reported, a special classification system is required to help predict the complexity and perioperative outcomes of off-clamp nephron-sparing surgery (NSS). We developed a novel criterion-zero ischemia index (ZII), aiming to help predict the perioperative outcomes after off-clamp NSS and guide patient selection. We retrospectively evaluated 149 patients between June 2009 and July 2014 in our institution who underwent off-clamp NSS with available computed tomography images. ZII was defined as the product of the tumor diameter and depth within renal parenchyma. ZII was then analyzed to investigate its association with perioperative outcomes. A specific ZII score was further selected to best guide patient selection in off-clamp NSS. ZII was significantly associated with estimated blood loss >500 mL (OR 1.270, 95% CI 1.036-1.557, p = 0.021), operative time >2 h (OR 1.286, 95% CI 1.051-1.573, p = 0.014), surgical complications (OR 1.251, 95% CI 1.035-1.511, p = 0.020), overall complications (OR 1.208, 95% CI 1.016-1.436, p = 0.032), and >10% decrease in estimated glomerular filtration rate (OR 1.362, 95% CI 1.045-1.776, p = 0.022). Patients with ZII > 6 may bear a higher risk of hemorrhage, perioperative complications, and a longer operative time, if they underwent an off-clamp NSS, compared to those with ZII ≤ 6. The ZII is a novel and readily measurable criterion which can help predict renal complexity of tumor and risk of perioperative outcomes after off-clamp NSS. ZII = 6 is established as a preliminary threshold for patient selection of off-clamp NSS. A more robust criterion is to be validated with more samples in a prospective study.

  10. Self-discrepancy: Long-term test-retest reliability and test-criterion predictive validity.

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    Watson, Neill; Bryan, Brandon C; Thrash, Todd M

    2016-01-01

    Long-term test-retest reliability and predictive test-criterion evidence of validity of scores on measures of the real-ideal self-discrepancy and of the real-ought self-discrepancy were tested over periods of 1 year and 3 years. A sample of 184 undergraduates completed at 2 time points 1 year apart 3 instruments that each measure the 2 self-discrepancies: the idiographic Self-Concept Questionnaire-Personal Constructs, the nonidiographic Self-Concept Questionnaire-Conventional Constructs, and the content-free Abstract Measures. A separate sample of 141 undergraduates completed the instruments 3 years apart. Both samples completed 3 depression instruments and 3 anxiety instruments at the second time point. Results of analyses using latent variables modeled with 3 observed variables showed substantial statistically significant test-retest reliabilities and significant test-criterion prediction of anxiety and depression on the real-ideal and real-ought discrepancy measures over both time periods. Results for the observed variables showed significant 1-year and 3-year reliabilities for scores on all self-discrepancy measures, as well as significant 1-year and 3-year predictive validity for scores on all self-discrepancy measures, except the abstract measure of real-ought discrepancy in predicting scores on all depression measures and on at least 1 anxiety measure. The findings support very strong long-term stabilities of the self-discrepancy personality constructs and their long-term associations with anxiety and depression. (c) 2016 APA, all rights reserved).

  11. Mammography image quality: model for predicting compliance with posterior nipple line criterion.

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    Spuur, Kelly; Hung, Wai Tak; Poulos, Ann; Rickard, Mary

    2011-12-01

    To develop a model using measurements of pectoral muscle width and length together with the acceptability of the posterior nipple line criteria (PNL) to predict the acceptability of the presentation of the pectoral muscle in the mediolateral oblique view of the breast. A total of 400 mediolateral oblique mammogram images were randomly selected from BreastScreen NSW South West, Australia. Measurements of length and width of the pectoral muscle and the acceptability of the pectoral muscle position relative to the PNL were recorded. Data analysis involved logistic regression and ROC analysis to test the predictors of width and length and the performance of the model. The model was then used to predict the outcome of acceptable or unacceptable PNL criterion for each case. The estimated odds ratio for an increase of 10mm was 1.98 (CI=1.68, 2.34) for the length predictor and 2.14 (CI=1.56, 2.93) for the width predictor. A cut off point of 0.6083 was derived from the training set and applied with the developed model to the test set. The area under the ROC curve was 0.9339 demonstrating an accurate model. This paper describes a model to predict the acceptability of the PNL criterion using the width and length of the pectoral muscle. This model could be used in the automated assessment of image quality which has the potential to enhance the consistency in mammographic image quality evaluation. Optimising image quality contributes to increased accuracy in radiological interpretation, which maximises the early detection of breast cancer and potentially reduces mortality rates. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  12. Searching for success: Development of a combined patient-reported-outcome ("PRO") criterion for operationalizing success in multi-modal pain therapy.

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    Donath, Carolin; Dorscht, Lisa; Graessel, Elmar; Sittl, Reinhard; Schoen, Christoph

    2015-07-17

    There is a need for a way to measure success in multi-modal pain therapy that researchers and clinicians can agree upon. According to developments in health services research, operationalizing success should take patient-reported outcomes into account. We will present a success criterion for pain therapy that combines different patient-reported variables and includes validity measures. The usable criterion should be part of a statistically significant and satisfactory model identifying predictors of successful pain therapy. Routine data from 375 patients treated with multi-modal pain therapy from 2008 to 2013 were used. The change scores of five constructs were used for the combined success criterion: pain severity, disability due to pain, depressiveness, and physical- and mental-health-related quality of life. According to the literature, an improvement of at least ½ standard deviation was required on at least four of the five constructs to count as successful. A three-step analytical approach including multiple binary logistic regression analysis was chosen to identify the predictors of therapy success with the success criterion as the dependent variable. A total of 58.1% of the patients were classified as successful. Convergent and predictive validity data show significant correlations between the criterion and established instruments, while discriminative validity could also be shown. A multiple binary logistic regression analysis confirmed the feasibility; a significant model (Chi(2) (8) = 52.585; p criterion that combines several variables and includes patient-reported outcomes ("PROs") with routine data that can be used in a predictor analysis in multi-modal pain therapy. The criterion was based on basic constructs used in pain therapy and used widespread validated self-rating instruments. Thus, it should be easy to transfer this criterion to other institutions.

  13. Prediction of fracture initiation in square cup drawing of DP980 using an anisotropic ductile fracture criterion

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    Park, N.; Huh, H.; Yoon, J. W.

    2017-09-01

    This paper deals with the prediction of fracture initiation in square cup drawing of DP980 steel sheet with the thickness of 1.2 mm. In an attempt to consider the influence of material anisotropy on the fracture initiation, an uncoupled anisotropic ductile fracture criterion is developed based on the Lou—Huh ductile fracture criterion. Tensile tests are carried out at different loading directions of 0°, 45°, and 90° to the rolling direction of the sheet using various specimen geometries including pure shear, dog-bone, and flat grooved specimens so as to calibrate the parameters of the proposed fracture criterion. Equivalent plastic strain distribution on the specimen surface is computed using Digital Image Correlation (DIC) method until surface crack initiates. The proposed fracture criterion is implemented into the commercial finite element code ABAQUS/Explicit by developing the Vectorized User-defined MATerial (VUMAT) subroutine which features the non-associated flow rule. Simulation results of the square cup drawing test clearly show that the proposed fracture criterion is capable of predicting the fracture initiation with sufficient accuracy considering the material anisotropy.

  14. Numerical Prediction of the Parameters of a Yield Criterion for Fibrous Composites

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    Małachowski, E.; L'vov, G.; Daryazadeh, S.

    2017-11-01

    A numerical procedure is developed for predicting the parameters of a yield criterion for metal-matrix composites on the basis of known mechanical properties of the matrix and fibers. The macrocriterion of yielding is taken in the form of an invariant quadratic function of average stresses, with the use of a fourth-rank tensor. Transition to the plastic state is fixed using a FEM analysis of the distribution of stresses within the minimum representative volume of composite. A new procedure to simulate the periodicity conditions for the representative volume at a uniform average stress state of composite is proposed. A numerical analysis showed that the structure of yield function has to reflect the possibility of plastic deformations of composite in hydrostatic macroloading even if the matrix and fibers do not deform plastically at such a loading. For an orthogonally reinforced boron-aluminum composite, components of its yield tensor are determined, and convexity of the yield surface is established. Yield surfaces are constructed for different plane stress states of the composite.

  15. Discriminant and Criterion-Related Validity of Achievement Goals in Predicting Academic Achievement: A Meta-Analysis

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    Huang, Chiungjung

    2012-01-01

    This study examined the discriminant and criterion-related validity of achievement goals in predicting academic achievement. Analysis of 151 studies yielded 172 independent samples (N = 52,986) with correlations among achievement goals and between achievement goals and academic achievement. The discriminant validity of achievement goals in the 2-,…

  16. Criterion validity of the ARthritis Treatment Satisfaction (ARTS) questionnaire: patient satisfaction with treatment and need for switching therapy.

    Science.gov (United States)

    Rejas, Javier; Monfort, Jordi; Campillo, Miguel A; Ruiz, Miguel A; Pardo, Antonio; Soto, Javier

    2009-01-01

    The ARthritis Treatment Satisfaction (ARTS) questionnaire specifically assesses patients' satisfaction with osteoarthritis treatment. However, its usefulness is limited since its criterion validity is unknown. The goal of this research was to analyse the criterion validity of the questionnaire in order to identify a cut-off value able to differentiate patients who are satisfied and those who are unsatisfied with osteoarthritis treatment and to establish the possible need for switching therapy. We used responses to the ARTS questionnaire from outpatients with osteoarthritis included in an open-label, non-controlled, naturalistic, prospective switching therapy study. In addition, patients' responses to two questions on satisfaction with treatment and osteoarthritis-related health status were recorded. Receiver operative characteristic (ROC) curve analyses with estimators of validity were determined. The correlation between responses to the ARTS questionnaire, the question regarding satisfaction with treatment, and the osteoarthritis-related health status assessment were also analysed. A total of 1756 male and female subjects were enrolled in the study. ROC curve analysis identified a cut-off point of >or=61 points as optimal for the criterion validity estimators of sensitivity (0.86), specificity (0.83), and positive (0.87) and negative (0.81) predictive values. This threshold value was used to identify patients satisfied with treatment and patients with a need to switch therapy (kappa coefficient of agreement 0.68 and 0.66, respectively). ARTS questionnaire scoring correlated with satisfaction with treatment (p < 0.0001), and with patient (r = 0.655, p < 0.0001) and investigator (r = 0.565, p < 0.0001) health status assessments. The ARTS questionnaire was able to identify patients satisfied with treatment and those with a need to switch their osteoarthritis therapy.

  17. Multi-scale modeling of phase explosion in high fluence nanosecond laser ablation and clarification of ablation depth prediction criterion

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    Cao, Yunfeng; Shin, Yung C., E-mail: shin@purdue.edu

    2015-12-01

    Graphical abstract: - Highlights: • ns laser ablation of aluminum and copper with phase explosion is investigated. • Melt ejection behavior is successfully predicted through a HD/MD/SPH model. • 0.9T{sub c} does not always work for all materials for ablation depth prediction. • 0.75–0.8T{sub c} works better for copper in predicting ablation depth. - Abstract: When phase explosion occurs, accurate prediction of the ablation behavior in the high energy nanosecond laser ablation process still remains a difficult challenge. In this paper, nanosecond laser ablation of aluminum and copper with phase explosion is investigated through a multi-scale model and experimental verification. The melt ejection behavior during phase explosion is successfully predicted by combined molecular dynamics (MD) and smoothed particle hydrodynamics (SPH) simulations and validated against the experiments. The commonly adopted 0.9T{sub c} (critical temperature) criterion for phase explosion boundary is also assessed with the prediction of the ablation depth for both aluminum and copper, and it is found that the 0.9T{sub c} criterion does not always work. The multi-scale model developed in this work is shown to have better capability in predicting the ablation behavior when phase explosion is involved.

  18. Criterion validity of a functional cognitive task in patients with severe traumatic brain injury.

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    LeBlanc, Joanne; de Guise, Elaine; Lamoureux, Julie; Meyer, Kim; Duplantie, Jennifer; Thomas, Harle; Abouassaly, Michel; Champoux, Marie-Claude; Couturier, Céline; Lin, Howell; Lu, Lucy; Robinson, Cathlyn; Roger, Eric; Maleki, Mohammed; Feyz, Mitra

    2012-01-01

    To verify criterion validity of measures from a functional cognitive task (FCT) carried out with patients with severe traumatic brain injury (sTBI) at 2-5 years post-injury. Forty-six patients with sTBI took part in a long-term outcome study where the FCT and the Neurobehavioural Rating Scale-Revised (NBRS-R) were administered and the FIM™ instrument was rated. The FCT is a telephone information gathering task for evaluating functional cognitive skills. Ten of 16 measures of the FCT were significantly correlated with similar or related concepts from the NBRS-R. The FIM™ cognitive score and the individual items of this score were significantly correlated with 13 of the FCT measures and with the percentage of amount of information gathered. Internal consistency was good for 13 of 16 measures. Overall, patients generally had mild difficulty on the FCT concepts. The FCT can be used with patients with sTBI to evaluate certain aspects of functional cognition. It has good criterion validity and internal consistency, but additional research is required to further measure reliability and its applicability to other severity of TBI and to other phases of recovery.

  19. Specificity matters: criterion-related validity of contextualized and facet measures of conscientiousness in predicting college student performance.

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    Woo, Sang Eun; Jin, Jing; LeBreton, James M

    2015-01-01

    To enhance the predictive validity of self-report personality measures, 2 distinct ways of increasing specificity of personality measures have been proposed in the literature-contextual specificity (i.e., providing a contextual referent) and content specificity (i.e., focusing on more specific constructs such as the Big Five facets). This study extends this line of research by examining whether there is an optimal way to configure, align, or integrate contextual and content specificity using measures of conscientiousness to predict college student success. A sample of 478 undergraduate students completed 4 measures of conscientiousness that varied in the level of content and contextual specificity. These forms of specificity were crossed to yield 4 distinct measures of conscientiousness. We then evaluated and compared the relative importance and the incremental importance of these different measures in the prediction of academic success. Superior predictive validity was found for both contextualized and facet measures of conscientiousness compared to a measure of global conscientiousness in predicting grade-point average and a broader behavioral criterion of student performance. When contextual and content specificity approaches were compared and combined, we observed the strongest predictive validity when the level of specificity is appropriately matched between predictor and criterion.

  20. Construct and criterion validity of the Euro Qol-5D in patients with systemic lupus erythematosus.

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    Su-li Wang

    Full Text Available OBJECTIVE: To investigate the construct and criterion validity of the Euro Qol-5D (EQ-5D, which allows quality-adjusted life-years to be calculated, in patients with systemic lupus erythematosus (SLE. METHODS: Consecutive SLE patients who had been followed at the Renji Hospital, School of Medicine, Shanghai Jiao Tong University were recruited. Cross-sectional correlations of the EQ-5D with equivalent domains in disease-specific health-related quality of life (HRQoL, LupusQol, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI measures, the Systemic Lupus International Collaborating Clinics Damage Index (SDI, and patient characteristics were tested. Discriminant validity to assess the ability to distinguish between patients of different disease severity was assessed. There also were evaluations of ceiling and floor effects. RESULTS: 240 patients were recruited in total. The EQ-5D correlated moderately to strongly with all domains of the LupusQoL (r: 0.44-0.7 apart from intimate relationships (r = 0.25 and body image (r = 0.18. There was moderate negative correlation between EQ-5D and clinical assessment of disease, SLEDAI (r = -0.589 and SDI (r = -0.509. When compared with equivalent domains on LupusQoL, there was good construct validity in EQ-5D (r: 0.631-0.812. EQ-5D could also discriminate patients with varied disease severity (according SLEDAI and SDI. There was no floor effect in EQ-5D but the ceiling effect remains strong (34%. CONCLUSION: Our results provide sufficient evidence that the EQ-5D displays construct and criterion validity for use in SLE patients. Disease-specific measures of HRQoL used alongside may be a better choice.

  1. Construct and criterion validity of the Euro Qol-5D in patients with systemic lupus erythematosus.

    Science.gov (United States)

    Wang, Su-li; Wu, Bin; Zhu, Li-an; Leng, Lin; Bucala, Richard; Lu, Liang-jing

    2014-01-01

    To investigate the construct and criterion validity of the Euro Qol-5D (EQ-5D), which allows quality-adjusted life-years to be calculated, in patients with systemic lupus erythematosus (SLE). Consecutive SLE patients who had been followed at the Renji Hospital, School of Medicine, Shanghai Jiao Tong University were recruited. Cross-sectional correlations of the EQ-5D with equivalent domains in disease-specific health-related quality of life (HRQoL), LupusQol, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) measures, the Systemic Lupus International Collaborating Clinics Damage Index (SDI), and patient characteristics were tested. Discriminant validity to assess the ability to distinguish between patients of different disease severity was assessed. There also were evaluations of ceiling and floor effects. 240 patients were recruited in total. The EQ-5D correlated moderately to strongly with all domains of the LupusQoL (r: 0.44-0.7) apart from intimate relationships (r = 0.25) and body image (r = 0.18). There was moderate negative correlation between EQ-5D and clinical assessment of disease, SLEDAI (r = -0.589) and SDI (r = -0.509). When compared with equivalent domains on LupusQoL, there was good construct validity in EQ-5D (r: 0.631-0.812). EQ-5D could also discriminate patients with varied disease severity (according SLEDAI and SDI). There was no floor effect in EQ-5D but the ceiling effect remains strong (34%). Our results provide sufficient evidence that the EQ-5D displays construct and criterion validity for use in SLE patients. Disease-specific measures of HRQoL used alongside may be a better choice.

  2. The Cognitive Abilities Scale--Second Edition Preschool Form: Studies of Concurrent Criterion-Related, Construct, and Predictive Criterion-Related Validity

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    Swanson, Jennifer R.; Bradley-Johnson, Sharon; Johnson, C. Merle; O'Dell, Anna Rubenaker

    2009-01-01

    Three studies examine the validity of the Preschool Form of the Cognitive Abilities Scale--Second Edition (CAS-2). Significant high concurrent criterion-related validity correlations, corrected for restricted range, are found between the CAS-2 and the Detroit Test of Learning Ability--Primary: Third Edition for 26 three-year-olds (r[subscript c] =…

  3. Evaluation of probabilistic flow predictions in sewer systems using grey box models and a skill score criterion

    DEFF Research Database (Denmark)

    Thordarson, Fannar Ørn; Breinholt, Anders; Møller, Jan Kloppenborg

    2012-01-01

    In this paper we show how the grey box methodology can be applied to find models that can describe the flow prediction uncertainty in a sewer system where rain data are used as input, and flow measurements are used for calibration and updating model states. Grey box models are composed of a drift...... term and a diffusion term, respectively accounting for the deterministic and stochastic part of the models. Furthermore, a distinction is made between the process noise and the observation noise. We compare five different model candidates’ predictive performances that solely differ with respect...... coverage of the prediction intervals, i.e. the bias between these coverages should ideally be zero. The sharpness is a measure of the distance between the lower and upper prediction limits, and skill score criterion makes it possible to pinpoint the preferred model by taking into account both reliability...

  4. Montreal-Toulouse Language Assessment Battery: evidence of criterion validity from patients with aphasia.

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    Pagliarin, Karina Carlesso; Ortiz, Karin Zazo; Barreto, Simone dos Santos; Pimenta Parente, Maria Alice de Mattos; Nespoulous, Jean-Luc; Joanette, Yves; Fonseca, Rochele Paz

    2015-10-15

    The Montreal-Toulouse Language Assessment Battery - Brazilian version (MTL-BR) provides a general description of language processing and related components in adults with brain injury. The present study aimed at verifying the criterion-related validity of the Montreal-Toulouse Language Assessment Battery - Brazilian version (MTL-BR) by assessing its ability to discriminate between individuals with unilateral brain damage with and without aphasia. The investigation was carried out in a Brazilian community-based sample of 104 adults, divided into four groups: 26 participants with left hemisphere damage (LHD) with aphasia, 25 participants with right hemisphere damage (RHD), 28 with LHD non-aphasic, and 25 healthy adults. There were significant differences between patients with aphasia and the other groups on most total and subtotal scores on MTL-BR tasks. The results showed strong criterion-related validity evidence for the MTL-BR Battery, and provided important information regarding hemispheric specialization and interhemispheric cooperation. Future research is required to search for additional evidence of sensitivity, specificity and validity of the MTL-BR in samples with different types of aphasia and degrees of language impairment. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Sensitivity of radiographic changes of hand and foot joints as a diagnostic criterion in patients with rheumatoid arthritis

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    Okubo, S.; Lehtinen, K.; Isomaeki, H. (Rheumatism Foundation Hospital, Heinola (Finland))

    1992-01-01

    In order to evaluate the sensitivity of radiographic changes in both hand and foot joints as a diagnostic criterion, we have investigated radiographs of patients with seropositive RA in the early stage of the disease. In our study, the inclusion of radiographic changes in foot joints improved the sensitivity of the radiographic criterion by 16% at the first visit and 20% after three years. (4 refs., 3 tabs).

  6. Criterion and construct validity of the CogState Schizophrenia Battery in Japanese patients with schizophrenia.

    Directory of Open Access Journals (Sweden)

    Taisuke Yoshida

    Full Text Available BACKGROUND: The CogState Schizophrenia Battery (CSB, a computerized cognitive battery, covers all the same cognitive domains as the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS Consensus Cognitive Battery but is briefer to conduct. The aim of the present study was to evaluate the criterion and construct validity of the Japanese language version of the CSB (CSB-J in Japanese patients with schizophrenia. METHODOLOGY/PRINCIPAL FINDINGS: Forty Japanese patients with schizophrenia and 40 Japanese healthy controls with matching age, gender, and premorbid intelligence quotient were enrolled. The CSB-J and the Brief Assessment of Cognition in Schizophrenia, Japanese-language version (BACS-J were performed once. The structure of the CSB-J was also evaluated by a factor analysis. Similar to the BACS-J, the CSB-J was sensitive to cognitive impairment in Japanese patients with schizophrenia. Furthermore, there was a significant positive correlation between the CSB-J composite score and the BACS-J composite score. A factor analysis showed a three-factor model consisting of memory, speed, and social cognition factors. CONCLUSIONS/SIGNIFICANCE: This study suggests that the CSB-J is a useful and rapid automatically administered computerized battery for assessing broad cognitive domains in Japanese patients with schizophrenia.

  7. The criterion-related validity of personality measures for predicting GPA: a meta-analytic validity competition.

    Science.gov (United States)

    McAbee, Samuel T; Oswald, Frederick L

    2013-06-01

    Interest in the role of personality traits in predicting academic performance outcomes has steadily increased over the last several decades, enough to produce a number of meta-analyses that summarize this research (e.g., Poropat, 2009; Richardson, Abraham, & Bond, 2012). These previous meta-analyses combine a variety of alternative personality measures under the assumption that they all reflect the same personality traits and thus predict outcomes similarly. The current meta-analysis tests this assumption by comparing different personality measures when predicting postsecondary grade point average (GPA). The operational validities (r+) of 5 frequently used measures of the Big Five personality traits were compared: the NEO Personality Inventory--Revised (NEO-PI-R; Costa & McCrae, 1992), the NEO Five-Factor Inventory (NEO-FFI; Costa & McCrae, 1992), the Big Five Inventory (BFI; e.g., Benet-Martínez & John, 1998), Goldberg's (1992) unipolar Big Five Factor Markers (Markers), and the Big Five International Personality Item Pool (IPIP; Goldberg, 1999). A systematic review of the psychological literature from 1992 to 2012 was conducted, identifying 51 studies containing 274 correlations. Conscientiousness demonstrated the strongest criterion-related validity for predicting GPA (r+ = .23), consistent with previous meta-analyses; in addition, this overall validity was found to be robust across measures (r(BFI)(+) = .24, r(IPIP)(+) = .21, r(Markers)(+) = .15, r(NEO-FFI)(+) = .24, r(NEO-PI-R)(+) = .26). Although the criterion-related validities for Extraversion, Agreeableness, Neuroticism, and Openness to Experience (Intellect) differed by measure, they were generally low (r+s < .10). Practical implications of the findings and directions for future research are discussed. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  8. A new criterion for predicting rolling-element fatigue lives of through-hardened steels.

    Science.gov (United States)

    Chevalier, J. L.; Zaretsky, E. V.; Parker, R. J.

    1972-01-01

    A carbide factor was derived based upon a statistical analysis which related rolling-element fatigue life to the total number of residual carbide particles per unit area, median residual carbide size, and percent residual carbide area. An equation was empirically determined which predicts material hardness as a function of temperature. The limiting temperatures of all of the materials studied were dependent on initial room temperature hardness and tempering temperature. An equation was derived combining the effects of material hardness, carbide factor, and bearing temperature to predict rolling-element bearing life.

  9. Application of Wrinkling Criterion for Prediction of Side-Wall Wrinkles in Deepdrawing of Conical Cups

    NARCIS (Netherlands)

    Wisselink, H.H.; Nagy, G.T.; Meinders, Vincent T.; Tewari, A.; Narasimhan, K.; Date, P.P.

    2012-01-01

    A wrinkling indicator is used to predict the development of wrinkles in a conical cup of relatively thin packaging steel. The results of FEM simulations using a wrinkling indicator are validated with a set of experiments with varying blankholder force and lubrication.

  10. Physically based criterion for prediction of instability under stretchbending of sheet metal

    NARCIS (Netherlands)

    Perdahcioglu, E.S.; Hou, B.; Boogaard, A.H. van den

    2015-01-01

    This research focuses on the prediction of the forming limit of certain Advanced High Strength Steel grades under stretch-bending conditions. For these types of steels it is experimentally observed and shown that when there is a bending component added to the main membrane deformation the

  11. Predictive Power of Primary and Secondary School Success Criterion on Transition to Higher Education Examination Scores

    Directory of Open Access Journals (Sweden)

    Atilla ÖZDEMİR

    2016-12-01

    Full Text Available It is seen that education has a significant effect that changes an individual’s life in our country in which education is a way of moving up the social ladder. In order to continue to a higher education program after graduating from high school, students have to succeed in transition to higher education examination. Thus, the entrance exam is an important factor to determine the future of the students. In our country, middle school grades and high school grade point average that is added to university placement score are also determinants. When spiral structure of our curriculum is considered, it is expected that related courses’ grades at middle school will predict the scores obtained from the first stage of transition to higher education exam (YGS. Since high school grade point average forms university placement score, being aware of how related courses’ achievement scores at secondary school predict raw scores of YGS subtests is significant in terms of our education system’s feedback and integrity. As a result, observing students’ achievement scores in related courses during their middle and high school education longitudinally and predicting raw scores on the subtests of the first stage of university entrance exam, YGS, from middle school and high scool achievement scores are substantial with regards to provide feedback to our education system. Because of those reasons, the predictive power of 7th - 12th grade year-end grade point averages ofstudents who took YGS in 2013 on their 2013 YGS subtests’ raw scvores is examined. Students who took YGS exam in Ankara province at 2012-2013 school year formed the aimed population of this study and 533 students who took YGS exam in 2013 in Altındağ district of Ankara formed target population of the study. Data was obtained from 533 students at three different schools in Altındağ district of Ankara province. Stepwise multiple regression analysis was used to answer research questions

  12. Development of a criterion for predicting residual strength of composite structures damaged by impact loading

    OpenAIRE

    Ricardo de Medeiros

    2016-01-01

    Advanced aerospace materials, including fibre reinforced polymer and ceramic matrix composites, are increasingly being used in critical and demanding applications, challenging not only the current damage prediction, detection, and quantification methodologies, but also the residual life of the structure. The main objective of this work consists of developing theoretical and experimental studies about residual strength for composite structures, which are damaged by impact loading, aided by a S...

  13. Three-dimensional gamma criterion for patient-specific quality assurance of spot scanning proton beams.

    Science.gov (United States)

    Chang, Chang; Poole, Kendra L; Teran, Anthony V; Luckman, Scott; Mah, Dennis

    2015-09-08

    The purpose of this study was to evaluate the effectiveness of full three-dimensional (3D) gamma algorithm for spot scanning proton fields, also referred to as pencil beam scanning (PBS) fields. The difference between the full 3D gamma algorithm and a simplified two-dimensional (2D) version was presented. Both 3D and 2D gamma algorithms are used for dose evaluations of clinical proton PBS fields. The 3D gamma algorithm was implemented in an in-house software program without resorting to 2D interpolations perpendicular to the proton beams at the depths of measurement. Comparison between calculated and measured dose points was car-ried out directly using Euclidian distance in 3D space and the dose difference as a fourth dimension. Note that this 3D algorithm faithfully implemented the original concept proposed by Low et al. (1998) who described gamma criterion using 3D Euclidian distance and dose difference. Patient-specific proton PBS plans are separated into two categories, depending on their optimization method: single-field optimization (SFO) or multifield optimized (MFO). A total of 195 measurements were performed for 58 SFO proton fields. A MFO proton plan with four fields was also calculated and measured, although not used for treatment. Typically three dif-ferent depths were selected from each field for measurements. Each measurement was analyzed by both 3D and 2D gamma algorithms. The resultant 3D and 2D gamma passing rates are then compared and analyzed. Comparison between 3D and 2D gamma passing rates of SFO fields showed that 3D algorithm does show higher passing rates than its 2D counterpart toward the distal end, while little difference is observed at depths away from the distal end. Similar phenomenon in the lateral penumbra was well documented in photon radiation therapy, and in fact brought about the concept of gamma criterion. Although 2D gamma algorithm has been shown to suffice in addressing dose comparisons in lateral penumbra for photon

  14. Force Criterion Prediction of Damage for Carbon/Epoxy Composite Panels Impacted by High Velocity Ice

    Science.gov (United States)

    Rhymer, Jennifer D.

    The use of advanced fiber-reinforced polymer matrix composites in load-bearing aircraft structures is increasing, as evident by the various composites-intensive transport aircraft presently under development. A major impact source of concern for these structures is hail ice, which affects design and skin-sizing (skin thickness determination) at various locations of the aircraft. Impacts onto composite structures often cause internal damage that is not visually detectable due to the high strength and resiliency of the composite material (unlike impacts onto metallic structures). This internal damage and its effect on the performance of the structure are of great concern to the aircraft industry. The prediction of damage in composite structures due to SHI impact has been accomplished via experimental work, explicit dynamic nonlinear finite element analysis (FEA) and the definition of design oriented relationships. Experiments established the critical threshold and corresponding analysis provided contact force results not readily measurable in high velocity SHI impact experiments. The design oriented relationships summarize the FEA results and experimental database into contact force estimation curves that can be easily applied for damage prediction. Failure thresholds were established for the experimental conditions (panel thickness ranging from 1.56 to 4.66 mm and ice diameters from 38.1 to 61.0 mm). Additionally, the observations made by high-speed video during the impact event, and ultrasonic C-scan post-impact, showed how the ice failed during impact and the overall shape and location of the panel damage. Through analysis, the critical force, the force level where damage occurs above but not below, of a SHI impact onto the panel was found to be dependent only on the target structure. However, the peak force generated during impact was dependent on both the projectile and target. Design-oriented curves were generated allowing the prediction of the allowable

  15. Evaluating construct equivalence and criterion-related validity for repeat examinees on a standardized patient examination.

    Science.gov (United States)

    Raymond, Mark R; Kahraman, Nilufer; Swygert, Kimberly A; Balog, Kevin P

    2011-10-01

    Prior studies report large score gains for examinees who fail and later repeat standardized patient (SP) assessments. Although research indicates that score gains on SP exams cannot be attributed to memorizing previous cases, no studies have investigated the empirical validity of scores for repeat examinees. This report compares single-take and repeat examinees in terms of both internal (construct) validity and external (criterion-related) validity. Data consisted of test scores for examinees who took the United States Medical Licensing Examination Step 2 Clinical Skills (CS) exam between July 16, 2007, and September 12, 2009. The sample included 12,090 examinees who completed Step 2 CS on one occasion and another 4,030 examinees who completed the exam on two occasions. The internal measures included four separately scored performance domains of the Step 2 CS examination, whereas the external measures consisted of scores on three written assessments of medical knowledge (Step 1, Step 2 clinical knowledge, and Step 3). The authors subjected the four Step 2 CS domains to confirmatory factor analysis and evaluated correlations between Step 2 CS scores and the three written assessments for single-take and repeat examinees. The factor structure for repeat examinees on their first attempt was markedly different from the factor structure for single-take examinees, but it became more similar to that for single-take examinees by their second attempt. Scores on the second attempt correlated more highly with all three external measures. The findings support the validity of scores for repeat examinees on their second attempt.

  16. The German PASS-20 in patients with low back pain: new aspects of convergent, divergent, and criterion-related validity.

    Science.gov (United States)

    Kreddig, Nina; Rusu, Adina C; Burkhardt, Katja; Hasenbring, Monika I

    2015-04-01

    The PASS-20 (McCracken and Dhingra, Pain Res Manag 7:45-50, 2002) is a shortened version of the Pain Anxiety Symptoms Scale (PASS), a self-report measure of pain anxiety. The PASS-20 demonstrates good psychometric characteristics but has not yet been validated in a German population. The aims of the present study were to (1) examine the factor structure and psychometric characteristics of the German PASS-20; (2) investigate its construct validity with respect to depression, fear-avoidance, and endurance; and (3) determine its criterion-related validity with a special emphasis on pain, disability, and quality of life. A principal component analysis was performed on a sample (N = 195) of patients with acute, subacute, and chronic low back pain. Reliability was examined with Cronbach's α. Validity was assessed by correlating the PASS-20 to measures of depression, anxiety, disability, quality of life, and avoidance-endurance-related behavioral pain responses. The original four-factor structure proposed for the PASS-20 was replicated using the original subscale labels. The reliability of the total score and the subscales was satisfactory to excellent, and both convergent and divergent validity were moderate to high in the expected directions, showing positive correlations with anxiety, fear, depression, and fear-avoidance and negative correlations with endurance and quality of life. The PASS-20 showed unique predictive ability and advantages over the Tampa Scale of Kinesiophobia. The results for the German PASS-20 support the original factor structure and provide evidence of satisfactory psychometric characteristics and usefulness in patients with low back pain.

  17. Malnutrition in Geriatric Rehabilitation: Prevalence, Patient Outcomes, and Criterion Validity of the Scored Patient-Generated Subjective Global Assessment and the Mini Nutritional Assessment.

    Science.gov (United States)

    Marshall, Skye; Young, Adrienne; Bauer, Judith; Isenring, Elizabeth

    2016-05-01

    Accurate identification and management of malnutrition is essential so that patient outcomes can be improved and resources used efficaciously. In malnourished older adults admitted to rehabilitation: 1) report the prevalence, health and aged care use, and mortality of malnourished older adults; 2) determine and compare the criterion (concurrent and predictive) validity of the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and the Mini Nutritional Assessment (MNA) in diagnosing malnutrition; and 3) identify the Scored PG-SGA score cut-off value associated with malnutrition. Observational, prospective cohort. Participants were 57 older adults (65 years and older; mean±standard deviation age=79.1±7.3 years) from two rural rehabilitation units in New South Wales, Australia. Scored PG-SGA; MNA; and the International Statistical Classification of Diseases and Health Related Problems, 10th revision, Australian Modification (ICD-10-AM) classification of malnutrition were compared to establish concurrent validity and report malnutrition prevalence. Length of stay, discharge location, rehospitalization, admission to a residential aged care facility, and mortality were measured to report health-related outcomes and to establish predictive validity. Malnutrition prevalence varied according to assessment tool (ICD-10-AM: 46%; Scored PG-SGA: 53%; MNA: 28%). Using the ICD-10-AM as the reference standard, the Scored PG-SGA ratings (sensitivity 100%, specificity 87%) and score (sensitivity 92%, specificity 84%, ROC AUC [receiver operating characteristics area under the curve]=0.910±0.038) showed strong concurrent validity, and the MNA had moderate concurrent validity (sensitivity 58%, specificity 97%, receiver operating characteristics area under the curve=0.854±0.052). The Scored PG-SGA rating, Scored PG-SGA score, and MNA showed good predictive validity. Malnutrition can increase the risk of longer rehospitalization length of stay, admission to a residential

  18. ASDAS high disease activity versus BASDAI elevation in patients with ankylosing spondylitis as selection criterion for anti-TNF therapy.

    Science.gov (United States)

    Vastesaeger, Nathan; Cruyssen, Bert Vander; Mulero, Juan; Gratacós Masmitjá, Jordi; Zarco, Pedro; Almodovar, Raquel; Font, Pilar; Juanola, Xavier; Collantes-Estevez, Eduardo

    2014-01-01

    To investigate which of the 2 ankylosing spondylitis (AS) disease activity instruments identifies better those patients with characteristics that have been associated with positive response to anti-TNF therapy. Data from patients with AS in the REGISPONSER registry were analyzed. Patients were categorized by disease activity using 3 different selection criteria: elevated Bath Ankylosing Spondylitis Disease Activity Index criteria (BASDAI≥4), high Ankylosing Spondylitis Disease Activity Score (ASDAS≥2.1), or very high ASDAS (ASDAS≥3.5). To determine which criterion selects for patients most likely to respond to anti-TNF therapy, the groups of patients selected with each criterion were compared on five disease characteristics that are associated with good response to anti-TNF therapy: lower age, lower function score, less enthesitis, higher C-reactive protein (CRP), and HLA-B27-positive status. 50.9%, 66.3%, and 24.9% of 1156 patients had elevated BASDAI, high ASDAS, or very high ASDAS, respectively. Compared to patients selected with elevated BASDAI, more patients selected with high ASDAS had characteristics associated with good response to anti-TNF therapy. Patients with very high ASDAS had higher CRP and were younger, but more frequently had enthesitis and had higher function scores when compared to those with elevated BASDAI. Selection of AS patients with the ASDAS instrument results in patient sub-populations with different characteristics than those selected with the BASDAI instrument. Since some of these characteristics have been associated with response to anti-TNF therapy, further study should establish if the choice of selection instrument improves the outcome of therapy in the selected populations. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  19. Interpretation of ongoing thermal response tests of vertical (BHE) borehole heat exchangers with predictive uncertainty based stopping criterion

    DEFF Research Database (Denmark)

    Poulsen, Søren Erbs; Alberdi Pagola, Maria

    2015-01-01

    A method for real-time interpretation of ongoing thermal response tests of vertical borehole heat exchangers is presented. The method utilizes a statistically based stopping criterion for ongoing tests. The study finds minimum testing times for synthetic and actual TRTs to be in the interval 12–2...

  20. Modified Johnston Failure Criterion from Rock Mechanics to Predict the Ultimate Strength of Fiber Reinforced Polymer (FRP Confined Columns

    Directory of Open Access Journals (Sweden)

    Zehra Canan Girgin

    2013-12-01

    Full Text Available The failure criteria from rock mechanics, Hoek-Brown and Johnston failure criteria, may be extended and modified to assess the ultimate compressive strength of axially loaded circular fiber reinforced polymer (FRP-confined concrete columns. In addition to the previously modified Hoek-Brown criterion, in this study, the Johnston failure criterion is extended to scope of FRP-confined concrete, verified with the experimental data and compared with the significant relationships from the current literature. Wide-range compressive strengths from 7 to 108 MPa and high confinement ratios up to 2.0 are used to verify the ultimate strengths in short columns. The results are in good agreement with experimental data for all confinement levels and concrete strengths.

  1. Is a previous diagnosis of asthma a reliable criterion for asthma–COPD overlap syndrome in a patient with COPD?

    Science.gov (United States)

    Barrecheguren, Miriam; Román-Rodríguez, Miguel; Miravitlles, Marc

    2015-01-01

    Background Some patients share characteristics of both COPD and asthma. As yet, there is no gold standard to identify patients with the so-called asthma–COPD overlap syndrome (ACOS). Objective To describe the differences between ACOS patients and the remaining COPD patients, and to compare the clinical characteristics of patients diagnosed with ACOS by two different criteria: previous diagnosis of asthma before the age of 40 years; and the diagnostic criteria of the Spanish guidelines of COPD. Methods Multicenter, observational, cross-sectional study performed in 3,125 COPD patients recruited in primary care and specialized outpatient clinics. Patients with COPD and a history of asthma before the age of 40 years were diagnosed with ACOS and compared to the remaining COPD patients. Subsequently, ACOS patients were subdivided based on whether they fulfilled the Spanish guidelines of the COPD diagnostic criteria or not, and they were compared. Results ACOS was diagnosed in 15.9% of the patients. These patients had different basal characteristics compared to the remaining COPD patients, including a higher frequency of women and more exacerbations despite lower tobacco exposure and better lung function. They were more likely to have features of asthma, such as a positive bronchodilator test, higher peripheral eosinophilia, and higher total immunoglobulin E. Within the ACOS group, only one-third fulfilled the diagnostic criteria of the Spanish guidelines of COPD; these individuals were not significantly different from the remaining ACOS patients, except for having more exacerbations and poorer lung function. Conclusion ACOS patients diagnosed on the basis of a previous diagnosis of asthma differed from the remaining COPD patients, but they were similar to ACOS patients diagnosed according to more restrictive criteria, suggesting that a history of asthma before the age of 40 years could be a useful criterion to suspect ACOS in a patient with COPD. PMID:26366067

  2. Predictive value of biopsy specimens suspicious for melanoma: support for 6-mm criterion in the ABCD rule.

    Science.gov (United States)

    Soltani-Arabshahi, Razieh; Sweeney, Carol; Jones, Benjamin; Florell, Scott R; Hu, Nan; Grossman, Douglas

    2015-03-01

    Clinical detection of melanoma can be challenging. The number of biopsy specimens performed to diagnose 1 melanoma is a measure of efficiency of skin cancer detection, but few data are available to describe this measure from US health care. We studied the diagnosis of melanoma among biopsy specimens of clinically concerning pigmented lesions at an academic dermatology department. We searched for all biopsy specimens that were performed because of clinical suspicion of melanoma in 2013. Characteristics of the patient, lesion, and clinician performing the biopsy, and the final pathology diagnosis were recorded. A total of 2643 biopsy specimens from 2213 patients submitted by 43 providers were included. Melanoma was diagnosed in 165 cases (positive predictive value 6.4%, 95% confidence interval 5.5%-7.4%). Older age (P < .001), male gender (P = .045), and nontrunk location (P < .001) were predictors of higher probability of melanoma detection. Lesions larger than 6 mm in size had higher positive predictive value 11.5% (8.8%-14.1%) than smaller lesions 2.6% (1.6%-3.6%). Factors influencing the decision to biopsy a lesion may be difficult to evaluate retrospectively. At an academic medical center, 16 clinically concerning lesions were biopsied to diagnose 1 melanoma. Biopsy specimens of clinically concerning pigmented lesions larger than 6 mm on older men had the highest yield. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  3. Fatigue Criterion for System Design

    Science.gov (United States)

    Zeretsky, E. V.

    1986-01-01

    Report discusses principles of structural-life prediction. Generalized methodology developed for structural life prediction, design, and reliability, based upon fatigue criterion. Approach incorporates computed life of elemental stress volumes of complex machine elements to predict system life. Results of coupon fatigue testing incorporated into analysis, allowing for life prediction and component or structural renewal rates, with reasonable statistical certainty.

  4. Criterion validation of the rate of recovery, a single alphanumeric measure, in patients with shoulder pain.

    Science.gov (United States)

    O'Halloran, Bryan; Wright, Alexis; Cook, Chad E

    2013-12-01

    The aim of this study was to identify the minimal clinically important threshold score for rate of recovery (RoR) using the Patient Acceptable Symptom State (PASS) as an anchor measure, and to measure the association of the RoR with the raw and percentage change scores of the QuickDASH and the Numeric Pain Rating Scale (NPRS). Threshold measures for RoR and the PASS were examined using a Receiver Operating Characteristic (ROC) Curve. Participants were dichotomized to those who stated "yes" and those who stated "no" on the PASS. Pearson correlation coefficients were performed to determine the relationship between the NPRS and QuickDASH raw and percentage change scores and the RoR at discharge. ROC curve statistics suggest that a cut-point of greater than 87% on the self-report RoR (SN=0.62, SP=0.73; +LR=2.26: -LR=0.56) corresponded to the patient considering their state acceptable. No significant associations existed between either the raw NPRS or the raw QuickDASH, and the RoR scores although percentage change scores were associated with the RoR (QuickDASH r=0.29; p=0.02; NPRS = r=0.30; p=0.02). Patients reporting greater than or equal to 87% on RoR are likely to have met the Patient Acceptable Symptom State. Although statistically significant, the lack of strong association between RoR and change scores for the NPRS and QuickDASH suggests that the measures capture different constructs. Level 2C.

  5. Prediction of post-buckling strength of stiffened laminated composite panels based on the criterion of mixed-mode stress intensity factors

    Science.gov (United States)

    Chow, W. T.; Atluri, S. N.

    1996-07-01

    An analytical investigation is conducted to predict the post-buckling strength of laminated composite stiffened panels under compressive loads. When a stiffened composite panel buckles, the skin would deform into a sinusoidal mode shape, and hence induces additional moments and forces near the skin-stiffener interface region. These induced loads would cause the existing small edge delamination cracks to propagate along the skin-stiffener interface, and this in turn would lead to the global failure of the stiffened panel. To reduce the cost of the analytical investigation, the failure of the stiffened panel under post-buckling loads is modeled in two stages: a global analysis to model the post-buckling behavior of the stiffened panel; and a local analysis to model the onset of propagation of the edge delamination crack at the skin-stiffener interface. The results from this study are compared with an experimental investigation conducted by Starnes, Knight, and Rouse (1987). It is found that for the eight different specimens that are considered in this study, the calculated critical energy release rate for the propagation of the edge delamination crack in each specimen differs substantially from those for the others; hence it may be concluded that the total energy release rate would not be a suitable fracture parameter for predicting the post-buckling strength of the stiffened panels. On the other hand, using the fracture criterion based on the critical mixed-mode stress intensity factors, the predicted post-buckling strength of the stiffened panels compares quite favorably with the experimental results and the standard deviation of the error of prediction is less than 10%. Furthermore, by applying the criterion of critical mixed-mode stress intensity factors on a simple damage model, the present analysis is able to predict the significant reduction in the post-buckling strenght of stiffened panels with a damage due to a low-speed impact at the skin

  6. Predicting the dynamic fracture of steel via a non-local strain-energy density failure criterion.

    Science.gov (United States)

    2014-06-01

    Predicting the onset of fracture in a material subjected to dynamic loading conditions has typically been heavily mesh-dependent, and often must be specifically calibrated for each geometric design. This can lead to costly models and even : costlier ...

  7. Manual unloading of the lumbar spine: can it identify immediate responders to mechanical traction in a low back pain population? A study of reliability and criterion referenced predictive validity.

    Science.gov (United States)

    Swanson, Brian T; Riley, Sean P; Cote, Mark P; Leger, Robin R; Moss, Isaac L; Carlos, John

    2016-05-01

    To date, no research has examined the reliability or predictive validity of manual unloading tests of the lumbar spine to identify potential responders to lumbar mechanical traction. To determine: (1) the intra and inter-rater reliability of a manual unloading test of the lumbar spine and (2) the criterion referenced predictive validity for the manual unloading test. Ten volunteers with low back pain (LBP) underwent a manual unloading test to establish reliability. In a separate procedure, 30 consecutive patients with LBP (age 50·86±11·51) were assessed for pain in their most provocative standing position (visual analog scale (VAS) 49·53±25·52 mm). Patients were assessed with a manual unloading test in their most provocative position followed by a single application of intermittent mechanical traction. Post traction, pain in the provocative position was reassessed and utilized as the outcome criterion. The test of unloading demonstrated substantial intra and inter-rater reliability K = 1·00, P = 0·002, K = 0·737, P = 0·001, respectively. There were statistically significant within group differences for pain response following traction for patients with a positive manual unloading test (P0·05). There were significant between group differences for proportion of responders to traction based on manual unloading response (P = 0·031), and manual unloading response demonstrated a moderate to strong relationship with traction response Phi = 0·443, P = 0·015. The manual unloading test appears to be a reliable test and has a moderate to strong correlation with pain relief that exceeds minimal clinically important difference (MCID) following traction supporting the validity of this test.

  8. A Fisher’s Criterion-Based Linear Discriminant Analysis for Predicting the Critical Values of Coal and Gas Outbursts Using the Initial Gas Flow in a Borehole

    Directory of Open Access Journals (Sweden)

    Xiaowei Li

    2017-01-01

    Full Text Available The risk of coal and gas outbursts can be predicted using a method that is linear and continuous and based on the initial gas flow in the borehole (IGFB; this method is significantly superior to the traditional point prediction method. Acquiring accurate critical values is the key to ensuring accurate predictions. Based on ideal rock cross-cut coal uncovering model, the IGFB measurement device was developed. The present study measured the data of the initial gas flow over 3 min in a 1 m long borehole with a diameter of 42 mm in the laboratory. A total of 48 sets of data were obtained. These data were fuzzy and chaotic. Fisher’s discrimination method was able to transform these spatial data, which were multidimensional due to the factors influencing the IGFB, into a one-dimensional function and determine its critical value. Then, by processing the data into a normal distribution, the critical values of the outbursts were analyzed using linear discriminant analysis with Fisher’s criterion. The weak and strong outbursts had critical values of 36.63 L and 80.85 L, respectively, and the accuracy of the back-discriminant analysis for the weak and strong outbursts was 94.74% and 92.86%, respectively. Eight outburst tests were simulated in the laboratory, the reverse verification accuracy was 100%, and the accuracy of the critical value was verified.

  9. The Utilization of Gleason Grade as the Primary Criterion for Ordering Nuclear Bone Scan in Newly Diagnosed Prostate Cancer Patients

    Directory of Open Access Journals (Sweden)

    Chad W. M. Ritenour

    2009-01-01

    Full Text Available Utilization of nuclear bone scans for staging newly diagnosed prostate cancer has decreased dramatically due to PSA-driven stage migration. The current criteria for performing bone scans are based on limited historical data. This study evaluates serum PSA and Gleason grade in predicting positive scans in a contemporary large series of newly diagnosed prostate cancer patients. Eight hundred consecutive cases of newly diagnosed prostate cancer over a 64-month period underwent a staging nuclear scan. All subjects had histologically confirmed cancer. The relationship between PSA, Gleason grade, and bone scan was examined by calculating series of crude, stratified, and adjusted odds ratios with corresponding 95% confidence intervals. Four percent (32/800 of all bone scans were positive. This proportion was significantly lower in patients with Gleason score ≤7 (1.9% vs. Gleason score ≥8 (18.8%, p 30 ng/ml compared to ≤30 ng/ml (p 10 ng/ml compared to ≤10 ng/ml (p = 0.002. The combination of Gleason score and PSA enhances predictability of bone scans in newly diagnosed prostate cancer patients. The PSA threshold for ordering bone scans should be adjusted according to Gleason score. For patients with Gleason scores ≤7, we recommend a bone scan if the PSA is >30 ng/ml. However, for patients with a high Gleason score (8–10, we recommend a bone scan if the PSA is >10 ng/ml.

  10. Decreasing the minimum length criterion for an episode of hypomania: evaluation using self-reported data from patients with bipolar disorder.

    Science.gov (United States)

    Bauer, Michael; Glenn, Tasha; Rasgon, Natalie; Marsh, Wendy; Sagduyu, Kemal; Grof, Paul; Alda, Martin; Murray, Greg; Munoz, Rodrigo; Quiroz, Danilo; Bauer, Rita; Jabs, Burkhard; Whybrow, Peter C

    2011-08-01

    Brief hypomania lasting less than 4 days may impair functioning and help to detect bipolarity. This study analyzed brief hypomania that occurred in patients with bipolar disorder who were diagnosed according to the DSM-IV criteria. Daily self-reported mood ratings were obtained from 393 patients (247 bipolar I and 146 bipolar II) for 6 months (75,284 days of data, mean 191.6 days). Episodes of hypomania were calculated using a 4, 3, 2, and single day length criterion. Brief hypomania occurred frequently. With a decrease in the minimum criterion from 4 days to 2 days, there were almost twice as many patients with an episode of hypomania (102 vs. 190), and more than twice as many episodes (305 vs. 863). Single days of hypomania were experienced by 271 (69%) of the sample. With a 2-day episode length, 33% of all hypomania remained outside of an episode. There was no significant difference in the percent of hypomanic days outside of an episode between patients with bipolar I and II disorders. There were no significant differences in the demographic characteristics of patients who met the 4-day minimum as compared with those who only experienced episodes of hypomania using a shortened length criterion. Decreasing the minimum length criterion for an episode of hypomania will cause a large increase in the number of patients who experience an episode and in the aggregate number of episodes, but will not distinguish subgroups within a sample who meet the DSM-IV criteria for bipolar disorder. Frequency may be an important dimensional aspect of brief hypomania. Clinicians should regularly probe for brief hypomania.

  11. The A-test: Assessment of functional recovery during early rehabilitation of patients in an orthopedic ward - content, criterion and construct validity

    Directory of Open Access Journals (Sweden)

    Vukomanović Aleksandra

    2014-01-01

    Full Text Available Background/Aim. The A-test was designed for assessment of functional recovery during early rehabilitation of patients in an orthopedic ward. This performance-based test consists of 10 items for assessing basic activities by a six level ordinal scale (0-5. Total scores can range from 0 to 50, i.e. from inability to perform any activity despite the help of therapists to complete independence and safety in performing all activities. The aim of this study was to examine the A-test validity. Methods. This prospective study was conducted in an orthopedic ward and included 120 patients [60 patients with hip osteoarthritis that underwent arthroplasty and 60 surgically treated patients with hip fracture (HF] during early inpatient rehabilitation (1st-5th day. Validity was examined through 3 aspects: content validity - floor and ceiling effect, range, skewness; criterion validity - concurrent validity [correlation with the University of Iowa Level of Assistance Scale (ILAS for patients with hip osteoarthritis, and with the Cumulated Ambulation Score (CAS for patients with HF, Spearman rank correlation] and predictive validity [the New Mobility Score (NMS 4 weeks after surgery, Mann-Whitney U test]; construct validity - 4 hypotheses: 1 on the fifth day of rehabilitation in patients underwent arthroplasty due to hip osteoarthritis, the A-test results will strongly correlate with those of ILAS, while the correlation with the Harris hip score will be less strong; 2 in patients with HF, the A-test results will be significantly better in those with allowed weight bearing as compared to patients whom weight bearing is not allowed while walking; 3 results of the A-test will be significantly better in patients with hip osetoarthritis than in those with HF; 4 the A-test results will be significantly better in patients younger than 65 years than in those aged 65 years and older. Results. The obtained results were: low floor (1% and ceiling (2% effect, range 0

  12. Communicating the results of criterion referenced prediction measures: Risk categories for the Static-99R and Static-2002R sexual offender risk assessment tools.

    Science.gov (United States)

    Hanson, R Karl; Babchishin, Kelly M; Helmus, L Maaike; Thornton, David; Phenix, Amy

    2017-05-01

    This article describes principles for developing risk category labels for criterion referenced prediction measures, and demonstrates their utility by creating new risk categories for the Static-99R and Static-2002R sexual offender risk assessment tools. Currently, risk assessments in corrections and forensic mental health are typically summarized in 1 of 3 words: low, moderate, or high. Although these risk labels have strong influence on decision makers, they are interpreted differently across settings, even among trained professionals. The current article provides a framework for standardizing risk communication by matching (a) the information contained in risk tools to (b) a broadly applicable classification of "riskiness" that is independent of any particular offender risk scale. We found that the new, common STATIC risk categories not only increase concordance of risk classification (from 51% to 72%)-they also allow evaluators to make the same inferences for offenders in the same category regardless of which instrument was used to assign category membership. More generally, we argue that the risk categories should be linked to the decisions at hand, and that risk communication can be improved by grounding these risk categories in evidence-based definitions. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  13. Criterion for surface contact deformation of metals

    NARCIS (Netherlands)

    Jamari, Jamari; Schipper, Dirk J.

    2007-01-01

    In most engineering applications, bulk plastic deformation of the surface is avoided. There is, however, no criterion for determining whether or not bulk plastic deformation occurs during the contact between rough surfaces. This paper presents a criterion for predicting the deformation behaviour of

  14. Ginzburg Criterion for Coulombic Criticality

    OpenAIRE

    Fisher, Michael E.; Lee, Benjamin P.

    1996-01-01

    To understand the range of close-to-classical critical behavior seen in various electrolytes, generalized Debye-Hueckel theories (that yield density correlation functions) are applied to the restricted primitive model of equisized hard spheres. The results yield a Landau-Ginzburg free-energy functional for which the Ginzburg criterion can be explicitly evaluated. The predicted scale of crossover from classical to Ising character is found to be similar in magnitude to that derived for simple f...

  15. Prediction of Fitness to Drive in Patients with Alzheimer's Dementia.

    Directory of Open Access Journals (Sweden)

    Dafne Piersma

    Full Text Available The number of patients with Alzheimer's disease (AD is increasing and so is the number of patients driving a car. To enable patients to retain their mobility while at the same time not endangering public safety, each patient should be assessed for fitness to drive. The aim of this study is to develop a method to assess fitness to drive in a clinical setting, using three types of assessments, i.e. clinical interviews, neuropsychological assessment and driving simulator rides. The goals are (1 to determine for each type of assessment which combination of measures is most predictive for on-road driving performance, (2 to compare the predictive value of clinical interviews, neuropsychological assessment and driving simulator evaluation and (3 to determine which combination of these assessments provides the best prediction of fitness to drive. Eighty-one patients with AD and 45 healthy individuals participated. All participated in a clinical interview, and were administered a neuropsychological test battery and a driving simulator ride (predictors. The criterion fitness to drive was determined in an on-road driving assessment by experts of the CBR Dutch driving test organisation according to their official protocol. The validity of the predictors to determine fitness to drive was explored by means of logistic regression analyses, discriminant function analyses, as well as receiver operating curve analyses. We found that all three types of assessments are predictive of on-road driving performance. Neuropsychological assessment had the highest classification accuracy followed by driving simulator rides and clinical interviews. However, combining all three types of assessments yielded the best prediction for fitness to drive in patients with AD with an overall accuracy of 92.7%, which makes this method highly valid for assessing fitness to drive in AD. This method may be used to advise patients with AD and their family members about fitness to drive.

  16. Intra- and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions.

    Science.gov (United States)

    Brosseau, L; Balmer, S; Tousignant, M; O'Sullivan, J P; Goudreault, C; Goudreault, M; Gringras, S

    2001-03-01

    To examine the intra- and intertester reliability of the universal goniometer (UG) and parallelogram goniometer (PG), and to assess the criterion validity of the same instruments on subjects with knee restrictions. Reliability and validation study. Radiology department at university hospital. Sixty subjects (34 men, 26 women; mean age, 52yr) with various knee restrictions. Sixteen goniometric measurements were collected per patient by 2 physical therapists. Subjects were evaluated in knee flexion and knee extension positions. To serve as a gold standard, radiographs were taken in both positions. Active knee flexion and knee extension on 2 goniometers, radiographs. Maximum active range of motion (AROM). The UG intratester reliability (intraclass correlation coefficients [ICCs]) was .997 in flexion and .972 to .985 in extension. The results were also high with the PG (ICC =.996,.953-.955) for flexion and extension, respectively. The intertester reliability was high for flexion (ICC =.977-.982) and for extension (ICC =.893-.926) when using the UG. For the PG, ICC results ranged from .959 to .970 for flexion and from .856 to .898 for extension. Criterion validity (r) varied from .975 to .987 for flexion and from .390 to .442 for extension with the UG, and from .976 to .985 for flexion and .423 to .514 for extension with the PG. Intra- and intertester reliability were high for both goniometers. The results for the criterion validity varied. Our study also revealed that it is preferable to use goniometry rather than visual estimations when measuring AROM. It is recommended that the same therapist take all the measurements when assessing AROM for UG and PG goniometric measurements on patients with knee restrictions.

  17. Development of a Microsoft Excel tool for applying a factor retention criterion of a dimension coefficient to a survey on patient safety culture.

    Science.gov (United States)

    Chien, Tsair-Wei; Shao, Yang; Jen, Dong-Hui

    2017-10-27

    Many quality-of-life studies have been conducted in healthcare settings, but few have used Microsoft Excel to incorporate Cronbach's α with dimension coefficient (DC) for describing a scale's characteristics. To present a computer module that can report a scale's validity, we manipulated datasets to verify a DC that can be used as a factor retention criterion for demonstrating its usefulness in a patient safety culture survey (PSC). Microsoft Excel Visual Basic for Applications was used to design a computer module for simulating 2000 datasets fitting the Rasch rating scale model. The datasets consisted of (i) five dual correlation coefficients (correl. = 0.3, 0.5, 0.7, 0.9, and 1.0) on two latent traits (i.e., true scores) following a normal distribution and responses to their respective 1/3 and 2/3 items in length; (ii) 20 scenarios of item lengths from 5 to 100; and (iii) 20 sample sizes from 50 to 1000. Each item containing 5-point polytomous responses was uniformly distributed in difficulty across a ± 2 logit range. Three methods (i.e., dimension interrelation ≥0.7, Horn's parallel analysis (PA) 95% confidence interval, and individual random eigenvalues) were used for determining one factor to retain. DC refers to the binary classification (1 as one factor and 0 as many factors) used for examining accuracy with the indicators sensitivity, specificity, and area under receiver operating characteristic curve (AUC). The scale's reliability and DC were simultaneously calculated for each simulative dataset. PSC real data were demonstrated with DC to interpret reports of the unit-based construct validity using the author-made MS Excel module. The DC method presented accurate sensitivity (=0.96), specificity (=0.92) with a DC criterion (≥0.70), and AUC (=0.98) that were higher than those of the two PA methods. PA combined with DC yielded good sensitivity (=0.96), specificity (=1.0) with a DC criterion (≥0.70), and AUC (=0.99). Advances in computer

  18. An empirical Kaiser criterion.

    Science.gov (United States)

    Braeken, Johan; van Assen, Marcel A L M

    2017-09-01

    In exploratory factor analysis (EFA), most popular methods for dimensionality assessment such as the screeplot, the Kaiser criterion, or-the current gold standard-parallel analysis, are based on eigenvalues of the correlation matrix. To further understanding and development of factor retention methods, results on population and sample eigenvalue distributions are introduced based on random matrix theory and Monte Carlo simulations. These results are used to develop a new factor retention method, the Empirical Kaiser Criterion. The performance of the Empirical Kaiser Criterion and parallel analysis is examined in typical research settings, with multiple scales that are desired to be relatively short, but still reliable. Theoretical and simulation results illustrate that the new Empirical Kaiser Criterion performs as well as parallel analysis in typical research settings with uncorrelated scales, but much better when scales are both correlated and short. We conclude that the Empirical Kaiser Criterion is a powerful and promising factor retention method, because it is based on distribution theory of eigenvalues, shows good performance, is easily visualized and computed, and is useful for power analysis and sample size planning for EFA. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  19. Age, criterion flexibility, and item recognition.

    Science.gov (United States)

    North, Lione J; Olfman, Darlene; Caldera, Daniel R; Munoz, Emily; Light, Leah L

    2017-04-26

    We examined young and older adults' ability to flexibly adapt response criterion on a recognition test when the probability that a test item had been studied was cued by test color. One word color signaled that the probability of the test item being old was 70% and a second color signaled that the probability of the test item being new was 70%. Young and older adults demonstrated similar levels of criterion shifting in response to color cues. Moreover, although both young and older adults were slowed when test-item color incorrectly predicted test-item status, the extent of slowing did not differ across age group. Putative measures of cognitive control predicted recognition accuracy but not the degree to which criterion changed with test-item color. These results suggest that adaptive criterion shifting does not tax cognitive control or, if it does require effort, may be no more onerous for older than for young adults.

  20. Prediction ofamikacin dose requiretnents in neutropenic patients ...

    African Journals Online (AJOL)

    Prediction ofamikacin dose requiretnents in neutropenic patients with haetnatological disease. C. S. ZENT, R. ALLIN, P. I. FOLB. Abstract This study reports on the use of an easily applied. Bayesian forecasting ptogranune (OPT; Clyde- soft) to predict atnikacin dose requirements in 10 patients with haematological disease ...

  1. Ginzburg Criterion for Coulombic Criticality

    Science.gov (United States)

    Fisher, Michael E.; Lee, Benjamin P.

    1996-10-01

    To understand the range of close-to-classical critical behavior seen in various electrolytes, generalized Debye-Hückel theories (that yield density correlation functions) are applied to the restricted primitive model of equisized hard spheres. The results yield a Landau-Ginzburg free-energy functional for which the Ginzburg criterion can be explicitly evaluated. The predicted scale of crossover from classical to Ising character is found to be similar in magnitude to that derived for simple fluids in comparable fashion. The consequences in relation to experiments are discussed briefly.

  2. An Empirical Kaiser Criterion.

    NARCIS (Netherlands)

    Braeken, Johan; Van Assen, Marcel A. L. M.

    2016-01-01

    In exploratory factor analysis (EFA), most popular methods for dimensionality assessment such as the screeplot, the Kaiser criterion, or—the current gold standard—parallel analysis, are based on eigenvalues of the correlation matrix. To further understanding and development of factor retention

  3. Early Surgery Does Not Seem to Be a Pivotal Criterion to Improve Prognosis in Patients with Frontal Depressed Skull Fractures

    Directory of Open Access Journals (Sweden)

    Iuri Santana Neville

    2014-01-01

    Full Text Available Introduction. There has been much debate about the ideal timing of surgery of frontal depressed skull fractures (DSF. In this paper, we assess whether timing of surgery may have influenced outcome. Methods. Retrospective cohort of 40 consecutive patients with frontal DSF who underwent surgical treatment over a 36-month period. The patients were divided into early surgery group (ESG which were operated within 24 h and delayed surgery group (DSG. Results. The population comprised 39 (97.50% men and the mean age was 27.9 years (range, 2–81 yr. There was no difference of age (P=0.53, gender male (P=1.00, presence of focal lesion on head CT (P=0.89, hypotension (P=0.28, and hypoxia (P=0.15. Mean Glasgow Coma Scale (GCS was significantly lower in patients of ESG than DSG (8.75 and 11.7, resp., P=0.02. There was no difference between the groups in relation to death (P=0.13, unfavourable outcome (P=0.41, late posttraumatic epilepsy (P=0.64, and smell-and-taste disturbances (P=1.00. Only one patient (3.5% evolved meningitis during follow-up. Conclusion. We found no difference between the ESG and DSG in respect to death, unfavourable outcome, LPE, and STD.

  4. Anxiety Predicts Mortality in ICD Patients

    DEFF Research Database (Denmark)

    Kikkenborg Berg, Selina; Caspar Thygesen, Lau; Hastrup Svendsen, Jesper

    2014-01-01

    BACKGROUND: Although highly effective in preventing arrhythmic death, patients receiving an implantable cardioverter defibrillator (ICD) may still experience psychological difficulties such as anxiety, depression, and reduced quality of life. The objectives of this study were to describe patient......-reported outcomes among ICD patients: (1) compared to a matched healthy population, (2) compared by ICD indication, (3) factors predicting patient-reported outcomes, and (4) if patient-reported outcomes predicted mortality. METHODS: The study was a mailed survey to an unselected group of patients 18+ years old...... receiving ICD between January 1, 2011 and June 30, 2011 (n = 499). The following instruments were used: SF-36, Hospital Anxiety and Depression Scale, HeartQoL, EQ-5D, and the Multidimensional Fatigue Inventory. RESULTS: The response rate was 72%. Mean age was 65.5 years and 82% patients were males. Fifty...

  5. Criterion validity and inter-rater reliability of a palliative care screening tool for patients admitted to an emergency department intensive care unit.

    Science.gov (United States)

    Corrêa da Costa Ribeiro, Sabrina; Tavares de Carvalho, Ricardo; Aparecida Rocha, Juraci; Daglius Dias, Roger

    2017-12-26

    The use of palliative care (PC) screening criteria to trigger PC consultations may optimize the utilization of PC services, improve patient comfort, and reduce invasive and futile end-of-life care. The aim of the present study was to assess the criterion validity and inter-rater reliability of a PC screening tool for patients admitted to an emergency department intensive care unit (ED-ICU). Observational retrospective study evaluating PC screening criteria based on the presence of advanced diagnosis and the use of two "surprise questions" (traditional and modified). Patients were classified at ED-ICU admission in four categories according to the proposed algorithm. Result A total of 510 patients were included in the analysis. From these, 337 (66.1%) were category 1, 0 (0.0%) category 2, 63 (12.4%) category 3, and 110 (21.6%) category 4. Severity of illness (Simplified Acute Physiology Score III score and mechanical ventilation), mortality (ED-ICU and intrahospital), and PC-related measures (order for a PC consultation, time between admission and PC consultation, and transfer to a PC bed) were significantly different across groups, more evidently between categories 4 and 1. Category 3 patients presented similar outcomes to patients in category 1 for severity of illness and mortality. However, category 3 patients had a PC consultation ordered more frequently than did category 1 patients. The screening criteria were assessed by two independent raters (n = 100), and a substantial interrater reliability was found, with 80% of agreement and a kappa coefficient of 0.75 (95% confidence interval = 0.62, 0.88). Significance of results This study is the first step toward the implementation of a PC screening tool in the ED-ICU. The tool was able to discriminate three groups of patients within a spectrum of increasing severity of illness, risk of death, and PC needs, presenting substantial inter-rater reliability. Future research should investigate the implementation of these

  6. General Criterion for Harmonicity

    Science.gov (United States)

    Proesmans, Karel; Vandebroek, Hans; Van den Broeck, Christian

    2017-10-01

    Inspired by Kubo-Anderson Markov processes, we introduce a new class of transfer matrices whose largest eigenvalue is determined by a simple explicit algebraic equation. Applications include the free energy calculation for various equilibrium systems and a general criterion for perfect harmonicity, i.e., a free energy that is exactly quadratic in the external field. As an illustration, we construct a "perfect spring," namely, a polymer with non-Gaussian, exponentially distributed subunits which, nevertheless, remains harmonic until it is fully stretched. This surprising discovery is confirmed by Monte Carlo and Langevin simulations.

  7. Probabilistic Threshold Criterion

    Energy Technology Data Exchange (ETDEWEB)

    Gresshoff, M; Hrousis, C A

    2010-03-09

    The Probabilistic Shock Threshold Criterion (PSTC) Project at LLNL develops phenomenological criteria for estimating safety or performance margin on high explosive (HE) initiation in the shock initiation regime, creating tools for safety assessment and design of initiation systems and HE trains in general. Until recently, there has been little foundation for probabilistic assessment of HE initiation scenarios. This work attempts to use probabilistic information that is available from both historic and ongoing tests to develop a basis for such assessment. Current PSTC approaches start with the functional form of the James Initiation Criterion as a backbone, and generalize to include varying areas of initiation and provide a probabilistic response based on test data for 1.8 g/cc (Ultrafine) 1,3,5-triamino-2,4,6-trinitrobenzene (TATB) and LX-17 (92.5% TATB, 7.5% Kel-F 800 binder). Application of the PSTC methodology is presented investigating the safety and performance of a flying plate detonator and the margin of an Ultrafine TATB booster initiating LX-17.

  8. Using the Existential Criterion for Assessing the Personality of Overprotective and Overly Demanding Parents in the Families of Patients Who Have Sought Psychological Counseling for Parent-Child Problems

    Science.gov (United States)

    Kapustin, S. A.

    2016-01-01

    The article presents the results of applying the existential criterion of normal and abnormal personalities for assessing the personality of overprotective and overly demanding parents in 176 families of patients who have sought psychological counseling. It is shown that the position of overprotective parents is one-sided in relation to the…

  9. Predicting healthcare associated infections using patients' experiences

    Science.gov (United States)

    Pratt, Michael A.; Chu, Henry

    2016-05-01

    Healthcare associated infections (HAI) are a major threat to patient safety and are costly to health systems. Our goal is to predict the HAI performance of a hospital using the patients' experience responses as input. We use four classifiers, viz. random forest, naive Bayes, artificial feedforward neural networks, and the support vector machine, to perform the prediction of six types of HAI. The six types include blood stream, urinary tract, surgical site, and intestinal infections. Experiments show that the random forest and support vector machine perform well across the six types of HAI.

  10. Postural balance in low back pain patients: criterion-related validity of centre of pressure assessed on a portable force platform.

    Science.gov (United States)

    Maribo, Thomas; Schiøttz-Christensen, Berit; Jensen, Lone Donbæk; Andersen, Niels Trolle; Stengaard-Pedersen, Kristian

    2012-03-01

    Altered postural control has been observed in low back pain (LBP) patients. They seem to be more dependent on vision when standing. The objective of the study was to determine concurrent and predictive validity of measures of postural stability in LBP patients. Centre of Pressure (CoP) measurements were tested against pain, fear of pain, and physical function. Velocity, anterior-posterior displacement, and the Romberg Ratio obtained on a portable force platform were used as measures of postural stability. Baseline and 12-week follow-up results of 97 LBP patients were evaluated. The correlations between CoP measurements and pain, fear of pain, and physical function were poor. There were no significant differences in CoP measurements between patients with no change or deterioration and patients with improvement in pain and back-specific function. This first study of concurrent and predictive validity of postural balance in LBP patients revealed no association between CoP measures and pain, fear of pain, and physical function.

  11. Relative stability of DNA as a generic criterion for promoter prediction: whole genome annotation of microbial genomes with varying nucleotide base composition.

    Science.gov (United States)

    Rangannan, Vetriselvi; Bansal, Manju

    2009-12-01

    The rapid increase in genome sequence information has necessitated the annotation of their functional elements, particularly those occurring in the non-coding regions, in the genomic context. Promoter region is the key regulatory region, which enables the gene to be transcribed or repressed, but it is difficult to determine experimentally. Hence an in silico identification of promoters is crucial in order to guide experimental work and to pin point the key region that controls the transcription initiation of a gene. In this analysis, we demonstrate that while the promoter regions are in general less stable than the flanking regions, their average free energy varies depending on the GC composition of the flanking genomic sequence. We have therefore obtained a set of free energy threshold values, for genomic DNA with varying GC content and used them as generic criteria for predicting promoter regions in several microbial genomes, using an in-house developed tool PromPredict. On applying it to predict promoter regions corresponding to the 1144 and 612 experimentally validated TSSs in E. coli (50.8% GC) and B. subtilis (43.5% GC) sensitivity of 99% and 95% and precision values of 58% and 60%, respectively, were achieved. For the limited data set of 81 TSSs available for M. tuberculosis (65.6% GC) a sensitivity of 100% and precision of 49% was obtained.

  12. Criterion-Referenced Measurement: Half a Century Wasted?

    Science.gov (United States)

    Popham, W. James

    2014-01-01

    Fifty years ago, Robert Glaser introduced the concept of criterion-referenced measurement in an article in American Psychologist. Its early proponents predicted that this measurement strategy would revolutionize education. But has it lived up to its promise? W. James Popham explores this question by looking at the history of criterion-referenced…

  13. The criterion-related validity of the Northwick Park Dependency Score as a generic nursing dependency instrument for different rehabilitation patient groups

    NARCIS (Netherlands)

    Plantinga, E.; Tiesinga, L. J.; van der Schans, C. P.; Middel, B.

    2006-01-01

    Objective: To investigate the criterion or concurrent validity of the Northwick Park Dependency Score (NPDS) for determining nursing dependence in different rehabilitation groups, with the Barthel Index (BI) and the Care Dependency Scale (C D S). Design: Cross-sectional study. Setting: Centre for

  14. Cerebrovascular insufficiency as the criterion for revascularization procedures in selected patients: a correlation study of xenon contrast-enhanced CT and PWI.

    Science.gov (United States)

    Schubert, Gerrit Alexander; Weinmann, Carolin; Seiz, Marcel; Gerigk, Lars; Weiss, Christel; Horn, Peter; Thomé, Claudius

    2009-01-01

    In order to identify patients who suffer from hemodynamic cerebral insufficiency and can benefit from cerebral revascularization procedures, xenon-CT scanning has been established to reliably measure the critical cerebrovascular reserve capacity. As a need for alternative quantification methods arises, this study aims to characterize the significance of both time-to-peak (TTP) and mean transit time (MTT) in perfusion-weighted imaging (PWI) in this particular subset of patients. Ten patients in routine preoperative work-up for cerebral revascularization were prospectively enrolled and underwent both XeCT scanning and PWI. Cerebrovascular reserve capacity (CVRC) was calculated for each region of interest (ROI, n = 504) after administration of a vasoactive stimulus. ROIs were anatomically matched with those of PWI after TTP and MTT were calculated. Highly significant negative correlation was found for TTP and CVRC for all ROIs (r = -0.3954, p 4.4 s for symptomatic ROIs, specificity 88.4%, sensitivity 62.7%). An approximative equation to calculate the probability of pathological findings could be derived from the data. The positive predictive value (PPV) was 0.76 (symptomatic 0.78) with a negative predictive value (NPV) of 0.71 (symptomatic 0.78). While PWI currently is not able to replace XeCT in the direct quantification of CVRC, it may serve as a readily available follow-up tool. A TTP threshold of greater than 4 s allows to confirm a cerebrovascular compromise in a selected high-risk subgroup of patients.

  15. Copeptin Predicts Mortality in Critically Ill Patients.

    Science.gov (United States)

    Krychtiuk, Konstantin A; Honeder, Maria C; Lenz, Max; Maurer, Gerald; Wojta, Johann; Heinz, Gottfried; Huber, Kurt; Speidl, Walter S

    2017-01-01

    Critically ill patients admitted to a medical intensive care unit exhibit a high mortality rate irrespective of the cause of admission. Besides its role in fluid and electrolyte balance, vasopressin has been described as a stress hormone. Copeptin, the C-terminal portion of provasopressin mirrors vasopressin levels and has been described as a reliable biomarker for the individual's stress level and was associated with outcome in various disease entities. The aim of this study was to analyze whether circulating levels of copeptin at ICU admission are associated with 30-day mortality. In this single-center prospective observational study including 225 consecutive patients admitted to a tertiary medical ICU at a university hospital, blood was taken at ICU admission and copeptin levels were measured using a commercially available automated sandwich immunofluorescent assay. Median acute physiology and chronic health evaluation II score was 20 and 30-day mortality was 25%. Median copeptin admission levels were significantly higher in non-survivors as compared with survivors (77.6 IQR 30.7-179.3 pmol/L versus 45.6 IQR 19.6-109.6 pmol/L; p = 0.025). Patients with serum levels of copeptin in the third tertile at admission had a 2.4-fold (95% CI 1.2-4.6; p = 0.01) increased mortality risk as compared to patients in the first tertile. When analyzing patients according to cause of admission, copeptin was only predictive of 30-day mortality in patients admitted due to medical causes as opposed to those admitted after cardiac surgery, as medical patients with levels of copeptin in the highest tertile had a 3.3-fold (95% CI 1.66.8, p = 0.002) risk of dying independent from APACHE II score, primary diagnosis, vasopressor use and need for mechanical ventilation. Circulating levels of copeptin at ICU admission independently predict 30-day mortality in patients admitted to a medical ICU.

  16. Numerical and Experimental Validation of a New Damage Initiation Criterion

    Science.gov (United States)

    Sadhinoch, M.; Atzema, E. H.; Perdahcioglu, E. S.; van den Boogaard, A. H.

    2017-09-01

    Most commercial finite element software packages, like Abaqus, have a built-in coupled damage model where a damage evolution needs to be defined in terms of a single fracture energy value for all stress states. The Johnson-Cook criterion has been modified to be Lode parameter dependent and this Modified Johnson-Cook (MJC) criterion is used as a Damage Initiation Surface (DIS) in combination with the built-in Abaqus ductile damage model. An exponential damage evolution law has been used with a single fracture energy value. Ultimately, the simulated force-displacement curves are compared with experiments to validate the MJC criterion. 7 out of 9 fracture experiments were predicted accurately. The limitations and accuracy of the failure predictions of the newly developed damage initiation criterion will be discussed shortly.

  17. A Failure Criterion for Concrete

    DEFF Research Database (Denmark)

    Ottosen, N. S.

    1977-01-01

    A four-parameter failure criterion containing all the three stress invariants explicitly is proposed for short-time loading of concrete. It corresponds to a smooth convex failure surface with curved meridians, which open in the negative direction of the hydrostatic axis, and the trace in the devi......A four-parameter failure criterion containing all the three stress invariants explicitly is proposed for short-time loading of concrete. It corresponds to a smooth convex failure surface with curved meridians, which open in the negative direction of the hydrostatic axis, and the trace...

  18. Predictability of Sleep in Patients with Insomnia

    Science.gov (United States)

    Vallières, Annie; Ivers, Hans; Beaulieu-Bonneau, Simon; Morin, Charles M.

    2011-01-01

    Study Objectives: To evaluate whether the night-to-night variability in insomnia follows specific predictable patterns and to characterize sleep patterns using objective sleep and clinical variables. Design: Prospective observational study. Setting: University-affiliated sleep disorders center. Participants: 146 participants suffering from chronic and primary insomnia. Measurements and Results: Daily sleep diaries were completed for an average of 48 days and self-reported questionnaires once. Three nights were spent in the sleep laboratory for polysomnographic (PSG) assessment. Sleep efficiency, sleep onset latency, wake after sleep onset, and total sleep time were derived from sleep diaries and PSG. Time-series diary data were used to compute conditional probabilities of having an insomnia night after 1, 2, or 3 consecutive insomnia night(s). Conditional probabilities were submitted to a k-means cluster analysis. A 3-cluster solution was retained. One cluster included 38 participants exhibiting an unpredictable insomnia pattern. Another included 30 participants with a low and decreasing probability to have an insomnia night. The last cluster included 49 participants exhibiting a high probability to have insomnia every night. Clusters differed on age, insomnia severity, and mental fatigue, and on subjective sleep variables, but not on PSG sleep variables. Conclusion: These findings replicate our previous study and provide additional evidence that unpredictability is a less prevalent feature of insomnia than suggested previously in the literature. The presence of the 3 clusters is discussed in term of sleep perception and sleep homeostasis dysregulation. Citation: Vallières A; Ivers H; Beaulieu-Bonneau S; Morin CM. Predictability of sleep in patients with insomnia. SLEEP 2011;34(5):609-617. PMID:21532954

  19. Distance criterion for hydrogen bond

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Distance criterion for hydrogen bond. In a D-H ...A contact, the D...A distance must be less than the sum of van der Waals Radii of the D and A atoms, for it to be a hydrogen bond.

  20. Fatigue criterion to system design, life and reliability

    Science.gov (United States)

    Zaretsky, E. V.

    1985-01-01

    A generalized methodology to structural life prediction, design, and reliability based upon a fatigue criterion is advanced. The life prediction methodology is based in part on work of W. Weibull and G. Lundberg and A. Palmgren. The approach incorporates the computed life of elemental stress volumes of a complex machine element to predict system life. The results of coupon fatigue testing can be incorporated into the analysis allowing for life prediction and component or structural renewal rates with reasonable statistical certainty.

  1. A modified failure criterion for transversely isotropic rocks

    Directory of Open Access Journals (Sweden)

    Omid Saeidi

    2014-03-01

    Full Text Available A modified failure criterion is proposed to determine the strength of transversely isotropic rocks. Mechanical properties of some metamorphic and sedimentary rocks including gneiss, slate, marble, schist, shale, sandstone and limestone, which show transversely isotropic behavior, were taken into consideration. Afterward, introduced triaxial rock strength criterion was modified for transversely isotropic rocks. Through modification process an index was obtained that can be considered as a strength reduction parameter due to rock strength anisotropy. Comparison of the parameter with previous anisotropy indexes in literature showed reasonable results for the studied rock samples. The modified criterion was compared to modified Hoek-Brown and Ramamurthy criteria for different transversely isotropic rocks. It can be concluded that the modified failure criterion proposed in this study can be used for predicting the strength of transversely isotropic rocks.

  2. Estimating the brain pathological age of Alzheimer’s disease patients from MR image data based on the separability distance criterion

    Science.gov (United States)

    Li, Yongming; Li, Fan; Wang, Pin; Zhu, Xueru; Liu, Shujun; Qiu, Mingguo; Zhang, Jingna; Zeng, Xiaoping

    2016-10-01

    Traditional age estimation methods are based on the same idea that uses the real age as the training label. However, these methods ignore that there is a deviation between the real age and the brain age due to accelerated brain aging. This paper considers this deviation and searches for it by maximizing the separability distance value rather than by minimizing the difference between the estimated brain age and the real age. Firstly, set the search range of the deviation as the deviation candidates according to prior knowledge. Secondly, use the support vector regression (SVR) as the age estimation model to minimize the difference between the estimated age and the real age plus deviation rather than the real age itself. Thirdly, design the fitness function based on the separability distance criterion. Fourthly, conduct age estimation on the validation dataset using the trained age estimation model, put the estimated age into the fitness function, and obtain the fitness value of the deviation candidate. Fifthly, repeat the iteration until all the deviation candidates are involved and get the optimal deviation with maximum fitness values. The real age plus the optimal deviation is taken as the brain pathological age. The experimental results showed that the separability was apparently improved. For normal control-Alzheimer’s disease (NC-AD), normal control-mild cognition impairment (NC-MCI), and MCI-AD, the average improvements were 0.178 (35.11%), 0.033 (14.47%), and 0.017 (39.53%), respectively. For NC-MCI-AD, the average improvement was 0.2287 (64.22%). The estimated brain pathological age could be not only more helpful to the classification of AD but also more precisely reflect accelerated brain aging. In conclusion, this paper offers a new method for brain age estimation that can distinguish different states of AD and can better reflect the extent of accelerated aging.

  3. Intrinsic ductility criterion for interfaces in solids

    Science.gov (United States)

    Thomson, Robb

    1995-09-01

    This paper explores the cleavage vs blunting dislocation emission from a crack on an interface in a two-dimensional simple hexagonal lattice for a variety of nearest-neighbor central force laws, and compares the results with elastic predictions of the criteria couched in terms of the interfacial surface energy, γs, and the unstable stacking fault, γus. The mode conversion characteristic of interfacial cracks is interpreted in terms of a local phase at the core of the crack, with a cutoff at the force law range parameter. The results are that the emission criterion has two regimes. When γs>3γus the emission criterion is proportional to the product, γsγus, while when γsChemical embrittlement of a crack is a direct consequence of these results, and is discussed. It is shown, however, that the localized interactions associated with chemical effects at a crack tip are inherently too complex to be encompassed in simple criteria such as these, and that quantitative predictions for chemical effects will require more detailed considerations of the specific lattice and bonding configurations in hand. But these results should serve usefully as ``rule of thumb'' guides.

  4. Utility of the "Surprise" Question in Predicting Survival among Older Patients with Acute Surgical Conditions.

    Science.gov (United States)

    Lilley, Elizabeth J; Gemunden, Sean A; Kristo, Gentian; Changoor, Navin; Scott, John W; Rickerson, Elizabeth; Shimizu, Naomi; Salim, Ali; Cooper, Zara

    2017-04-01

    The surprise question is a validated tool for identifying patients with increased risk of death within one year who could, therefore, benefit from palliative care. However, its utility in surgery is unknown. We sought to determine whether the surprise question predicted 12-month mortality in older emergency general surgery patients. This was a prospective cohort study. Emergency general surgery attendings and surgical residents in or beyond their third year of training at a single tertiary care academic hospital from January to July 2014. Surgeons responded to the surprise question within 72 hours of evaluating patients, ≥65 years, hospitalized with an acute surgical condition. Patient data, including demographic and clinical characteristics, were extracted from the medical record. Mortality within 12 months of initial evaluation was determined by using Social Security death data. Ten attending surgeons and 18 surgical residents provided 163 responses to the surprise question for 119 patients: 60% of responses were "No, I would not be surprised" and 40% were "Yes, I would be surprised." A "No" response was associated with increased odds of death within 12 months in binary logistic regression (OR 4.8 [95% CI 2.1-11.1]). The surprise question is a valuable tool for identifying older patients with higher risk of death, and it may be a useful screening criterion for older emergency general surgery patients who would benefit from palliative care evaluation.

  5. Kinetics of blood lipoprotein spectrum indices in patients with angina pectoris during and after low-intensity laser therapy as a paraclinical criterion for treatment efficiency

    Science.gov (United States)

    Babushkina, G. V.; Kartelishev, A. V.

    2001-04-01

    An investigation was made of applying (lambda) equals 0.63 micrometers laser radiation in treating 403 patients affected by angina pectoris. The patients were administered a course of combined laser therapy consisting of the intravenous laser irradiation of blood combined with laser acupuncture. Apart from that, the patients took the maintenance doses of antianginal preparations and therapeutic doses of vitamins A and E. The blood lipoprotein spectrum revealed that this combined laser therapy was capable of producing an antiatherogenic effect. It was also found that the most effective exposure time of laser radiation was in the range of 10 to 15 min.

  6. On the Modified Barkhausen Criterion

    DEFF Research Database (Denmark)

    Lindberg, Erik; Murali, K.

    2016-01-01

    Oscillators are normally designed according to the Modified Barkhausen Criterion i.e. the complex pole pair is moved out in RHP so that the linear circuit becomes unstable. By means of the Mancini Phaseshift Oscillator it is demonstrated that the distortion of the oscillator may be minimized by i...... by introducing a nonlinear ”Hewlett Resistor” so that the complex pole-pair is in the RHP for small signals and in the LHP for large signals i.e. the complex pole pair of the instant linearized small signal model is moving around the imaginary axis in the complex frequency plane....

  7. Immunofluorescence serration pattern analysis as a diagnostic criterion in antilaminin-332 mucous membrane pemphigoid : immunopathological findings and clinical experience in 10 Dutch patients

    NARCIS (Netherlands)

    Terra, J. B.; Pas, H. H.; Hertl, M.; Dikkers, F. G.; Kamminga, N.; Jonkman, M. F.

    2011-01-01

    Background Antilaminin-332 mucous membrane pemphigoid (anti-LN-332 MMP) is a chronic subepidermal blistering disease characterized by IgG anti-epidermal basement membrane zone (BMZ) autoantibodies against laminin-332 (LN-332). Patients with anti-LN-332 MMP have an increased relative risk of

  8. Immunofluorescence serration pattern analysis as a diagnostic criterion in antilaminin-332 mucous membrane pemphigoid: immunopathological findings and clinical experience in 10 Dutch patients.

    Science.gov (United States)

    Terra, J B; Pas, H H; Hertl, M; Dikkers, F G; Kamminga, N; Jonkman, M F

    2011-10-01

    Antilaminin-332 mucous membrane pemphigoid (anti-LN-332 MMP) is a chronic subepidermal blistering disease characterized by IgG anti-epidermal basement membrane zone (BMZ) autoantibodies against laminin-332 (LN-332). with anti-LN-332 MMP have an increased relative risk of malignancy. Laboratory techniques that are difficult to obtain are needed for diagnosis of anti-LN-332 MMP. Objectives  To incorporate direct immunofluorescence (DIF) serration pattern analysis of IgG depositions in the diagnostic criteria of anti-LN-332 MMP. Patients who met our revised inclusion criteria for anti-LN-332 MMP were selected from our biobank over the period 1997-2009. Inclusion criteria were clinical symptoms, DIF serration pattern analysis, indirect immunofluorescence (IIF) on salt-split skin, and antigen-specificity analysis of the serum including immunoblotting and/or immunoprecipitation and/or enzyme-linked immunosorbent assay (ELISA) against native LN-332. Ten patients met the inclusion criteria. A malignancy was found in two patients (20%). In all patients in whom it was performed (n = 9), DIF showed linear IgG deposition along the BMZ in an n-serrated pattern. Nine sera reacted by salt-split skin analysis and bound to the dermal side of the split skin. ELISA against native LN-332 was positive in 78% of the tested sera. Anti-LN-332 MMP can clinically resemble other forms of pemphigoid. Although state-of-the-art laboratory diagnostics are necessary for definite diagnosis, the combination of simple DIF serration pattern and IIF salt-split skin analysis will exclude other forms of MMP and epidermolysis bullosa acquisita from the differential diagnosis. Because of the increased risk for malignancy patients should be thoroughly oncologically screened. © 2011 The Authors. BJD © 2011 British Association of Dermatologists 2011.

  9. Predicting mortality in patients with diabetes starting dialysis.

    Directory of Open Access Journals (Sweden)

    Merel van Diepen

    Full Text Available BACKGROUND: While some prediction models have been developed for diabetic populations, prediction rules for mortality in diabetic dialysis patients are still lacking. Therefore, the objective of this study was to identify predictors for 1-year mortality in diabetic dialysis patients and use these results to develop a prediction model. METHODS: Data were used from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD, a multicenter, prospective cohort study in which incident patients with end stage renal disease (ESRD were monitored until transplantation or death. For the present analysis, patients with DM at baseline were included. A prediction algorithm for 1-year all-cause mortality was developed through multivariate logistic regression. Candidate predictors were selected based on literature and clinical expertise. The final model was constructed through backward selection. The model's predictive performance, measured by calibration and discrimination, was assessed and internally validated through bootstrapping. RESULTS: A total of 394 patients were available for statistical analysis; 82 (21% patients died within one year after baseline (3 months after starting dialysis therapy. The final prediction model contained seven predictors; age, smoking, history of macrovascular complications, duration of diabetes mellitus, Karnofsky scale, serum albumin and hemoglobin level. Predictive performance was good, as shown by the c-statistic of 0.810. Internal validation showed a slightly lower, but still adequate performance. Sensitivity analyses showed stability of results. CONCLUSIONS: A prediction model containing seven predictors has been identified in order to predict 1-year mortality for diabetic incident dialysis patients. Predictive performance of the model was good. Before implementing the model in clinical practice, for example for counseling patients regarding their prognosis, external validation is necessary.

  10. Measurement versus prediction in the construction of patient-reported outcome questionnaires: can we have our cake and eat it?

    Science.gov (United States)

    Smits, Niels; van der Ark, L Andries; Conijn, Judith M

    2017-11-02

    Two important goals when using questionnaires are (a) measurement: the questionnaire is constructed to assign numerical values that accurately represent the test taker's attribute, and (b) prediction: the questionnaire is constructed to give an accurate forecast of an external criterion. Construction methods aimed at measurement prescribe that items should be reliable. In practice, this leads to questionnaires with high inter-item correlations. By contrast, construction methods aimed at prediction typically prescribe that items have a high correlation with the criterion and low inter-item correlations. The latter approach has often been said to produce a paradox concerning the relation between reliability and validity [1-3], because it is often assumed that good measurement is a prerequisite of good prediction. To answer four questions: (1) Why are measurement-based methods suboptimal for questionnaires that are used for prediction? (2) How should one construct a questionnaire that is used for prediction? (3) Do questionnaire-construction methods that optimize measurement and prediction lead to the selection of different items in the questionnaire? (4) Is it possible to construct a questionnaire that can be used for both measurement and prediction? An empirical data set consisting of scores of 242 respondents on questionnaire items measuring mental health is used to select items by means of two methods: a method that optimizes the predictive value of the scale (i.e., forecast a clinical diagnosis), and a method that optimizes the reliability of the scale. We show that for the two scales different sets of items are selected and that a scale constructed to meet the one goal does not show optimal performance with reference to the other goal. The answers are as follows: (1) Because measurement-based methods tend to maximize inter-item correlations by which predictive validity reduces. (2) Through selecting items that correlate highly with the criterion and lowly with

  11. Predictability of sleep in patients with insomnia

    OpenAIRE

    Vallières, Annie; Ivers, Hans; Beaulieu-Bonneau, Simon; Morin, Charles M.

    2011-01-01

    Study Objectives: To evaluate whether the night-to-night variability in insomnia follows specific predictable patterns and to characterize sleep patterns using objective sleep and clinical variables. Design: Prospective observational study. Setting: University-affiliated sleep disorders center. Participants: 146 participants suffering from chronic and primary insomnia. Measurements and Results: Daily sleep diaries were completed for an average of 48 days and self-reported question...

  12. Prediction of 6-minute walk performance in patients with peripheral artery disease.

    Science.gov (United States)

    Chen, Xi; Stoner, Julie A; Montgomery, Polly S; Casanegra, Ana I; Silva-Palacios, Federico; Chen, Sixia; Janitz, Amanda E; Gardner, Andrew W

    2017-10-01

    Peripheral artery disease (PAD) is a highly prevalent disease that impairs walking ability. Walking tests, such as the 6-minute walk test (6MWT) and 4-meter walk test, are commonly used to assess exercise endurance and ambulatory function over a short distance, respectively. The 6MWT performance is predictive of PAD severity and disease outcomes, but it is not feasible in many clinical settings because it requires a long walkway to serve as the test route and lengthens clinic visits. As an alternative, the 4-meter walk test is convenient, inexpensive, and repeatable, but whether it accurately predicts endurance performance in the long-distance 6MWT is not known. The goal of this study was to develop a statistical model to predict 6MWT gait speed from 4-meter walk test results and clinical characteristics among patients with PAD. Measures of 6MWT gait speed were derived from 183 patients with symptomatic PAD who were evaluated at the University of Oklahoma Health Sciences Center (2004-2012). The testing procedures and research personnel remained constant throughout the duration of the study. Independent variables included demographic and clinical information and 4-meter walk test gait speed. Fivefold cross validation and manual backward selection were used for model selection. Adjusted R 2 and corrected Akaike information criterion were applied to quantify the predictive performance of the regression models. A total of 183 people (54% male; mean age, 65 [standard deviation (SD), 10] years) with moderate PAD severity (ankle-brachial index [ABI]; mean, 0.72 [SD, 0.24]) performed the walking tests. Participants covered an average distance of 335 (SD, 97) m distance in the 6MWT. The 4-meter walk gait speed, ABI, and dyspnea were independent predictors of 6MWT speed in the multivariate model (adjusted R 2  = 0.55). The model resulted in 95% prediction interval widths of 30 m for mean and 260 m for individual predicted 6MWT distance measures. Slower 4-meter walking

  13. Factors predicting malnutrition in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Moncef El M′Barki Kadiri

    2011-01-01

    Full Text Available Signs of protein-energy malnutrition are common in maintenance hemodialyis (HD patients and are associated with increased morbidity and mortality. To evaluate the nutritional status and relationship between various parameters used for assessing malnutrition, we performed a cross-sectional study in 37 HD patients treated with thrice weekly sessions for at least two weeks. Global nutritional status was evaluated by the dual-energy X-ray absorptiometry (DEXA scan. Body weight and several laboratory values, including serum albumin (Salb, serum prealbumin, bicarbonate, cholesterol, serum C-reactive protein (SCRP, and hemoglobin, were recorded. Dose of dialysis was evaluated by urea kinetic modeling. The patients were subdivided into two groups based on body mass index: group I, normal nutritional status (71% and group II, malnutrition (29%. The clinical factors associated with malnutrition included advanced age and cardio-vascular diseases (CVD, decreased fat mass (FM measured by DEXA, low Salb and prealbumin, and severe anemia. The Salb level was not only a predictor of nutritional status, but also was independently influenced by age and SCRP, which was more common in malnourished patients than in patients with normal nutritional status. Both low Kt/V and less weekly dialysis time were associated with malnutrition. The FM and lean body mass (LBM calculated by DEXA correlated with CVD and other markers of malnutrition (Salb, total cholesterol.

  14. Patient selection for upper airway stimulation: is concentric collapse in sleep endoscopy predictable?

    Science.gov (United States)

    Steffen, Armin; Frenzel, Henning; Wollenberg, Barbara; König, Inke R

    2015-12-01

    Upper airway stimulation is an effective treatment option for obstructive sleep apnea after failure of positive airway pressure (PAP) therapy. To ensure a therapeutic effect, closed-loop hypoglossal nerve implants require the absence of palatal complete concentric collapse during sleep endoscopy. The frequency and potential predictors of this exclusion criterion are unknown. Over a 2-year period, 74 consecutive patients with sleep apnea who sought PAP alternatives were evaluated with sleep endoscopy using propofol. The influence of sleep apnea severity and anthropometric characteristics as predictors of sleep endoscopy results was investigated. One-fifth of all patients showed a concentric collapse. Gender and age did not predict the presence of concentric collapse, but higher body mass and apnea hypopnea index values were predictive (p = 0.011; e.g., 0.026). The most commonly used body mass index values for upper airway stimulation indications demonstrated acceptable specificity (BMI 32 kg/m(2) 0.71, 95 % confidence interval = 0.57, 0.82; e.g., 35 kg/m(2) 0.81, 95 % confidence interval = 0.69, 0.90). Despite the association with overweight, a significant number of severely overweight patients had no concentric palatal collapse. Concentric collapse is a somewhat common condition encountered in sleep endoscopy evaluations of PAP alternatives, and cannot be sustainably predicted with anthropometric or sleep assessments. Sleep surgeons should be aware of the possibility of concentric collapse, especially in candidates who are more overweight and have severe sleep apnea. Sleep endoscopy can be useful for providing information about continuous positive airway pressure (CPAP) alternatives or to motivate patient adherence to treatment.

  15. A Heuristic Criterion for Instability to Fragmentation in Rotating, Interstellar Clouds

    Science.gov (United States)

    Boss, Alan Paul

    1982-01-01

    A heuristic criterion, based on linear perturbation analysis, is applied to the initial growth of density perturbations in isothermal or adiabatic gas clouds, with initially uniform density and uniform rotation. The heuristic criterion is shown to be consistent with the available results from numerical calculations of cloud collapse. The criterion predicts that perturbations varying as cos (m(phi)) will be most likely to grow when )pi is small, unless the cloud is nearly pressureless.

  16. Normal Criterion Concerning Shared Values

    Directory of Open Access Journals (Sweden)

    Wei Chen

    2012-01-01

    Full Text Available We study normal criterion of meromorphic functions shared values, we obtain the following. Let F be a family of meromorphic functions in a domain D, such that function f∈F has zeros of multiplicity at least 2, there exists nonzero complex numbers bf,cf depending on f satisfying (i  bf/cf is a constant;  (iimin {σ(0,bf,σ(0,cf,σ(bf,cf≥m} for some m>0;  (iii  (1/cfk-1(f′k(z+f(z≠bfk/cfk-1 or (1/cfk-1(f′k(z+f(z=bfk/cfk-1⇒f(z=bf, then F is normal. These results improve some earlier previous results.

  17. A sequential criterion analysis for assessing coping with chronic illness.

    Science.gov (United States)

    Turk, D C; Sobel, H J; Follick, M J; Youkilis, H D

    1980-01-01

    A three-stage sequential criterion analysis based on the Goldfried-D'Zurilla behavior model is presented as a heuristic approach for studying chronic illness. The three interrelated stages consist of: (a) problem identification, (b) response enumeration, and (c) response evaluation. The utility of this systematic approach for understanding the adaptive process, helping to identify patients who might benefit from intervention, providing content for actual intervention, and reducing the myth of homogeneity among chronic patient populations for both clinicians and researches, is discussed. Examples of the utility of the criterion analysis are provided throughout the paper.

  18. Extremes of shock index predicts death in trauma patients

    Directory of Open Access Journals (Sweden)

    Stephen R Odom

    2016-01-01

    Full Text Available Context: We noted a bimodal relationship between mortality and shock index (SI, the ratio of heart rate to systolic blood pressure. Aims: To determine if extremes of SI can predict mortality in trauma patients. Settings and Designs: Retrospective evaluation of adult trauma patients at a tertiary care center from 2000 to 2012 in the United States. Materials and Methods: We examined the SI in trauma patients and determined the adjusted mortality for patients with and without head injuries. Statistical Analysis Used: Descriptive statistics and multivariable logistic regression. Results: SI values demonstrated a U-shaped relationship with mortality. Compared with patients with a SI between 0.5 and 0.7, patients with a SI of 1.3 had an odds ratio of death of 3.1. (95% CI 1.6–5.9. Elevated SI is associated with increased mortality in patients with isolated torso injuries, and is associated with death at both low and high values in patients with head injury. Conclusion: Our data indicate a bimodal relationship between SI and mortality in head injured patients that persists after correction for various co-factors. The distribution of mortality is different between head injured patients and patients without head injuries. Elevated SI predicts death in all trauma patients, but low SI values only predict death in head injured patients.

  19. Do illness perceptions predict health outcomes in primary care patients?

    DEFF Research Database (Denmark)

    Frostholm, Lisbeth; Oernboel, Eva; Christensen, Kaj S

    2007-01-01

    patients, (2) patients without chronic disorders presenting physical disease, and (3) patients presenting medically unexplained symptoms (MUS). RESULTS: Negative illness perceptions were associated with poor physical and mental health at baseline. They most strongly predicted changes in health status...... at follow-up for the whole group of patients. Patients presenting with MUS had more negative illness perceptions and lower mental and physical components subscale of the SF-36 scores at all time points. CONCLUSIONS: Patients' perception of a new or recurrent health problem predicts self-reported physical......OBJECTIVE: Little is known about whether illness perceptions affect health outcomes in primary care patients. The aim of this study was to examine if patients' illness perceptions were associated with their self-rated health in a 2-year follow-up period. METHODS: One thousand seven hundred eighty...

  20. Prediction of outcome in patients with low back pain

    DEFF Research Database (Denmark)

    Kongsted, Alice; Andersen, Cathrine Hedegaard; Mørk Hansen, Martin

    2016-01-01

    The clinical course of low back pain (LBP) cannot be accurately predicted by existing prediction tools. Therefore clinicians rely largely on their experience and clinical judgement. The objectives of this study were to investigate 1) which patient characteristics were associated with chiropractors...

  1. Boey Score in Predicting Mortality in Patients with Perforated Peptic ...

    African Journals Online (AJOL)

    Background: A number of prognostic factors for morbidity and mortality following perforated peptic ulcer have been reported, but the most well known is Boey's score which is simple with a high predictive value. Aim: The aim of this study was to predict mortality in patients with perforated peptic ulcer using the Boey's score.

  2. Generalized measurable ignition criterion for inertial confinement fusion.

    Science.gov (United States)

    Chang, P Y; Betti, R; Spears, B K; Anderson, K S; Edwards, J; Fatenejad, M; Lindl, J D; McCrory, R L; Nora, R; Shvarts, D

    2010-04-02

    A multidimensional measurable criterion for central ignition of inertial-confinement-fusion capsules is derived. The criterion accounts for the effects of implosion nonuniformities and depends on three measurable parameters: the neutron-averaged total areal density (rhoR(n)(tot)), the ion temperature (T(n)), and the yield over clean (YOC=ratio of the measured neutron yield to the predicted one-dimensional yield). The YOC measures the implosion uniformity. The criterion can be approximated by chi=(rhoR(n)(tot))(0.8) x (T(n)/4.7)(1.7)YOC(mu)>1 (where rhoR is in g cm(-2), T in keV, and mu approximately 0.4-0.5) and can be used to assess the performance of cryogenic implosions on the NIF and OMEGA. Cryogenic implosions on OMEGA have achieved chi approximately 0.02-0.03.

  3. Copeptin Predicts Mortality in Critically Ill Patients

    OpenAIRE

    Krychtiuk, Konstantin A.; Honeder, Maria C.; Lenz, Max; Maurer, Gerald; Wojta, Johann; Heinz, Gottfried; Huber, Kurt; Speidl, Walter S.

    2017-01-01

    Background Critically ill patients admitted to a medical intensive care unit exhibit a high mortality rate irrespective of the cause of admission. Besides its role in fluid and electrolyte balance, vasopressin has been described as a stress hormone. Copeptin, the C-terminal portion of provasopressin mirrors vasopressin levels and has been described as a reliable biomarker for the individual?s stress level and was associated with outcome in various disease entities. The aim of this study was t...

  4. INTELLIGENT TOOLS FOR PREDICTING ANXIETY OF ALZHEIMER'S PATIENTS

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective To predict the incidence of anxiety in Alzheimer's disease (AD) patients by using machine-learning models. Methods A large randomized controlled clinical trial was analyzed in this study, which involved AD patients and caregivers from 6 different sites in the United States. The incidence of anxiety in AD patients was predicted by backpropagation artificial neural networks and several machine learning models, including Bayesian Networks, logistic regression, ADTree, J48, and Decision table. Results Among all models for predicting the incidence of anxiety in AD patients, the artificial neural network with respectively 6 and 3 neurons in the first and second hidden layers achieved the highest predictive accuracy of 85.56 %. The decision tree revealed three main risk factors: "caregiver experiencing psychological distress", "caregiver suffering from chronic disease or cancer", and "lack of professional care service". Conclusion The unique ability of artificial neural networks on classifying nonlinearly separable problems may substantially benefit the prediction, prevention and early intervention of anxiety in Alzheimer's patients. Decision tree has the double efficacy of predicting the incidence and discovering the risk factors of anxiety in Alzheimer's patients. More resources should be provided to caregivers to improve their mental and physical health, and more professional care services should be adopted by Alzheimer's families.

  5. Early prediction of blonanserin response in Japanese patients with schizophrenia.

    Science.gov (United States)

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

    2014-01-01

    Blonanserin is a second-generation antipsychotic used for the treatment of schizophrenia in Japan and Korea. The present study aimed to examine early prediction of blonanserin in patients with schizophrenia. An 8-week, prospective, single-arm, flexible-dose clinical trial of blonanserin in patients with schizophrenia was conducted under real-world conditions. The inclusion criteria were antipsychotic naïve, and first-episode schizophrenia patients or schizophrenia patients with no consumption of any antipsychotic medication for more than 4 weeks before enrollment in this study. The positive predictive value, negative predictive value, sensitivity, specificity, and predictive power were calculated for the response status at week 4 to predict the subsequent response at week 8. Thirty-seven patients were recruited (56.8% of them had first-episode schizophrenia), and 28 (75.7%) completed the trial. At week 8, blonanserin was associated with a significant improvement in the Positive and Negative Syndrome Scale (PANSS) total score (Pblonanserin response at week 4 could predict the later response at week 8.

  6. A criterion for estimating the probability of microporosity formation in castings

    Science.gov (United States)

    Poliakov, S. N.; Korotchenko, A. Yu; Timchenko, S. L.

    2017-11-01

    The study tested a new dimensionless criterion for microporosity formation, which takes a number of significant technological factors into account, including atmospheric and metallostatic pressure, and alloy gas saturation. We recommend using the criterion in systems that model casting solidification to predict microporosity formation more accurately

  7. Rayleigh Number Criterion for Formation of A-Segregates in Steel Castings and Ingots

    DEFF Research Database (Denmark)

    Rad, M. Torabi; Kotas, Petr; Beckermann, C.

    2013-01-01

    A Rayleigh number-based criterion is developed for predicting the formation of A-segregates in steel castings and ingots. The criterion is calibrated using available experimental data for ingots involving 27 different steel compositions. The critical Rayleigh number above which A-segregates can b...

  8. Risk acceptance criterion for tanker oil spill risk reduction measures.

    Science.gov (United States)

    Psarros, George; Skjong, Rolf; Vanem, Erik

    2011-01-01

    This paper is aimed at investigating whether there is ample support for the view that the acceptance criterion for evaluating measures for prevention of oil spills from tankers should be based on cost-effectiveness considerations. One such criterion can be reflected by the Cost of Averting a Tonne of oil Spilt (CATS) whereas its target value is updated by elaborating the inherent uncertainties of oil spill costs and establishing a value for the criterion's assurance factor. To this end, a value of $80,000/t is proposed as a sensible CATS criterion and the proposed value for the assurance factor F=1.5 is supported by the retrieved Protection and Indemnity (P&I) Clubs' Annual Reports. It is envisaged that this criterion would allow the conversion of direct and indirect costs into a non-market value for the optimal allocation of resources between the various parties investing in shipping. A review of previous cost estimation models on oil spills is presented and a probability distribution (log-normal) is fitted on the available oil spill cost data, where it should be made abundantly clear that the mean value of the distribution is used for deriving the updated CATS criterion value. However, the difference between the initial and the updated CATS criterion in the percentiles of the distribution is small. It is found through the current analysis that results are partly lower than the predicted values from the published estimation models. The costs are also found to depend on the type of accident, which is in agreement with the results of previous studies. Other proposals on acceptance criteria are reviewed and it is asserted that the CATS criterion can be considered as the best candidate. Evidence is provided that the CATS approach is practical and meaningful by including examples of successful applications in actual risk assessments. Finally, it is suggested that the criterion may be refined subject to more readily available cost data and experience gained from future

  9. Does the World Health Organization criterion adequately define glaucoma blindness?

    Directory of Open Access Journals (Sweden)

    Mokhles P

    2017-03-01

    Full Text Available P Mokhles, JSAG Schouten, HJM Beckers, CAB Webers University Eye Clinic Maastricht, Maastricht, the Netherlands Purpose: Blindness in glaucoma is difficult to assess with merely the use of the current World Health Organization (WHO definition (a visual field restricted to 10° in a radius around central fixation, as this criterion does not cover other types of visual field loss that are encountered in clinical practice and also depict blindness. In this study, a 5-point ordinal scale was developed for the assessment of common visual field defect patterns, with the purpose of comparing blindness as outcome to the findings with the WHO criterion when applied to the same visual fields. The scores with the two methods were compared between two ophthalmologists. In addition, the variability between these assessors in assessing the different visual field types was determined.Methods: Two glaucoma specialists randomly assessed a sample of 423 visual fields from 77 glaucoma patients, stripped of all indices and masked for all patient variables. They applied the WHO criterion and a 5-point ordinal scale to all visual fields for the probability of blindness.Results: The WHO criterion was mostly found applicable and in good agreement for both assessors to visual fields depicting central island of vision or a temporal crescent. The percentage of blindness scores was higher when using the ordinal scale, 21.7% and 19.6% for assessors A and B, respectively, versus 14.4% and 11.3% for the WHO criterion. However, Kappa was lower, 0.71 versus 0.78 for WHO.Conclusions: The WHO criterion is strictly applied and shows good agreement between assessors; however, blindness does not always fit this criterion. More visual fields are labeled as blind when a less stringent criterion is used, but this leads to more interobserver variability. A new criterion that describes the extent, location, and depth of visual field defects together with their consequence for the

  10. Emerging markers of cachexia predict survival in cancer patients

    OpenAIRE

    Mondello, Patrizia; Lacquaniti,Antonio; Mondello, Stefania; Bolignano, Davide; Pitini, Vincenzo; Aloisi, Carmela; Buemi, Michele

    2014-01-01

    Background Cachexia may occur in 40% of cancer patients, representing the major cause of death in more than 20% of them. The aim of this study was to investigate the role of leptin, ghrelin and obestatin as diagnostic and predictive markers of cachexia in oncologic patients. Their impact on patient survival was also evaluated. Methods 140 adults with different cancer diagnoses were recruited. Thirty healthy volunteers served as control. Serum ghrelin, obestatin and leptin were tested at basel...

  11. Predictive model of mortality in patients with spontaneous bacterial peritonitis.

    Science.gov (United States)

    Poca, M; Alvarado-Tapias, E; Concepción, M; Pérez-Cameo, C; Cañete, N; Gich, I; Romero, C; Casas, M; Román, E; Castells, L; Vargas, V; Carrión, J A; Guarner, C; Soriano, G

    2016-09-01

    Hospital mortality in patients with spontaneous bacterial peritonitis (SBP) is high despite albumin treatment, particularly in those with worse liver and/or renal function. To determine the independent predictive factors of in-hospital mortality and to create and validate a predictive model of mortality in patients with SBP. We analysed all cirrhotic patients with high-risk SBP (serum urea ≥11 mmol/L and/or serum bilirubin ≥68 μmol/L) between 2001 and 2011. We developed a predictive model of in-hospital mortality and validated this in a different cohort. We included 118 high-risk SBP episodes treated with antibiotics and albumin. In-hospital mortality was 33/118 (28%). The independent predictive factors of in-hospital mortality at SBP diagnosis were serum urea, blood leucocyte count, Child-Pugh score and mean arterial pressure. A predictive model including these four variables showed a discrimination accuracy (AUC) of 0.850, 95% CI 0.777-0.922. A cut-off point of 0.245 showed a sensitivity of 0.85 and specificity of 0.75. The in-hospital mortality was 28/49 (57.1%) in patients with a model value ≥0.245, and 5/69 (7.2%) in patients with a model value model value ≥0.245, and 10/84 (11.9%) in those with a model value predictive model of mortality that includes serum urea, blood leucocyte count, Child-Pugh score and mean arterial pressure in high-risk patients with spontaneous bacterial peritonitis. These findings may help to identify patients who would benefit from additional therapeutic strategies. © 2016 John Wiley & Sons Ltd.

  12. Predicting Recovery Potential for Individual Stroke Patients Increases Rehabilitation Efficiency.

    Science.gov (United States)

    Stinear, Cathy M; Byblow, Winston D; Ackerley, Suzanne J; Barber, P Alan; Smith, Marie-Claire

    2017-04-01

    Several clinical measures and biomarkers are associated with motor recovery after stroke, but none are used to guide rehabilitation for individual patients. The objective of this study was to evaluate the implementation of upper limb predictions in stroke rehabilitation, by combining clinical measures and biomarkers using the Predict Recovery Potential (PREP) algorithm. Predictions were provided for patients in the implementation group (n=110) and withheld from the comparison group (n=82). Predictions guided rehabilitation therapy focus for patients in the implementation group. The effects of predictive information on clinical practice (length of stay, therapist confidence, therapy content, and dose) were evaluated. Clinical outcomes (upper limb function, impairment and use, independence, and quality of life) were measured 3 and 6 months poststroke. The primary clinical practice outcome was inpatient length of stay. The primary clinical outcome was Action Research Arm Test score 3 months poststroke. Length of stay was 1 week shorter for the implementation group (11 days; 95% confidence interval, 9-13 days) than the comparison group (17 days; 95% confidence interval, 14-21 days; P=0.001), controlling for upper limb impairment, age, sex, and comorbidities. Therapists were more confident (P=0.004) and modified therapy content according to predictions for the implementation group (Prehabilitation efficiency after stroke without compromising clinical outcome. URL: http://anzctr.org.au. Unique identifier: ACTRN12611000755932. © 2017 American Heart Association, Inc.

  13. New Predictive Equations for Serum Ionized Calcium in Hospitalized Patients.

    Science.gov (United States)

    Mateu-de Antonio, Javier

    2016-01-01

    To study a new and easy way to calculate equations to predict ionized calcium (Ca2+) for adult hospitalized patients with the usual laboratory and clinical parameters. This retrospective observational study was conducted in a third-level university hospital. An initial learning cohort (cohort L: 269 patients) was selected to derive the new equations. These equations were tested in a validation of another cohort (cohort V: 146 patients). Patients selected were hospitalized adults who had simultaneous determinations of Ca2+ and serum total calcium (CaTot). They were classified using their estimated glomerular filtration rate (GFRe) into normal function, moderate and severe kidney dysfunction. Demographic and biochemical parameters, in addition to comorbidities, were collected from hospital databases. Nine published equations to predict Ca2+ and 2 widely used equations to predict corrected CaTot were also selected to be compared to newer equations for accuracy in detecting serum calcium alterations. New equations were derived by a multiple linear-regression analysis from patients in cohort L. Three equations were derived containing the CaTot square root as the main independent variable. Equation 1: Ca2+ = 0.815 × CaTot(0.5). Equation 2: Ca2+ = 0.826 × CaTot(0.5) - 0.023 × renal function. Equation 3: Ca2+ = 0.813 × CaTot(0.5) - 0.006 × albumin(0.75) + 0.079. These equations performed better than published equations to predict Ca2+ when their error measures were analyzed in cohort V, even in special populations such as critically ill and very old patients. Three new equations predicting Ca2+ were derived requiring easily available clinical and laboratory parameters. They could be valuable in predicting hypocalcemia but are of limited use in hypercalcemia. © 2015 S. Karger AG, Basel.

  14. Predicting blood transfusion in patients undergoing minimally invasive oesophagectomy.

    Science.gov (United States)

    Schneider, Crispin; Boddy, Alex P; Fukuta, Junaid; Groom, William D; Streets, Christopher G

    2014-12-01

    To evaluate predictors of allogenic blood transfusion requirements in patients undergoing minimal invasive oesophagectomy at a tertiary high volume centre for oesophago-gastric surgery. Retrospective analysis of all patients undergoing minimal access oesophagectomy in our department between January 2010 and December 2011. Patients were divided into two groups depending on whether they required a blood transfusion at any time during their index admission. Factors that have been shown to influence perioperative blood transfusion requirements in major surgery were included in the analysis. Binary logistic regression analysis was performed to determine the impact of patient and perioperative characteristics on transfusion requirements during the index admission. A total of 80 patients underwent minimal access oesophagectomy, of which 61 patients had a laparoscopic assisted oesophagectomy and 19 patients had a minimal invasive oesophagectomy. Perioperative blood transfusion was required in 28 patients at any time during hospital admission. On binary logistic regression analysis, a lower preoperative haemoglobin concentration (p blood transfusion requirements. It has been reported that requirement for blood transfusion can affect long-term outcomes in oesophageal cancer resection. Two factors which could be addressed preoperatively; haemoglobin concentration and type of oesophageal resection, may be valuable in predicting blood transfusions in patients undergoing minimally invasive oesophagectomy. Our analysis revealed that preoperative haemoglobin concentration, occurrence of significant complications and type of minimal access oesophagectomy predicted blood transfusion requirements in the patient population examined. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  15. Predicting difficult airway in apparently normal adult and pediatric patients.

    Science.gov (United States)

    Shirgoska, B; Netkovski, J

    2013-01-01

    The aim of the study was to determine the predicting tests for difficult airway and difficult intubation in apparently normal patients. We were using the literature about the specific tests for predicting difficult airway and single parameters that could be a significant test for prediction of difficult or impossible intubation. Clinical risk factors for difficult intubation in pediatric patients are related to the anatomic differences between pediatric patients and adults. Quantitative evaluation of difficult intubations could be realized using Cormack-Lehane (CL) scale and Mallampati score (without speaking--Mallampati test--and modified Mallampati test during speech). The Cormack-Lehane (CL) scale is a grading system commonly used to describe the view of the larynx during direct laryngoscopy. Grades 3 and 4, in which the glottis is not visualized, are considered difficult intubations. The Mallampati score, estimates the size of the tongue relative to the oral cavity and the ability to open the mouth. This system graded the patient (grades 1 to 4) based on the structures visible in the oropharynx with maximal mouth opening. Grade 3 or 4 suggests a significant chance that the patient will be difficult to intubate. Our results showed that 24 patients (20 adult patients and 4 pediatric patients), 3.2% from total of 750 involved in the study had difficult intubation (Mallampati grades 3 and 4). 35% of the patients had impaired glottis exposure (grades 3 and 4 of the Cormack-Lehane scale). We used only two criteria for describing both the visibility of the oropharyngeal structures and the quality of the laryngeal view. The effective and reliable prediction requires a combination of several parameters (BMI, head and neck movement, dentition status, upper lip bite test, interincisor gap and thyromental distance).

  16. Predictive value of low interleukin-33 in critically ill patients.

    Science.gov (United States)

    Krychtiuk, Konstantin A; Stojkovic, Stefan; Lenz, Max; Brekalo, Mira; Huber, Kurt; Wojta, Johann; Heinz, Gottfried; Demyanets, Svitlana; Speidl, Walter S

    2017-09-30

    Patients admitted to a medical intensive care unit (ICU) are characterized by an activated immune system and exhibit a high mortality rate irrespective of the underlying cause of admission. Interleukin (IL)-33 has been shown to be protective in experimental sepsis models and it has been demonstrated that circulating levels of its "decoy" receptor soluble ST2 (sST2) are associated with outcome in critically ill patients. The aim of the present study was to investigate whether circulating IL-33 is associated with 30-day mortality in patients admitted to a medical ICU. In this prospective, observational study, both IL-33 and sST2 levels were assessed in 223 consecutive patients at ICU admission using specific enzyme-linked immunosorbent assays (ELISAs). During the 30-day follow-up, 58 patients (26%) died. Circulating IL-33 was detectable in 166 patients and in 57 patients, serum IL-33 was below the detection limit. Both detectable IL-33 and sST2 below the median were strong predictors of survival in critically ill patients independent of acute physiology and chronic health evaluation II (APACHE II) score. IL-33 and sST2 predicted risk independent from each other. Patients with both, non-detectable levels of IL-33 and sST2 levels above the median, showed a dramatically increased mortality risk (HR 6.9 95% CI 3.0-16.2; p<0.001). Low levels of IL-33 and increased levels of sST2 predict mortality risk in critically ill patients independent from each other and APACHE II score. Both together showed additive predictive value suggesting a pathogenic role of the IL-33/ST2 system in critically ill patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Prediction of amikacin dose requirements in neutropenic patients ...

    African Journals Online (AJOL)

    This study reports on the use of an easily applied Bayesian forecasting programme (OPT; Clyde-soft) to predict amikacin dose requirements in 10 patients with haematological disease and neutropenic fever. OPT-determined dose adjustment achieved therapeutic drug levels for 80% of the peak and 94% of the trough ...

  18. Predicting referral practices of traditional healers of their patients ...

    African Journals Online (AJOL)

    present study applies the Theory of Planned Behaviour (TPB) to predict traditional healer referral practices of patients with a mental illness. ..... Soc Sci Med. 1992;35:1183-1190. 3. Ngubane H. Body and Mind in Zulu medicine. 1977. London: Academic Press. 4. Edwards SD, Grobbelaar PW, Makunga NV et al. Traditional ...

  19. Factors predicting mortality in elderly patients admitted to a ...

    African Journals Online (AJOL)

    Factors predicting mortality in elderly patients admitted to a Moroccan medical intensive care unit. Jihane Belayachi, Mina El khayari, Tarek Dendane, Naoufel Madani, Khalid Abidi, Redouane Abouqal, Amine Ali Zeggwagh. Medical Intensive Care Unit, Ibn Sina University Hospital, Rabat, Morocco. Jihane Belayachi, MD.

  20. Early prediction of blonanserin response in Japanese patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Kishi T

    2014-09-01

    Full Text Available Taro Kishi,1 Yuki Matsuda,1 Kiyoshi Fujita,2,3 Nakao Iwata1 1Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; 2Department of Psychiatry, Okehazama Hospital, Toyoake, Aichi, Japan; 3The Neuroscience Research Center, Toyoake, Aichi, Japan Background: Blonanserin is a second-generation antipsychotic used for the treatment of schizophrenia in Japan and Korea. The present study aimed to examine early prediction of blonanserin in patients with schizophrenia. Methods: An 8-week, prospective, single-arm, flexible-dose clinical trial of blonanserin in patients with schizophrenia was conducted under real-world conditions. The inclusion criteria were antipsychotic naïve, and first-episode schizophrenia patients or schizophrenia patients with no consumption of any antipsychotic medication for more than 4 weeks before enrollment in this study. The positive predictive value, negative predictive value, sensitivity, specificity, and predictive power were calculated for the response status at week 4 to predict the subsequent response at week 8.Results: Thirty-seven patients were recruited (56.8% of them had first-episode schizophrenia, and 28 (75.7% completed the trial. At week 8, blonanserin was associated with a significant improvement in the Positive and Negative Syndrome Scale (PANSS total score (P<0.0001 and in positive (P<0.0001, negative (P<0.0001, and general subscale scores (P<0.0001. In terms of percentage improvement of PANSS total scores from baseline to week 8, 64.9% of patients showed a ≥20% reduction in the PANSS total score and 48.6% showed a ≥30% reduction. However, 8.1% of patients experienced at least one adverse event. Using the 20% reduction in the PANSS total score at week 4 as a definition of an early response, the negative predictive values for later responses (ie, reductions of ≥30 and ≥40 in the PANSS total scores were 88.9% and 94.1%, respectively. The specificities were 80.0% and

  1. AN EFFICIENT PATIENT INFLOW PREDICTION MODEL FOR HOSPITAL RESOURCE MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Kottalanka Srikanth

    2017-07-01

    Full Text Available There has been increasing demand in improving service provisioning in hospital resources management. Hospital industries work with strict budget constraint at the same time assures quality care. To achieve quality care with budget constraint an efficient prediction model is required. Recently there has been various time series based prediction model has been proposed to manage hospital resources such ambulance monitoring, emergency care and so on. These models are not efficient as they do not consider the nature of scenario such climate condition etc. To address this artificial intelligence is adopted. The issues with existing prediction are that the training suffers from local optima error. This induces overhead and affects the accuracy in prediction. To overcome the local minima error, this work presents a patient inflow prediction model by adopting resilient backpropagation neural network. Experiment are conducted to evaluate the performance of proposed model inter of RMSE and MAPE. The outcome shows the proposed model reduces RMSE and MAPE over existing back propagation based artificial neural network. The overall outcomes show the proposed prediction model improves the accuracy of prediction which aid in improving the quality of health care management.

  2. A criterion-related validity study of the nursing-care dependency (NCD) scale

    NARCIS (Netherlands)

    Dijkstra, A.; Buist, G.; Dassen, Th.W.N.

    The purpose of this study was to examine some aspects of the criterion-related validity of the Nursing-Care Dependency (NCD) scale. This 15-item counting scale has recently been developed for assessing the care dependency of demented or mentally handicapped in-patients. Its criterion-related

  3. Cardiovascular risk prediction in chronic kidney disease patients.

    Science.gov (United States)

    Cedeño Mora, Santiago; Goicoechea, Marian; Torres, Esther; Verdalles, Úrsula; Pérez de José, Ana; Verde, Eduardo; García de Vinuesa, Soledad; Luño, José

    Scores underestimate the prediction of cardiovascular risk (CVR) as they are not validated in patients with chronic kidney disease (CKD). Two of the most commonly used scores are the Framingham Risk Score (FRS-CVD) and the ASCVD (AHA/ACC 2013). The aim of this study is to evaluate the predictive ability of experiencing a cardiovascular event (CVE) via these 2scores in the CKD population. Prospective, observational study of 400 prevalent patients with CKD (stages 4 and 5 according the KDOQI; not on dialysis). Cardiovascular risk was calculated according to the 2scores and the predictive capacity of cardiovascular events (atherosclerotic events: myocardial infarction, ischaemic and haemorrhagic stroke, peripheral vascular disease; and non-atherosclerotic events: heart failure) was analysed. Forty-nine atherosclerotic cardiovascular events occurred in 40.3±6.6 months of follow-up. Most of the patients were classified as high CVR by both scores (59% by the FRS-CVD and 75% by the ASCVD). All cardiovascular events occurred in the high CVR patients and both scores (FRS-CVD log-rank 12.2, Prenal function, albuminuria and previous cardiovascular events. The cardiovascular risk scores (FRS-CVD and ASCVD [AHA/ACC 2013]) can estimate the probability of atherosclerotic cardiovascular events in patients with CKD regardless of renal function, albuminuria and previous cardiovascular events. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Predicting bacterial infections among pediatric cancer patients with febrile neutropenia

    DEFF Research Database (Denmark)

    Ojha, Rohit P; Asdahl, Peter H; Steyerberg, Ewout W

    2017-01-01

    INTRODUCTION: The Predicting Infectious Complications in Neutropenic Children and Young People with Cancer (PICNICC) model was recently developed for antibiotic stewardship among pediatric cancer patients, but limited information is available about its clinical usefulness. We aimed to assess...... the performance of the PICNICC model for predicting microbiologically documented bacterial infections among pediatric cancer patients with febrile neutropenia. MATERIALS AND METHODS: We used data for febrile neutropenia episodes at a pediatric cancer center in Aarhus, Denmark between 2000 and 2016. We assessed...... calibration but did not improve net benefit. CONCLUSIONS: The PICNICC model has potential for reducing unnecessary antibiotic exposure for pediatric cancer patients with febrile neutropenia, but continued validation and refinement is necessary to optimize clinical usefulness....

  5. Can hospices predict which patients will die within six months?

    Science.gov (United States)

    Harris, Pamela S; Stalam, Tapati; Ache, Kevin A; Harrold, Joan E; Craig, Teresa; Teno, Joan; Smither, Eugenia; Dougherty, Meredith; Casarett, David

    2014-08-01

    To determine whether it is possible to predict, at the time of hospice enrollment, which patients will die within 6 months. Electronic health record-based retrospective cohort study. Patients admitted to 10 hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Comparative Effectiveness). Hospice patients. Mortality at 6 months following hospice admission. Among 126,620 patients admitted to 10 hospices, 118,532 (93.6%) died within 6 months. In a multivariable logistic regression model, five characteristics were independent predictors of 6-month mortality. For instance, patients younger than 65 years were less likely to die within 6 months (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.45-0.91; p=0.014). Conversely, male patients were more likely to die within 6 months (OR 1.47; 95% CI 1.05-2.02; p=;0.036). After adjusting for other variables in this model, there were several subgroups with a low probability of 6-month probability (e.g., stroke and Palliative Performance Scale [PPS] score=50; adjusted probability of 6-month mortality=39.4%; 95% CI: 13.9%-72.5%). However, 95% confidence intervals of these 6-month mortality predictions extended above 50%. Hospices might use several variables to identify patients with a relatively low risk for 6-month mortality and who therefore may become ineligible to continue hospice services if they fail to show significant disease progression.

  6. Selection of patient samples and genes for outcome prediction.

    Science.gov (United States)

    Liu, Huiqing; Li, Jinyan; Wong, Limsoon

    2004-01-01

    Gene expression profiles with clinical outcome data enable monitoring of disease progression and prediction of patient survival at the molecular level. We present a new computational method for outcome prediction. Our idea is to use an informative subset of original training samples. This subset consists of only short-term survivors who died within a short period and long-term survivors who were still alive after a long follow-up time. These extreme training samples yield a clear platform to identify genes whose expression is related to survival. To find relevant genes, we combine two feature selection methods -- entropy measure and Wilcoxon rank sum test -- so that a set of sharp discriminating features are identified. The selected training samples and genes are then integrated by a support vector machine to build a prediction model, by which each validation sample is assigned a survival/relapse risk score for drawing Kaplan-Meier survival curves. We apply this method to two data sets: diffuse large-B-cell lymphoma (DLBCL) and primary lung adenocarcinoma. In both cases, patients in high and low risk groups stratified by our risk scores are clearly distinguishable. We also compare our risk scores to some clinical factors, such as International Prognostic Index score for DLBCL analysis and tumor stage information for lung adenocarcinoma. Our results indicate that gene expression profiles combined with carefully chosen learning algorithms can predict patient survival for certain diseases.

  7. Predicting discharge location of hip fracture patients; the new discharge of hip fracture patients score

    NARCIS (Netherlands)

    A.J.H. Vochteloo (Anne); W.E. Tuinebreijer (Wim); A.B. Maier (Andrea); R.G.H.H. Nelissen (Rob); R.M. Bloem (Rolf); P. Pilot (Peter)

    2012-01-01

    textabstractPurpose This paper reports on the development and validity of a new instrument, called the discharge of hip fracture patients score (DHP), that predicts at admission the discharge location in patients living in their own home prior to hip fracture surgery. Methods A total of 310 patients

  8. Illness Beliefs Predict Mortality in Patients with Diabetic Foot Ulcers.

    Science.gov (United States)

    Vedhara, Kavita; Dawe, Karen; Miles, Jeremy N V; Wetherell, Mark A; Cullum, Nicky; Dayan, Colin; Drake, Nicola; Price, Patricia; Tarlton, John; Weinman, John; Day, Andrew; Campbell, Rona; Reps, Jenna; Soria, Daniele

    2016-01-01

    Patients' illness beliefs have been associated with glycaemic control in diabetes and survival in other conditions. We examined whether illness beliefs independently predicted survival in patients with diabetes and foot ulceration. Patients (n=169) were recruited between 2002 and 2007. Data on illness beliefs were collected at baseline. Data on survival were extracted on 1st November 2011. Number of days survived reflected the number of days from date of recruitment to 1st November 2011. Cox regressions examined the predictors of time to death and identified ischemia and identity beliefs (beliefs regarding symptoms associated with foot ulceration) as significant predictors of time to death. Our data indicate that illness beliefs have a significant independent effect on survival in patients with diabetes and foot ulceration. These findings suggest that illness beliefs could improve our understanding of mortality risk in this patient group and could also be the basis for future therapeutic interventions to improve survival.

  9. Prediction of outcome in patients with low back pain

    DEFF Research Database (Denmark)

    Kongsted, Alice; Andersen, Cathrine Hedegaard; Mørk Hansen, Martin

    2016-01-01

    intensity (0-10) and disability (RMDQ) after 2-weeks, 3-months, and 12-months. The course of LBP in 859 patients was predicted to be short (54%), prolonged (36%), or chronic (7%). Clinicians' expectations were most strongly associated with education, LBP history, radiating pain, and neurological signs......' expectations of outcome from a LBP episode, 2) if clinicians' expectations related to outcome, 3) how accurate clinical predictions were as compared to those of the STarT Back Screening Tool (SBT), and 4) if accuracy was improved by combining clinicians' expectations and the SBT. Outcomes were measured as LBP...

  10. [Predictive ability of clinical parameters of bacteremia in hemodialysed patients].

    Science.gov (United States)

    Egea, Ana L; Vilaró, Mario; De la Fuente, Jorge; Cuestas, Eduardo; Bongiovanni, María E

    2012-01-01

    No clinical events to differentiate bacteteremia from other pathologies in hemodialysis patients therefore the physicians makes diagnosis and treatment decisions based on clinical evidence an local epidemiology. the aim of this work was to study the frequency of microorganism isolated from blood culture of hemodialysis patients with suspected bacteraemia and evaluate Sensitivity (S) and Specificity (E) of medical diagnostic orientation in this cases of suspected Materials and methods: we performed an observational and prospective study for one year in hemodialysis patient with suspected bacteremia. We evaluated blood pressure, temperature (Tº), altered conscious state (AEC), respiratory frequency (FR), chills (ESC),diarrhea (DIARR), blood culture results and microbiological identification. We work with the mean ± standar desviation for continuous variables and frequencies for categorical variables We analyzed S, E, negative predictive value (VPN), positive predictive value (VPP) RESULTADOS: a total of 87 events with suspected bacteremia 34 (39%) were confirmed with positive blood culture the most common microorganisms were cocci Gram positive (CGP) 65%, Most relevant clinical variables were PCP ≥ 2 (VPN 81%), Tº ≥ 38 (VPN 76%) and AEC (E 98% y VPP 80%). CGP were the most prevalent microorganisms None of the clinical variables shows high S and E indicating low usefulness as a predictive tool of bacteremia Excepting AEC with E98% and VPP 80% but it would be necessary to evaluate this variable with a more number patient. Results justify to routine HC use like diagnostic tool.

  11. Generalized Majority Logic Criterion to Analyze the Statistical Strength of S-Boxes

    Science.gov (United States)

    Hussain, Iqtadar; Shah, Tariq; Gondal, Muhammad Asif; Mahmood, Hasan

    2012-05-01

    The majority logic criterion is applicable in the evaluation process of substitution boxes used in the advanced encryption standard (AES). The performance of modified or advanced substitution boxes is predicted by processing the results of statistical analysis by the majority logic criteria. In this paper, we use the majority logic criteria to analyze some popular and prevailing substitution boxes used in encryption processes. In particular, the majority logic criterion is applied to AES, affine power affine (APA), Gray, Lui J, residue prime, S8 AES, Skipjack, and Xyi substitution boxes. The majority logic criterion is further extended into a generalized majority logic criterion which has a broader spectrum of analyzing the effectiveness of substitution boxes in image encryption applications. The integral components of the statistical analyses used for the generalized majority logic criterion are derived from results of entropy analysis, contrast analysis, correlation analysis, homogeneity analysis, energy analysis, and mean of absolute deviation (MAD) analysis.

  12. Orthotropic ductile fracture criterion based on linear transformation

    Science.gov (United States)

    Yoon, J. W.; Zhang, S.; Stoughton, T. B.

    2017-09-01

    Accurate modelling of orthotropic ductile fracture is key to carry out reliable numerical prediction of rupture in plastic deformation of lightweight metals, such as ultra high strength steel, aluminum alloys, titanium alloys and magnesium alloys. Experiments are conducted for an aluminum alloy in shear, uniaxial tension, plane strain tension along the rolling direction, the diagonal direction and the transverse direction. Loading processes are recorded and fracture strain is measured by analysis of deformation with digital image correlation. First, isotropic fracture behavior is modeled by both linear model (Maximum Shear Stress (MSS) plus mean stress) and nonlinear model (Hosford yield function plus mean stress) considering different triaxiality conditions. It is observed that the mean stress model shows significant difference in the compression area compared to Mohr Coulomb-based normal stress model and a new isotropic model with the mean stress term shows a good correlation for AA 6k21. This approach is extended to an anisotropic ductile fracture criterion based on linear transformation. The anisotropic ductile fracture criterion is applied to model orthotropic fracture strain in shear, uniaxial tension and plane strain tension. The predicted anisotropy in ductile fracture is compared with experimental results for the verification of its accuracy. The comparison indicates that the proposed anisotropic ductile fracture criterion accurately models orthotropic ductile fracture in various loading conditions in shear, uniaxial tension and plane strain tension.

  13. Criterion validation of a stress measure: the Stress Overload Scale.

    Science.gov (United States)

    Amirkhan, James H; Urizar, Guido G; Clark, Sarah

    2015-09-01

    Validating stress scales poses problems beyond those of other psychological measures. Here, 3 studies were conducted to address those problems and assess the criterion validity of scores from a new theory-derived measure, the Stress Overload Scale (SOS; Amirkhan, 2012). In Study 1, the SOS was tested for its ability to predict postsemester illness in a sample of college students (n = 127). Even with precautions to minimize criterion contamination, scores were found to predict health problems in the month following a final exam on all of 5 different criteria. In Study 2, a community sample (n = 231) was used to test the SOS' ability to differentiate people in stressful circumstances from those in more relaxed contexts. SOS scores demonstrated excellent sensitivity (96%) and specificity (100%) in this general population application. In Study 3, the SOS was tested for its ability to differentiate salivary cortisol responses to a laboratory stressor in a group of pregnant women (n = 40). High scores were found to be associated with a blunted cortisol response, which is indicative of HPA-axis overload and typical of persons suffering chronic stress and stress-related pathology. Across all 3 studies, despite variations in the stressor, criterion, population, and methods, SOS scores emerged as valid indicators of stress. However, each study also introduced new problems that beg additional corrective steps in future stress-scale validity tests. These strategies, and the SOS' utility as a research and diagnostic tool in varied applications and populations, are discussed. (c) 2015 APA, all rights reserved.

  14. Heart rate variability predicts mortality in peritoneal dialysis patients.

    Science.gov (United States)

    Pei, Juan; Tang, Wen; Li, Li-Xian; Su, Chun-Yan; Wang, Tao

    2015-08-01

    The predictive value of heart rate variability (HRV) in peritoneal dialysis (PD) has never been tested. In this study, the associations between HRV measures and the mortality in 81 PD patients were analyzed. HRV was measured by using 5-min recordings of a stationary system by a standardized method. Both time domain and frequency domain parameters were analyzed. During a follow-up period of 43.78 ± 14.77 months, 25 patients died, four patients were transferred to hemodialysis. Of the 81 patients, the time domain parameters, such as the standard deviation of differences between adjacent normal sinus to normal sinus (NN) intervals (SDSD) and the square root of the mean of the squared differences between adjacent normal NN intervals (RMSSD), were higher; the frequency domain parameters, such as the ratio of low-frequency power to high-frequency power (LF/HF) and the normalized LF, were lower, and the normalized HF was higher in the non-survived group as compared with the survived group. A Cox proportional hazards model analysis revealed that, of the HRV measures, decrease of the normalized LF, LF/HF and increase of rMSSD, SDSD, normalized HF had significant predictive value for mortality. After adjustment for other univariate predictors including age, urine volume, renal Kt/V, high-sensitivity C-reactive protein (hs-CRP), the predictive value of decreased LF/HF remained significant. Kaplan-Meier survival analysis showed mortality rate was much higher in patients with a low LF/HF (median value of 1.56). The decreases of LF/HF which reflects impaired sympathetic nerve regulation is an independent predictor of mortality in PD patients.

  15. Multimodal movement prediction - towards an individual assistance of patients.

    Directory of Open Access Journals (Sweden)

    Elsa Andrea Kirchner

    Full Text Available Assistive devices, like exoskeletons or orthoses, often make use of physiological data that allow the detection or prediction of movement onset. Movement onset can be detected at the executing site, the skeletal muscles, as by means of electromyography. Movement intention can be detected by the analysis of brain activity, recorded by, e.g., electroencephalography, or in the behavior of the subject by, e.g., eye movement analysis. These different approaches can be used depending on the kind of neuromuscular disorder, state of therapy or assistive device. In this work we conducted experiments with healthy subjects while performing self-initiated and self-paced arm movements. While other studies showed that multimodal signal analysis can improve the performance of predictions, we show that a sensible combination of electroencephalographic and electromyographic data can potentially improve the adaptability of assistive technical devices with respect to the individual demands of, e.g., early and late stages in rehabilitation therapy. In earlier stages for patients with weak muscle or motor related brain activity it is important to achieve high positive detection rates to support self-initiated movements. To detect most movement intentions from electroencephalographic or electromyographic data motivates a patient and can enhance her/his progress in rehabilitation. In a later stage for patients with stronger muscle or brain activity, reliable movement prediction is more important to encourage patients to behave more accurately and to invest more effort in the task. Further, the false detection rate needs to be reduced. We propose that both types of physiological data can be used in an and combination, where both signals must be detected to drive a movement. By this approach the behavior of the patient during later therapy can be controlled better and false positive detections, which can be very annoying for patients who are further advanced in

  16. Early warning score predicts acute mortality in stroke patients

    DEFF Research Database (Denmark)

    Liljehult, J; Christensen, Thomas

    2016-01-01

    OBJECTIVES: Clinical deterioration and death among patients with acute stroke are often preceded by detrimental changes in physiological parameters. Systematic and effective tools to identify patients at risk of deterioration early enough to intervene are therefore needed. The aim of the study wa...... tool for identifying patients at risk of dying after acute stroke. Readily available physiological parameters are converted to a single score, which can guide both nurses and physicians in clinical decision making and resource allocation.......OBJECTIVES: Clinical deterioration and death among patients with acute stroke are often preceded by detrimental changes in physiological parameters. Systematic and effective tools to identify patients at risk of deterioration early enough to intervene are therefore needed. The aim of the study...... was to investigate whether the aggregate weighted track and trigger system early warning score (EWS) can be used as a simple observational tool to identify patients at risk and predict mortality in a population of patients with acute stroke. MATERIALS AND METHODS: Patients admitted with acute stroke...

  17. Machine learning landscapes and predictions for patient outcomes

    Science.gov (United States)

    Das, Ritankar; Wales, David J.

    2017-07-01

    The theory and computational tools developed to interpret and explore energy landscapes in molecular science are applied to the landscapes defined by local minima for neural networks. These machine learning landscapes correspond to fits of training data, where the inputs are vital signs and laboratory measurements for a database of patients, and the objective is to predict a clinical outcome. In this contribution, we test the predictions obtained by fitting to single measurements, and then to combinations of between 2 and 10 different patient medical data items. The effect of including measurements over different time intervals from the 48 h period in question is analysed, and the most recent values are found to be the most important. We also compare results obtained for neural networks as a function of the number of hidden nodes, and for different values of a regularization parameter. The predictions are compared with an alternative convex fitting function, and a strong correlation is observed. The dependence of these results on the patients randomly selected for training and testing decreases systematically with the size of the database available. The machine learning landscapes defined by neural network fits in this investigation have single-funnel character, which probably explains why it is relatively straightforward to obtain the global minimum solution, or a fit that behaves similarly to this optimal parameterization.

  18. Bone Marrow Pathology Predicts Mortality in Chronic Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Cheng-Hao Weng

    2015-01-01

    Full Text Available Introduction. A bone marrow biopsy is a useful procedure for the diagnosis and staging of various hematologic and systemic diseases. The objective of this study was to investigate whether the findings of bone marrow studies can predict mortality in chronic hemodialysis patients. Methods. Seventy-eight end-stage renal disease patients on maintenance hemodialysis underwent bone marrow biopsies between 2000 and 2011, with the most common indication being unexplained anemia followed by unexplained leukocytosis and leukopenia. Results. The survivors had a higher incidence of abnormal megakaryocyte distribution P=0.001, band and segmented cells P=0.021, and lymphoid cells P=0.029 than the nonsurvivors. The overall mortality rate was 38.5% (30/78, and the most common cause of mortality was sepsis (83.3% followed by respiratory failure (10%. In multivariate Cox regression analysis, both decreased (OR 3.714, 95% CI 1.671–8.253, P=0.001 and absent (OR 9.751, 95% CI 2.030–45.115, P=0.004 megakaryocyte distribution (normal megakaryocyte distribution as the reference group, as well as myeloid/erythroid ratio (OR 1.054, CI 1.012–1.098, P=0.011, were predictive of mortality. Conclusion. The results of a bone marrow biopsy can be used to assess the pathology, and, in addition, myeloid/erythroid ratio and abnormal megakaryocyte distribution can predict mortality in chronic hemodialysis patients.

  19. Predictive factors of small bowel patency in Crohn's disease patients

    Directory of Open Access Journals (Sweden)

    Andreia Albuquerque

    2016-02-01

    Full Text Available Background: Patency capsule was developed to avoid small bowel video capsule endoscopy retention, namely in patients with Crohn's disease. Aims: To evaluate the predictive factors of small bowel patency in Crohn's disease patients. Patients and methods: Retrospective analysis including 151 Crohn's disease patients submitted to patency capsule (Agile® Patency Capsule from 2011 to 2012. Patients that excreted the intact patency capsule were classified as having a patent small bowel (without patency capsule retention, other patients were considered to have negative patency of the small bowel (patency capsule retention. Results: Patients had a mean age of 41±14 years, 54% were female and 25% had been previously submitted to surgery. Stricturing disease was seen in 20% of cases and penetrating disease in 16% of cases. Left-sided colonic lesions and ileal strictures were observed at colonoscopy in 13% and 9% of patients, respectively. In our sample, 28% of patients had negative patency of the small bowel (patency capsule retention. In multivariate analysis, independent factors that were associated with negative patency of the small bowel in Crohn's disease patients were stricturing (OR 10.16, p < 0.001 and penetrating phenotypes (OR 11.73, p = 0.001, left-sided colonic lesions (OR 3.77, p = 0.038, ileal stricture (OR 9.76, p = 0.003; previous intestinal surgery was found to be protective (OR 0.16, p = 0.006. Conclusions: Stricturing or penetrating disease, ileal strictures, no previous surgery and left-sided colonic lesions were the factors associated with negative small bowel patency in Crohn's disease patients.

  20. Predicting neutropenia risk in patients with cancer using electronic data.

    Science.gov (United States)

    Pawloski, Pamala A; Thomas, Avis J; Kane, Sheryl; Vazquez-Benitez, Gabriela; Shapiro, Gary R; Lyman, Gary H

    2017-04-01

    Clinical guidelines recommending the use of myeloid growth factors are largely based on the prescribed chemotherapy regimen. The guidelines suggest that oncologists consider patient-specific characteristics when prescribing granulocyte-colony stimulating factor (G-CSF) prophylaxis; however, a mechanism to quantify individual patient risk is lacking. Readily available electronic health record (EHR) data can provide patient-specific information needed for individualized neutropenia risk estimation. An evidence-based, individualized neutropenia risk estimation algorithm has been developed. This study evaluated the automated extraction of EHR chemotherapy treatment data and externally validated the neutropenia risk prediction model. A retrospective cohort of adult patients with newly diagnosed breast, colorectal, lung, lymphoid, or ovarian cancer who received the first cycle of a cytotoxic chemotherapy regimen from 2008 to 2013 were recruited from a single cancer clinic. Electronically extracted EHR chemotherapy treatment data were validated by chart review. Neutropenia risk stratification was conducted and risk model performance was assessed using calibration and discrimination. Chemotherapy treatment data electronically extracted from the EHR were verified by chart review. The neutropenia risk prediction tool classified 126 patients (57%) as being low risk for febrile neutropenia, 44 (20%) as intermediate risk, and 51 (23%) as high risk. The model was well calibrated (Hosmer-Lemeshow goodness-of-fit test = 0.24). Discrimination was adequate and slightly less than in the original internal validation (c-statistic 0.75 vs 0.81). Chemotherapy treatment data were electronically extracted from the EHR successfully. The individualized neutropenia risk prediction model performed well in our retrospective external cohort.

  1. Predicting perioperative venous thromboembolism in Japanese gynecological patients.

    Directory of Open Access Journals (Sweden)

    Masae Ikeda

    Full Text Available OBJECTIVE: To develop a convenient screening method that can predict perioperative venous thromboembolism (VTE and identify patients at risk of fatal perioperative pulmonary embolism (PE. METHODS: Patients hospitalized for gynecological abdominal surgery (n = 183 underwent hematology tests and multidetector computed tomography (MDCT to detect VTE. All statistical analyses were carried out using the SPSS software program (PASWV19.0J. RESULTS: The following risk factors for VTE were identified by univariate analysis: plasmin-alpha2-plasmin inhibitor complex (PIC, thrombin-antithrombin III complex (TAT, and prolonged immobility (all p<0.001; age, neoadjuvant chemotherapy (NAC, malignancy, hypertension, past history of VTE, and hormone therapy (all p<0.01; and hemoglobin, transverse tumor diameter, ovarian disease, and menopause (all p<0.05. Multivariate analysis using these factors revealed that PIC, age, and transverse tumor diameter were significant independent determinants of the risk of VTE. We then calculated the incidence rate of perioperative VTE using PIC and transverse tumor diameter in patient groups stratified by age. In patients aged ≤40 years, PIC ≥1.3 µg/mL and a transverse tumor diameter ≥10 cm identified the high-risk group for VTE with an accuracy of 93.6%. For patients in their 50 s, PIC ≥1.3 µg/mL identified a high risk of VTE with an accuracy of 78.2%. In patients aged ≥60 years, a transverse tumor diameter ≥15 cm (irrespective of PIC or PIC ≥1.3 µg/mL identified the high-risk group with an accuracy of 82.4%. CONCLUSIONS: We propose new screening criteria for VTE risk that are based on PIC, transverse tumor diameter, and age. Our findings suggest the usefulness of these criteria for predicting the risk of perioperative VTE and for identifying patients with a high risk of fatal perioperative PE.

  2. Can we predict response to the McKenzie method in patients with acute low back pain? A secondary analysis of a randomized controlled trial.

    Science.gov (United States)

    Sheets, Charles; Machado, Luciana A C; Hancock, Mark; Maher, Chris

    2012-07-01

    To evaluate whether patients' treatment preferences, characteristics, or symptomatic response to assessment moderated the effect of the McKenzie method for acute low back pain (LBP). This study involved a secondary analysis of a previous RCT on the effect of adding the McKenzie method to the recommended first-line care for patients with acute non-specific LBP. 148 patients were randomized to the First-line Care Group (recommended first-line care alone) or the McKenzie Group (McKenzie method in addition to the first-line care) for a 3-week course of treatment. The primary outcome was pain intensity at 3 weeks. The ability of six patient characteristics to identify those who respond best to McKenzie method was assessed using interaction terms in linear regression models. The six investigated potential effect modifiers for response to the McKenzie method did not predict a more favorable response to this treatment. None of the point estimates for effect modification met our pre-specified criterion of clinical importance of a 1 point greater improvement in pain. For five of the six predictors, the 95% CI did not include our criterion for meaningful clinical improvement. We were unable to find any clinically useful effect modifiers for patients with acute LBP receiving the McKenzie method.

  3. Utility of predicted creatinine clearance using MDRD formula compared with other predictive formulas in Nigerian patients

    Directory of Open Access Journals (Sweden)

    Abefe Sanusi

    2009-01-01

    Full Text Available The new predictive formula generated during the study of Modification of Diet in Renal Disease (MDRD to estimate the glomerular filtration rate in chronic kidney disease (CKD patients was found to be superior to existing predictive formulas in all races including black Americans. We had previously published a study evaluating and comparing 5 predictive formulas and their applicability in Nigerian CKD patients and normal subjects. The existing data from this study were re-analyzed and the 5 previous formulas compared with the MDRD formula. All the pre-dictive formulas including the MDRD formula correlated significantly with measured creatinine clearance in CKD subjects and controls. Correlation Coefficient, (r ranged between 0.908-0.968 and Coefficient of Determination, (r 2 , ranged between 0.826-0.936. There was also good corre-lation between the measured and predicted CrCl in healthy state, though the r and r 2 values were weaker (0.718-0.957 and (0.516-0.916. Specifically, MDRD formula was only superior to Jelliffe and Gates and not so to Cockcroft and Gault, Hull, and Mawer equations in CRF. MDRD formula yielded r= 0.93 and r 2 = 0.86 and the values for Cockcroft and Gault, Hull and Mawer ranged between 0.96-0.97 and 0.93-0.94 respectively. In conclusion, MDRD formula, though useful and applicable was not superior to existing formulas. Cockcroft and Gault equation can still be used due to the ease of recall and its high correlation coefficient in health and disease states.

  4. Predictive factors for patient outcomes following open bedside tracheotomy.

    Science.gov (United States)

    Rayess, Hani M; Revenaugh, Peter C; Benninger, Michael S; Knott, P Daniel

    2013-04-01

    Open bedside tracheotomy (OBT) in the intensive care unit (ICU) has been advocated as a safe and more cost-effective alternative to tracheotomy performed in the operating room. The objective of this study is to determine predictive factors for postoperative outcomes, including decannulation and in-hospital mortality following OBT. Retrospective chart review. The charts of 330 consecutive adult patients who underwent OBT at a tertiary care medical center between January, 2005, and April, 2011, were reviewed. Perioperative variables including demographics, comorbidities, serological markers, and time to tracheotomy were collected and analyzed in relation to the endpoints of in-hospital mortality and decannulation rate. A total of 218 patients were included in the final analysis. The decannulation rate was 26.1% and inpatient mortality was 24.2%. On multivariate analysis, the inpatient mortality rate was significantly increased and the decannulation rate was significantly decreased among patients with concomitant cardiac or respiratory disease, or a coincident diagnosis of malignancy. ICU length of stay was increased by 4.5 days for each unit increase in cardiac comorbidity count. Admitting diagnosis and serological markers did not predict the rates of decannulation or in-hospital mortality. However, the presence of cardiac disease and/or oncologic comorbidities played a significant role in predicting hospital mortality or eventual decannulation. Several comorbidity combinations resulted in a greater than 60% likelihood of inpatient mortality. In this population, the overall benefit of an OBT may be debatable. Despite very high overall acuity levels, there were no serious procedural complications, indicating that bedside tracheotomy is safe in ill patients. Copyright © 2013 The American Laryngological, Rhinological, and Otological Society, Inc.

  5. Deep Patient: An Unsupervised Representation to Predict the Future of Patients from the Electronic Health Records

    Science.gov (United States)

    Miotto, Riccardo; Li, Li; Kidd, Brian A.; Dudley, Joel T.

    2016-05-01

    Secondary use of electronic health records (EHRs) promises to advance clinical research and better inform clinical decision making. Challenges in summarizing and representing patient data prevent widespread practice of predictive modeling using EHRs. Here we present a novel unsupervised deep feature learning method to derive a general-purpose patient representation from EHR data that facilitates clinical predictive modeling. In particular, a three-layer stack of denoising autoencoders was used to capture hierarchical regularities and dependencies in the aggregated EHRs of about 700,000 patients from the Mount Sinai data warehouse. The result is a representation we name “deep patient”. We evaluated this representation as broadly predictive of health states by assessing the probability of patients to develop various diseases. We performed evaluation using 76,214 test patients comprising 78 diseases from diverse clinical domains and temporal windows. Our results significantly outperformed those achieved using representations based on raw EHR data and alternative feature learning strategies. Prediction performance for severe diabetes, schizophrenia, and various cancers were among the top performing. These findings indicate that deep learning applied to EHRs can derive patient representations that offer improved clinical predictions, and could provide a machine learning framework for augmenting clinical decision systems.

  6. Predicting postoperative visual outcomes in cataract patients with maculopathy

    Directory of Open Access Journals (Sweden)

    Tamer A Macky

    2015-01-01

    Full Text Available Purpose: To assess the accuracy of the potential acuity meter (PAM in predicting postcataract surgery visual acuity outcome in patients with healed inactive maculopathies. Study Design: Prospective interventional clinical trial. Patients and Methods: Patients scheduled for phacoemulsification had preoperative and 1 month postoperative best-corrected visual acuity (BCVA, PAM test, fluorescein angiography, and macular optical coherence tomography. Patients were grouped to following preoperative BCVA: PRE1: 0.29 and better, PRE2: 0.25-0.13, and PRE3: 0.1 or worse; age: G1 70 years. PAM accuracy was divided into: Grade 1: Postoperative BCVA ≤1 or less line error of the PAM score, Grade 2: Between 1 and 2 lines error, and Grade 3: ≥3 lines or more error. Results: This study enrolled 57 patients with a mean age of 71.05 ± 6.78 years where 34 were females. There were 21 (36.84% patients with diabetic maculopathy and 36 (63.16% with age-related macular degeneration. The mean preoperative BCVA was 0.198 ± 0.12 (0.1-0.5. The mean PAM score was 0.442 ± 0.24 (0.1-1.3. The mean postoperative BCVA was 0.4352 ± 0.19 (0.17-1.00. The PAM score was in Grade 1, 2, and 3 in 46 (80.7%, 54 (94.7%, and 56 (98.2, respectively. There was a highly significant correlation between the PAM score and the postoperative BCVA (P < 0.001, Chi-square test. There was no correlation between the PAM test accuracy and age, gender, diagnosis, and preoperative BCVA (P = 0.661, 0.667, 0. 0.991, 0.833, Chi-square test; respectively. Conclusion: The PAM is an accurate method of predicting postoperative visual acuity for eyes with nuclear cataracts Grade I and II and inactive maculopathies.

  7. Emerging markers of cachexia predict survival in cancer patients.

    Science.gov (United States)

    Mondello, Patrizia; Lacquaniti, Antonio; Mondello, Stefania; Bolignano, Davide; Pitini, Vincenzo; Aloisi, Carmela; Buemi, Michele

    2014-11-16

    Cachexia may occur in 40% of cancer patients, representing the major cause of death in more than 20% of them. The aim of this study was to investigate the role of leptin, ghrelin and obestatin as diagnostic and predictive markers of cachexia in oncologic patients. Their impact on patient survival was also evaluated. 140 adults with different cancer diagnoses were recruited. Thirty healthy volunteers served as control. Serum ghrelin, obestatin and leptin were tested at baseline and after a follow-up period of 18 months. Ghrelin levels were significantly higher in cancer patients than in healthy subjects (573.31 ± 130 vs 320.20 ± 66.48 ng/ml, p obestatin (17.42 ± 7.12 vs 24.89 ± 5.54 ng/ml, p obestatin (AUC 0.798; sensitivity 74.5%; specificity 81.5%) and leptin (AUC 0.828; sensitivity 79%; specificity 73%) was superior to that of albumin (AUC 0.547; sensitivity 63%, specificity 69.4%) for detecting cachexia among cancer patients. On Cox multivariate analyses ghrelin (HR 1.02; 95% CI 1.01 - 1.03; p cancer patients.

  8. Working memory capacity predicts language comprehension in schizophrenic patients.

    Science.gov (United States)

    Condray, R; Steinhauer, S R; van Kammen, D P; Kasparek, A

    1996-05-01

    The association between language comprehension and working memory capacity was evaluated in 25 male DSM-III-R schizophrenic patients (14 inpatients; 11 outpatients), and in 11 male normal controls (no lifetime DSM-III-R disorder). Patients and controls did not differ significantly on age and education. Language comprehension was examined as a function of two types of processing demand: grammatical complexity (complex versus simple sentences) and presentation rate (accelerated versus conversational). Schizophrenic patients showed significantly reduced language comprehension and decreased working memory capacity for language, compared with controls. Patients showed general difficulty in comprehending accurately, rather than exhibiting problems with specific grammatical structures. Subject groups were highly accurate and did not differ in their ability to perceive the individual words in sentences presented at the accelerated rate (intelligibility). Presentation rate and grammatical complexity affected comprehension accuracy in all groups, however, with increases in rate and complexity producing decreases in understanding. Of most importance, theoretically, is the finding that working memory capacity predicted language comprehension accuracy in both schizophrenic patients and normal controls. Results suggest that language comprehension deficits in schizophrenic patients may involve a general dysfunction that is associated with working memory capacity for language.

  9. Predictive factors of clinical outcome in older surgical patients.

    Science.gov (United States)

    Bo, Mario; Cacello, Elena; Ghiggia, Federica; Corsinovi, Laura; Bosco, Francesca

    2007-01-01

    We aimed to identify predictors of mortality and length of stay-in hospital in older surgical patients. In 294 patients (mean age 74.1+/-6.4 years, 153 men), consecutively admitted to four surgery units of a university-teaching hospital to receive elective surgery (ES, 56.5%) or urgent surgery (US, 43.5%), the following variables were evaluated: demographics, clinical history (hypertension, diabetes mellitus (DM), coronary heart disease (CHD), heart failure (HF), cerebrovascular accidents, chronic obstructive pulmonary disease (COPD), active neoplasm, cognitive impairment, immobilization, pressure ulcers), physiopathology (Acute Physiology and Chronic Health Evaluation, APACHE, II), cognition/function (Short Portable Mental Status Questionnaire, SPMSQ; activity of daily living, ADL; instrumental activity of daily living, IADL), comorbidity (Cumulative Illness Rating Scale, CIRS, 1 and 2) and anesthesiology (American Score Anesthesiologist, ASA). The vital status of the patient at 1 month after discharge and the duration of hospitalization were recorded. One-month mortality rate was 6.1%. Low hemoglobin and body mass index (BMI) values, increasing ASA score, and, only in US patients, ADL dependence and higher CIRS 1 score, were independently predictive of mortality. Low hemoglobin levels and, only in ES patients, higher CIRS 1 score were associated with prolonged hospitalization. Prognostic indicators specific to older people have limited value in mortality models in elderly surgical patients.

  10. Aesthetical criterion in art and science

    CERN Document Server

    Milovanović, Miloš

    2016-01-01

    In the paper, the authors elaborate some recently published research concerning the originality of artworks in terms of self-organization in the complex systems physics. It has been demonstrated that the originality issue such conceived leads to the criterion of a substantial aesthetics whose applicability is not restricted to the fine arts domain only covering also physics, biology, cosmology and other fields construed in the complex systems terms. Moreover, it is about a truth criterion related to the traditional personality conception revealing the ontological context transcendent to the gnoseological dualism of subjective and objective reality that is characteristic of modern science and humanities. Thus, it is considered to be an aesthetical criterion substantiating art and science as well as the other developments of the postmodern era. Its impact to psychology, education, ecology, culture and other humanities is briefly indicated.

  11. Filamentary and hierarchical pictures - Kinetic energy criterion

    Science.gov (United States)

    Klypin, Anatoly A.; Melott, Adrian L.

    1992-01-01

    We present a new criterion for formation of second-generation filaments. The criterion called the kinetic energy ratio, KR, is based on comparison of peculiar velocities at different scales. We suggest that the clumpiness of the distribution in some cases might be less important than the 'coldness' or 'hotness' of the flow for formation of coherent structures. The kinetic energy ratio is analogous to the Mach number except for one essential difference. If at some scale KR is greater than 1, as estimated at the linear stage, then when fluctuations of this scale reach nonlinearity, the objects they produce must be anisotropic ('filamentary'). In the case of power-law initial spectra the kinetic ratio criterion suggests that the border line is the power-spectrum with the slope n = -1.

  12. One-Leg Standing Time of the Affected Side Moderately Predicts for Postdischarge Falls in Community Stroke Patients.

    Science.gov (United States)

    Yoshimoto, Yoshinobu; Oyama, Yukitsuna; Tanaka, Mamoru; Sakamoto, Asuka

    2016-08-01

    The purpose of the present study was to investigate the predictive accuracy of one-leg standing time at hospital discharge on falls in stroke patients. This was a retrospective cohort study. Participants included stroke patients (n = 65) who could walk when discharged from inpatient rehabilitation ward. To investigate the relationship between one-leg standing time and falls, logistic analysis was utilized with a criterion variable including the presence or absence of falls after 1-year hospital discharge as well as explanatory variables including Brunnstrom stage, knee extension strength on the affected side, Barthel Index, 10-m walking speed, and one-leg standing time on both sides. The accuracy of prediction by one-leg standing time was measured by the area under the curve of the receiver operating characteristic curve. Among the 65 patients, 38 (58.5%) experienced a fall 1 year after discharge. One-leg standing time of the affected side was not significantly associated with the falls (odds ratio: .89; 95% confidence interval: .79-1.01). When the fall incidents were assessed by area under the curve of the receiver operating characteristic curve, one-leg standing time of the affected side was observed to have increased marginally to .93 (95% confidence interval: .87-.99) as compared to the traditional prediction mode area under the curve (area under the curve .88; 95% confidence interval: .81-.97). One-leg standing time of the affected side may be considered as a moderately effective and simple assessment method for predicting postdischarge falls in a clinical setting. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. Predicting discharge location of hip fracture patients; the new discharge of hip fracture patients score

    OpenAIRE

    Vochteloo, Anne; Tuinebreijer, Wim; Maier, Andrea; Nelissen, Rob; Bloem, Rolf; Pilot, Peter

    2012-01-01

    textabstractPurpose This paper reports on the development and validity of a new instrument, called the discharge of hip fracture patients score (DHP), that predicts at admission the discharge location in patients living in their own home prior to hip fracture surgery. Methods A total of 310 patients aged 50 years and above were included. Risk factors for discharge to an alternative location (DAL) were analysed with a multivariable regression analysis taking the admission variables into accoun...

  14. Sampling Criterion for EMC Near Field Measurements

    DEFF Research Database (Denmark)

    Franek, Ondrej; Sørensen, Morten; Ebert, Hans

    2012-01-01

    An alternative, quasi-empirical sampling criterion for EMC near field measurements intended for close coupling investigations is proposed. The criterion is based on maximum error caused by sub-optimal sampling of near fields in the vicinity of an elementary dipole, which is suggested as a worst......-case representative of a signal trace on a typical printed circuit board. It has been found that the sampling density derived in this way is in fact very similar to that given by the antenna near field sampling theorem, if an error less than 1 dB is required. The principal advantage of the proposed formulation is its...

  15. Length of stay in surgical patients: nutritional predictive parameters revisited.

    Science.gov (United States)

    Almeida, Ana Isabel; Correia, Marta; Camilo, Maria; Ravasco, Paula

    2013-01-28

    Nutritional evaluation may predict clinical outcomes, such as hospital length of stay (LOS). We aimed to assess the value of nutritional risk and status methods, and to test standard anthropometry percentiles v. the 50th percentile threshold in predicting LOS, and to determine nutritional status changes during hospitalisation and their relation with LOS. In this longitudinal prospective study, 298 surgical patients were evaluated at admission and discharge. At admission, nutritional risk was assessed by Nutritional Risk Screening-2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST) and nutritional status by Subjective Global Assessment (SGA), involuntary % weight loss in the previous 6 months and anthropometric parameters; % weight loss and anthropometry were reassessed at discharge. At admission, risk/undernutrition results by NRS-2002 (Pclassification according to the 50th percentile threshold seem reliable undernutrition indicators.

  16. Predicting epiglottic collapse in patients with obstructive sleep apnoea.

    Science.gov (United States)

    Azarbarzin, Ali; Marques, Melania; Sands, Scott A; Op de Beeck, Sara; Genta, Pedro R; Taranto-Montemurro, Luigi; de Melo, Camila M; Messineo, Ludovico; Vanderveken, Olivier M; White, David P; Wellman, Andrew

    2017-09-01

    Obstructive sleep apnoea (OSA) is characterised by pharyngeal obstruction occurring at different sites. Endoscopic studies reveal that epiglottic collapse renders patients at higher risk of failed oral appliance therapy or accentuated collapse on continuous positive airway pressure. Diagnosing epiglottic collapse currently requires invasive studies (imaging and endoscopy). As an alternative, we propose that epiglottic collapse can be detected from the distinct airflow patterns it produces during sleep.23 OSA patients underwent natural sleep endoscopy. 1232 breaths were scored as epiglottic/nonepiglottic collapse. Several flow characteristics were determined from the flow signal (recorded simultaneously with endoscopy) and used to build a predictive model to distinguish epiglottic from nonepiglottic collapse. Additionally, 10 OSA patients were studied to validate the pneumotachograph flow features using nasal pressure signals.Epiglottic collapse was characterised by a rapid fall(s) in the inspiratory flow, more variable inspiratory and expiratory flow and reduced tidal volume. The cross-validated accuracy was 84%. Predictive features obtained from pneumotachograph flow and nasal pressure were strongly correlated.This study demonstrates that epiglottic collapse can be identified from the airflow signal measured during a sleep study. This method may enable clinicians to use clinically collected data to characterise underlying physiology and improve treatment decisions. Copyright ©ERS 2017.

  17. Microproteinuria Predicts Organ Failure in Patients Presenting with Acute Pancreatitis

    DEFF Research Database (Denmark)

    Bertilsson, Sara; Swärd, Per; Håkansson, Anders

    2016-01-01

    with the presence of systemic inflammatory response syndrome as well as trauma, although its association with AP is not well understood. The aim of this study was to investigate the value of microproteinuria to predict development of organ failure in AP. Methods: Consecutive AP patients were prospectively enrolled......Background and Aims: The disease course of acute pancreatitis (AP) ranges from mild and self-limiting to severe inflammation, associated with significant morbidity and mortality. At present, there are no universally accepted and reliable predictors for severity. Microproteinuria has been associated...

  18. Predicting At-Risk Patient Profiles from Big Prescription Data

    OpenAIRE

    Genevès, Pierre; Calmant, Thomas; Layaïda, Nabil; Lepelley, Marion; Artemova, Svetlana; Bosson, Jean-Luc

    2017-01-01

    We show how the analysis of very large amounts of drug prescription data make it possible to detect, on the day of hospital admission, patients at risk of developing complications during their hospital stay. We explore, for the first time, to which extent volume and variety of big prescription data help in constructing predictive models for the automatic detection of at-risk profiles.Our methodology is designed to validate our claims that: (1) drug prescription data on the day of admission co...

  19. Total tumor volume predicts recurrence of hepatocellular carcinoma after liver transplantation in patients beyond Milan or UCSF criteria.

    Science.gov (United States)

    Macaron, C; Hanouneh, I A; Lopez, R; Aucejo, F; Zein, N N

    2010-12-01

    The aim of tumor-based selection criteria in patients with hepatocellular carcinoma (HCC) is to prevent orthotopic liver transplantation (OLT) in patients likely to experience recurrence and to maximize OLT opportunities for those with a high likelihood of cure. Our aim was to assess total tumor volume (TTV) as a selection criterion for OLT in patients with HCC beyond Milan or University of California San Francisco criteria. We identified patients who underwent OLT for HCC between 2002 and 2008. TTV was calculated as the sum of the volumes of all tumors on pretransplant imaging before any therapy [(4/3)πr(3), where r is the maximum radius of each HCC]. Univariable and multivariable Cox proportional hazards regression analysis was used to assess factors associated with recurrence of HCC. 107 patients were included in the study. The mean follow-up was 21 months (interquartile range, 11.8-32.5), during which 13 patients (12.1%) experienced recurrence of HCC. Twenty-nine patients (27.1%) had HCC beyond the Milan criteria. A TTV cutoff value of 33.5 cm(3) was chosen on the basis of the risk of recurrence by using a receiver operating characteristic curve. Patients beyond the Milan criteria with TTV <33.5 experienced less recurrence (13.3% vs 42.8%; P < .001) and higher survival (13.3% vs 57.1%; P = .006) than those who were beyond the Milan criteria with TTV ≥33.5. Similarly, TTV predicted HCC recurrence and survival in those beyond the UCSF criteria. TTV is useful in identifying patients at risk of tumor recurrence and poor survival among those with tumor burden beyond traditional criteria, and it may improve the selection of OLT candidates. Copyright © 2010 Elsevier Inc. All rights reserved.

  20. Predicting outcome of patients with chest wall injury.

    Science.gov (United States)

    Pressley, Crystal M; Fry, William R; Philp, Allan S; Berry, Stepheny D; Smith, R Stephen

    2012-12-01

    Rib fractures occur in 10% of injured patients, are associated with morbidity and mortality, and frequently necessitate intensive care unit (ICU) care. A scoring system that identifies the risk for respiratory failure early in the evaluation process may allow early intervention to improve outcomes. The aim of this study was to test the hypothesis that a scoring system based on initial clinical findings can identify patients with rib fractures at greatest risk for morbidity and mortality. A simple scoring system to stratify risk was developed and applied to patients through a retrospective trauma registry review. Points were assigned as follows: age 65 years = 3 points; 5 fractures = 3 points; no pulmonary contusion = 0 points, mild pulmonary contusion = 1 point, severe pulmonary contusion = 2 points, bilateral pulmonary contusion = 3 points; and bilateral rib fracture absent = 0 points, bilateral rib fracture absent present = 2 points. A review of trauma registry patients with rib fractures (June 2008 to February 2010) at a state-designated level 1 trauma center was performed. Data reviewed included age, number of fractures, bilateral injury, presence of pulmonary contusion, classification of the contusion, length of hospital stay, mechanical ventilation, ICU admission, and length of stay. The scoring system was retrospectively applied to 649 patients to determine validity. A score ≤ 7 indicated lower mortality (24 of 579 [4.2%]) compared with patients with scores > 7 (10 of 70 [14.3%]) (Fisher's 2-sided P = .0018). Patients with scores ≤ 6 were less likely to be admitted to an ICU (29.7%) compared with those with scores ≥ 7 (56.7%) (P 4 (59.7%) (P 5 predicted a longer length of stay and a longer period of ventilation. This scoring system may assist in the earlier implementation of treatment strategies such epidural anesthesia, ventilation, and operative fixation of fractures. Copyright © 2012. Published by Elsevier Inc.

  1. The smoothness criterion as a trend diagnostic

    OpenAIRE

    P. Fogarty; Weber, N.C.

    2006-01-01

    The smoothness criterion is used in the design of symmetric moving average trend filters in time series and in graduation in actuarial studies. This measure of smoothness is used to motivate a diagnostic for determining the order of local polynomial trend.

  2. Early Stop Criterion from the Bootstrap Ensemble

    DEFF Research Database (Denmark)

    Hansen, Lars Kai; Larsen, Jan; Fog, Torben L.

    1997-01-01

    This paper addresses the problem of generalization error estimation in neural networks. A new early stop criterion based on a Bootstrap estimate of the generalization error is suggested. The estimate does not require the network to be trained to the minimum of the cost function, as required by ot...

  3. The definition and criterion of death.

    Science.gov (United States)

    Bernat, James L

    2013-01-01

    The definition and criterion of death have been rendered ambiguous by developments in organ support technology, particularly the positive-pressure ventilator and vasopressor medications, that uncouple the unitary loss of vital functions in death and create cases in which the brain has been destroyed while circulation and ventilation can be supported. Developing a biophilosophic analysis of the meaning of death before physicians can declare it requires four sequential steps: (1) agreement on the paradigm conditions that frame the analysis and clarify the task; (2) identifying the definition of death, which makes explicit the meaning of death that is accepted in our consensual usage of the term but that has become obscured by technology; (3) identifying the criterion of death that shows that the definition has been fulfilled, and that can be incorporated into a death statute; and (4) devising bedside tests of death for physicians to perform to satisfy the criterion. Although there is a strong consensus on death determination medical standards in countries around the world that has been enshrined into laws, and accepted by most societies and religions, there remains an active dispute among scholars on the precise definition and criterion of death. © 2013 Elsevier B.V. All rights reserved.

  4. Information criterion for the categorization quality evaluation

    Directory of Open Access Journals (Sweden)

    Michail V. Svirkin

    2011-05-01

    Full Text Available The paper considers the possibility of using the variation of information function as a quality criterion for categorizing a collection of documents. The performance of the variation of information function is being examined subject to the number of categories and the sample volume of the test document collection.

  5. A scale invariance criterion for LES parametrizations

    Directory of Open Access Journals (Sweden)

    Urs Schaefer-Rolffs

    2015-01-01

    Full Text Available Turbulent kinetic energy cascades in fluid dynamical systems are usually characterized by scale invariance. However, representations of subgrid scales in large eddy simulations do not necessarily fulfill this constraint. So far, scale invariance has been considered in the context of isotropic, incompressible, and three-dimensional turbulence. In the present paper, the theory is extended to compressible flows that obey the hydrostatic approximation, as well as to corresponding subgrid-scale parametrizations. A criterion is presented to check if the symmetries of the governing equations are correctly translated into the equations used in numerical models. By applying scaling transformations to the model equations, relations between the scaling factors are obtained by demanding that the mathematical structure of the equations does not change.The criterion is validated by recovering the breakdown of scale invariance in the classical Smagorinsky model and confirming scale invariance for the Dynamic Smagorinsky Model. The criterion also shows that the compressible continuity equation is intrinsically scale-invariant. The criterion also proves that a scale-invariant turbulent kinetic energy equation or a scale-invariant equation of motion for a passive tracer is obtained only with a dynamic mixing length. For large-scale atmospheric flows governed by the hydrostatic balance the energy cascade is due to horizontal advection and the vertical length scale exhibits a scaling behaviour that is different from that derived for horizontal length scales.

  6. The smoothness criterion as a trend diagnostic

    Directory of Open Access Journals (Sweden)

    2006-01-01

    Full Text Available The smoothness criterion is used in the design of symmetric moving average trend filters in time series and in graduation in actuarial studies. This measure of smoothness is used to motivate a diagnostic for determining the order of local polynomial trend.

  7. The smoothness criterion as a trend diagnostic

    Directory of Open Access Journals (Sweden)

    N. C. Weber

    2006-02-01

    Full Text Available The smoothness criterion is used in the design of symmetric moving average trend filters in time series and in graduation in actuarial studies. This measure of smoothness is used to motivate a diagnostic for determining the order of local polynomial trend.

  8. Criterion vs. Norm-referenced Testing.

    Science.gov (United States)

    Pimsleur, Paul

    1975-01-01

    A norm-referenced evaluation system, which evaluates the student in comparison to his peers, is rejected in favor of a criterion-referenced system. The latter, which rates the performance of a student on an absolute standard, makes for an individualized approach. Two kinds of tests are distinguished, the formative, administered during the course…

  9. Diagnostic accuracy of predicting somatization from patients' ICD-9 diagnoses.

    Science.gov (United States)

    Smith, Robert C; Gardiner, Joseph C; Luo, Zhehui; Rost, Kathryn

    2009-04-01

    To hypothesize in a new and different population that administrative database (ADB) screening would identify somatizing patients by increasing numbers of visits, female gender, and greater percent of International Classification of Diseases, 9th Edition (ICD-9) primary diagnosis codes in musculoskeletal, nervous, gastrointestinal (GI), and ill-defined body systems. We labeled these codes as having "somatization potential." Our earlier study demonstrated that ICD-9 codes and other data from the ADB effectively identified somatization. Using a prospective observational design in a staff model health maintenance organization, we evaluated 1364 patients aged 18 to 65 years who had > or =8 visits yearly in the 2 years before study. Clinician raters applied a reliable method of medical chart review to identify patients meeting the criteria for somatization. We randomly selected 2/3 for the derivation set (n = 901) for logistic regression to evaluate the contribution of potential ADB correlates (age, gender, all encounters, primary diagnosis codes (ICD-9), revenue codes, and charges) of a diagnosis of somatization. This prediction rule was then applied to the remaining 1/3 of subjects, the validation set (n = 463). Patients averaged 47.1 years, 12.8 visits per year, and 71.6% were female; 319 had somatization. Age, visits, and somatization potential were associated with clinician-rated somatization, with a c-statistic 0.72 in the derivation set and 0.68 in the validation set. These data support our earlier findings that selected ICD-9 diagnoses in the ADB predict somatization, suggesting their potential in identifying a common, costly, and usually unrecognized problem.

  10. Anorectal function evaluation and predictive factors for faecal incontinence in 600 patients

    NARCIS (Netherlands)

    Lam, T.J.; Kuik, D.J.; Felt-Bersma, R.J.F.

    2012-01-01

    Aim Anorectal function was assessed in patients with and without faecal incontinence (FI) Risk factors predictive for FI were determined. Method Between 2003 and 2009, all consecutive patients referred were assessed by questionnaire, anorectal manometry and anal endosonography. Predictive factors

  11. Criterion validity of the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale for the diagnosis of sleep disorders.

    Science.gov (United States)

    Nishiyama, Takeshi; Mizuno, Tomoki; Kojima, Masayo; Suzuki, Sadao; Kitajima, Tsuyoshi; Ando, Kayoko Bhardwaj; Kuriyama, Shinichi; Nakayama, Meiho

    2014-04-01

    (1) To examine criterion validity of the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) using obstructive sleep apnea (OSA), periodic limb movement disorder (PLMD), rapid eye movement sleep behavior disorder (RBD), and narcolepsy as criterion standard. (2) To summarize the evidence for criterion validity of the ESS for the diagnosis of OSA by a meta-analysis that combines the current and previous studies. (3) To investigate the determinants of the PSQI and ESS scores. The PSQI and ESS as well as the Hospital Anxiety and Depression Scale (HADS), which measures anxiety and depression levels, were administered to 367 patients consecutively referred to a sleep clinic. They underwent overnight polysomnography (PSG) and the multiple sleep latency test if narcolepsy was suspected. The area under the receiver operating characteristic curves for the ESS and PSQI (and its subscale) were <0.9, meaning that these questionnaires were not highly accurate for predicting the four sleep disorders. The meta-analysis found that the ESS had no value in identifying OSA. The variable that most strongly influenced PSQI or ESS scores was the HADS score. The PSQI and ESS should no longer be used as a screening or diagnostic instrument for the four PSG-defined sleep disorders, especially in a low-risk population. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. A Two-Gene Signature, SKI and SLAMF1, Predicts Time-to-Treatment in Previously Untreated Patients with Chronic Lymphocytic Leukemia

    Science.gov (United States)

    Schweighofer, Carmen D.; Coombes, Kevin R.; Barron, Lynn L.; Diao, Lixia; Newman, Rachel J.; Ferrajoli, Alessandra; O'Brien, Susan; Wierda, William G.; Luthra, Rajyalakshmi; Medeiros, L. Jeffrey; Keating, Michael J.; Abruzzo, Lynne V.

    2011-01-01

    We developed and validated a two-gene signature that predicts prognosis in previously-untreated chronic lymphocytic leukemia (CLL) patients. Using a 65 sample training set, from a cohort of 131 patients, we identified the best clinical models to predict time-to-treatment (TTT) and overall survival (OS). To identify individual genes or combinations in the training set with expression related to prognosis, we cross-validated univariate and multivariate models to predict TTT. We identified four gene sets (5, 6, 12, or 13 genes) to construct multivariate prognostic models. By optimizing each gene set on the training set, we constructed 11 models to predict the time from diagnosis to treatment. Each model also predicted OS and added value to the best clinical models. To determine which contributed the most value when added to clinical variables, we applied the Akaike Information Criterion. Two genes were consistently retained in the models with clinical variables: SKI (v-SKI avian sarcoma viral oncogene homolog) and SLAMF1 (signaling lymphocytic activation molecule family member 1; CD150). We optimized a two-gene model and validated it on an independent test set of 66 samples. This two-gene model predicted prognosis better on the test set than any of the known predictors, including ZAP70 and serum β2-microglobulin. PMID:22194822

  13. A two-gene signature, SKI and SLAMF1, predicts time-to-treatment in previously untreated patients with chronic lymphocytic leukemia.

    Directory of Open Access Journals (Sweden)

    Carmen D Schweighofer

    Full Text Available We developed and validated a two-gene signature that predicts prognosis in previously-untreated chronic lymphocytic leukemia (CLL patients. Using a 65 sample training set, from a cohort of 131 patients, we identified the best clinical models to predict time-to-treatment (TTT and overall survival (OS. To identify individual genes or combinations in the training set with expression related to prognosis, we cross-validated univariate and multivariate models to predict TTT. We identified four gene sets (5, 6, 12, or 13 genes to construct multivariate prognostic models. By optimizing each gene set on the training set, we constructed 11 models to predict the time from diagnosis to treatment. Each model also predicted OS and added value to the best clinical models. To determine which contributed the most value when added to clinical variables, we applied the Akaike Information Criterion. Two genes were consistently retained in the models with clinical variables: SKI (v-SKI avian sarcoma viral oncogene homolog and SLAMF1 (signaling lymphocytic activation molecule family member 1; CD150. We optimized a two-gene model and validated it on an independent test set of 66 samples. This two-gene model predicted prognosis better on the test set than any of the known predictors, including ZAP70 and serum β2-microglobulin.

  14. Shrinkage Porosity Criterion and Its Application to A 5.5 Ton Steel Ingot

    Directory of Open Access Journals (Sweden)

    Zhang C.

    2016-06-01

    Full Text Available In order to predict the distribution of shrinkage porosity in steel ingot efficiently and accurately, a criterion R√L and a method to obtain its threshold value were proposed. The criterion R√L was derived based on the solidification characteristics of steel ingot and pressure gradient in the mushy zone, in which the physical properties, the thermal parameters, the structure of the mushy zone and the secondary dendrite arm spacing were all taken into consideration. The threshold value of the criterion R√L was obtained with combination of numerical simulation of ingot solidification and total solidification shrinkage rate. Prediction of the shrinkage porosity in a 5.5 ton ingot of 2Cr13 steel with criterion R√L>0.21 m · °C1/2 · s−3/2 agreed well with the results of experimental sectioning. Based on this criterion, optimization of the ingot was carried out by decreasing the height-to-diameter ratio and increasing the taper, which successfully eliminated the centreline porosity and further proved the applicability of this criterion.

  15. Linear transformation based orthotropic shear ductile fracture criterion for lightweight metals

    Science.gov (United States)

    Lou, Yanshan; Yoon, Jeong Whan

    2017-10-01

    Accurate modelling of orthotropic ductile fracture is key to carry out reliable numerical prediction of rupture in plastic deformation of lightweight metals, such as ultra high strength steel, aluminum alloys, titanium alloys and magnesium alloys. Experiments are conducted for an aluminum alloy in shear, uniaxial tension, plane strain tension along rolling direction, diagonal direction and transverse direction as well as the balanced biaxial tension of the Nakajima test. Loading processes are recorded and fracture strain is measured by analysis of deformation with digital image correlation. Fracture behavior is modelled by a shear ductile fracture criterion of DF2016 along different loading directions. It is observed that anisotropy in ductile fracture cannot be correctly described by an isotropic ductile fracture criterion. Thus, an anisotropic ductile fracture criterion is proposed from a shear ductile fracture criterion of DF2014 based on linear transformation of the plastic strain vector into an isotropic equivalent damage strain vector. The anisotropic ductile fracture criterion is applied to model orthotropic fracture strain in shear, uniaxial tension and plane strain tension. The predicted anisotropy in ductile fracture is compared with experimental results for the verification of its accuracy. The comparison indicates that the proposed anisotropic ductile fracture criterion accurately models orthotropic ductile fracture in various loading conditions in shear, uniaxial tension and plane strain tension.

  16. Lung Injury Prediction Score Is Useful in Predicting Acute Respiratory Distress Syndrome and Mortality in Surgical Critical Care Patients

    Directory of Open Access Journals (Sweden)

    Zachary M. Bauman

    2015-01-01

    Full Text Available Background. Lung injury prediction score (LIPS is valuable for early recognition of ventilated patients at high risk for developing acute respiratory distress syndrome (ARDS. This study analyzes the value of LIPS in predicting ARDS and mortality among ventilated surgical patients. Methods. IRB approved, prospective observational study including all ventilated patients admitted to the surgical intensive care unit at a single tertiary center over 6 months. ARDS was defined using the Berlin criteria. LIPS were calculated for all patients and analyzed. Logistic regression models evaluated the ability of LIPS to predict development of ARDS and mortality. A receiver operator characteristic (ROC curve demonstrated the optimal LIPS value to statistically predict development of ARDS. Results. 268 ventilated patients were observed; 141 developed ARDS and 127 did not. The average LIPS for patients who developed ARDS was 8.8±2.8 versus 5.4±2.8 for those who did not (p<0.001. An ROC area under the curve of 0.79 demonstrates LIPS is statistically powerful for predicting ARDS development. Furthermore, for every 1-unit increase in LIPS, the odds of developing ARDS increase by 1.50 (p<0.001 and odds of ICU mortality increase by 1.22 (p<0.001. Conclusion. LIPS is reliable for predicting development of ARDS and predicting mortality in critically ill surgical patients.

  17. Mortality Prediction in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage

    Directory of Open Access Journals (Sweden)

    Alexis Suárez Quesada

    2016-03-01

    Full Text Available Background: spontaneous intracerebral hemorrhage is the deadliest, most disabling, and least treatable form of stroke. No therapy has proven to improve its outcome or reduce its mortality. Objective: to identify predictors of mortality in patients with spontaneous supratentorial intracerebral hemorrhage. Methods: a single cohort study was conducted involving 176 patients admitted consecutively to the stroke ward of the Carlos Manuel de Céspedes Provincial General Hospital with neuroimaging and clinical diagnosis of spontaneous supratentorial intracerebral hemorrhage from January 2013 to November 2015. Independent predictors were obtained using multivariable logistic regression. Results: seventy four point four percent of the patients were hypertensive. The median age among those who died was 67.45 ± 14.84 years. Forty three point eight percent of the patients under study died. Subjects with fatal outcome had lower score on the Glasgow Coma Scale (10.00 ± 3.47 vs. 14.00 ± 1.93, higher hematoma volume expressed in cubic centimeters (26.27 ± 36.86 vs. 6.19 ± 19.59, and displacement of the midline structures (2.00 ± 5.95 vs. 0.00 ± 4.49. The following predictors were identified: Glasgow score ≤ 10 points (Exp (B: 10.74; 95 % CI=4.69 to 24.59, hematoma volume ≥ 20 cm3 (Exp (B: 4.44; 95 % CI= 1.95 to 10.06, and pulse pressure ≥ 60 mmHg (Exp (B: 2.42, 95 % CI=1.10 to 5.33. The area under the ROC curve was 0.85. Conclusions: the Glasgow Coma Scale is the most significant independent variable to predict mortality in patients with spontaneous intracerebral hemorrhage.

  18. Derivation and validation of a clinical prediction rule for delirium in patients admitted to a medical ward: an observational study

    Science.gov (United States)

    Martinez, Juan Antonio; Belastegui, Ana; Basabe, Iban; Goicoechea, Xabier; Aguirre, Cristina; Lizeaga, Nerea; Urreta, Iratxe; Emparanza, Jose Ignacio

    2012-01-01

    Objectives To develop and validate a simple clinical prediction rule, based on variables easily measurable at admission, to identify patients at high risk of developing delirium during their hospital stay on an internal medicine ward. Design Prospective study of two cohorts of patients admitted between 1 May and 30 June 2008 (derivation cohort), and between 1 May and 30 June 2009 (validation cohort). Setting A tertiary hospital in Donostia-Gipuzkoa (Spain). Participants In total 397 patients participated in the study. The mean age and incidence of delirium were 75.9 years and 13%, respectively, in the derivation cohort, and 75.8 years and 25% in the validation cohort. Main outcome measures The predictive variables analysed and finally included in the rule were: being aged 85 years old or older, being dependent in five or more activities of daily living, and taking two or more psychotropic drugs (antipsychotics, benzodiazepines, antidepressants, anticonvulsant and/or antidementia drugs). The variable of interest was delirium as defined by the short Confusion Assessment Method, which assesses four characteristics: acute onset and fluctuating course, inattention, disorganised thinking and altered level of consciousness. Results We developed a rule in which the individual risk of delirium is obtained by adding one point for each criterion met (age≥85, high level of dependence, and being on psychotropic medication). The result is considered positive if the score is ≥1. The rule accuracy was: sensitivity=93.4% (95% CI 85.5% to 97.2%), specificity=60.6% (95% CI 54.1% to 66.8%), positive predictive value=44.4% (95% CI 36.9% to 52.1%) and negative predictive value=96.5% (95% CI: 92% to 98.5%). The area under the receiver operator characteristic (ROC) curve was 0.85 for the validation cohort. Conclusions The presence or absence of any of the three predictive factors (age≥85, high level of dependence and psychotropic medication) allowed us to classify patients on

  19. Predicting costs of care in heart failure patients

    Directory of Open Access Journals (Sweden)

    Smith David H

    2012-11-01

    Full Text Available Abstract Background Identifying heart failure patients most likely to suffer poor outcomes is an essential part of delivering interventions to those most likely to benefit. We sought a comprehensive account of heart failure events and their cumulative economic burden by examining patient characteristics that predict increased cost or poor outcomes. Methods We collected electronic medical data from members of a large HMO who had a heart failure diagnosis and an echocardiogram from 1999–2004, and followed them for one year. We examined the role of demographics, clinical and laboratory findings, comorbid disease and whether the heart failure was incident, as well as mortality. We used regression methods appropriate for censored cost data. Results Of the 4,696 patients, 8% were incident. Several diseases were associated with significantly higher and economically relevant cost changes, including atrial fibrillation (15% higher, coronary artery disease (14% higher, chronic lung disease (29% higher, depression (36% higher, diabetes (38% higher and hyperlipidemia (21% higher. Some factors were associated with costs in a counterintuitive fashion (i.e. lower costs in the presence of the factor including age, ejection fraction and anemia. But anemia and ejection fraction were also associated with a higher death rate. Conclusions Close control of factors that are independently associated with higher cost or poor outcomes may be important for disease management. Analysis of costs in a disease like heart failure that has a high death rate underscores the need for economic methods to consider how mortality should best be considered in costing studies.

  20. Predicting feeding tube and tracheotomy dependence in laryngeal cancer patients.

    Science.gov (United States)

    Lavo, John Patrick; Ludlow, David; Morgan, Matt; Caldito, Gloria; Nathan, Cherie-Ann

    2017-03-01

    The two scales reliably measure laryngeal edema and dysfunction in laryngeal cancer patients. The eight categories from these scales, and abnormal pharyngeal squeeze, can be used to form a new rating scale intended to help clinicians identify and circumvent swallowing complications after chemo-irradiation. The objectives were to compare two laryngeal edema rating scales in laryngeal cancer patients and determine if post-radiation +/- chemotherapy edema predicts dependence on a feeding tube and/or tracheostomy. A retrospective chart review between 2005-2008 revealed 28 laryngeal cancer patients status post-radiation +/- chemotherapy, with video laryngoscopies performed within 6 months after treatment. Four raters evaluated videos based on the Laryngopharyngeal Edema Scale (LES) and the Reflux Finding Score (RFS). Tracheostomy and feeding tube outcomes were then correlated with the two scales. Feeding tube and tracheostomy dependence were associated with pre-treatment vocal cord paralysis, advanced T stage, and chemoradiation. Eight categories from the LES and RFS scales were significantly associated with the need for a feeding tube.

  1. Minimum shear stress range: a criterion for crack path determination

    Science.gov (United States)

    Pereira, K.; Abdel Wahab, M.

    2017-05-01

    For problems under proportional mixed-mode conditions, various criteria are used to predict fatigue crack growth directions, most achieving reasonable accuracy. The crack propagation angle is often obtained by maximizing a quantity (for instance, energy or stresses) as function of the stress intensity factors KI and KII. This maximization is generally performed at the instant of maximum fatigue loading and a stress analysis at this instant is sufficient to predict the crack propagation angle and thus the fatigue crack growth direction. However, under non-proportional loading, the maximum values of KI and KII may occur at different instants of the fatigue cycle and so a simple analysis at the maximum loading instant is not appropriate; it is necessary to consider the entire loading cycle history. One possible criterion to treat problems under these circumstances is the minimum shear stress range criterion (MSSR). This paper presents a brief discussion of the most common criteria used for determination of crack propagation direction, focusing on an implementation of MSSR. Its performance is assessed in different conditions and the results are compared to literature data.

  2. Factors predicting recovery from suicide in attempted suicide patients.

    Science.gov (United States)

    Sun, Fan-Ko; Lu, Chu-Yun; Tseng, Yun Shan; Chiang, Chun-Ying

    2017-02-23

    The aim of this study was to explore the factors predicting suicide recovery and to provide guidance for healthcare professionals when caring for individuals who have attempted suicide. The high rate of suicide is a global health problem. Suicide prevention has become an important issue in contemporary mental health. Most suicide research has focused on suicidal prevention and care. There is a lack of research on the factors predicting suicidal recovery. A cross-sectional design was adopted. A correlational study with a purposive sample of 160 individuals from a suicide prevention centre in southern Taiwan was conducted. The questionnaires included the Brief Symptom Rating Scale-5, Suicidal Recovery Assessment Scale and Beck Hopelessness Scale. Descriptive statistics and linear regressions were used for the analysis. The mean age of the participants was 40.2 years. Many participants were striving to make changes to create a more stable and fulfilling life, had an improved recovery from suicide and had a good ability to adapt or solve problems. The linear regression showed that the Beck Hopelessness Scale scores (ß = -.551, p suicidal behaviour (ß = -.145, p = .008) were significant predictors of individuals' recovery from suicide. They accounted for 57.1% of the variance. Suicidal individuals who have a lower level of hopelessness, a better ability to cope with their mental condition and fewer past suicidal behaviours may better recover from suicide attempts. The nurses could use the results of this study to predict recovery from suicide in patients with attempted suicide. © 2017 John Wiley & Sons Ltd.

  3. Predicting diabetic nephropathy in insulin-dependent patients

    DEFF Research Database (Denmark)

    Mogensen, C E; Christensen, Cramer

    1984-01-01

    We studied whether microalbuminuria (urinary albumin excretion rates of 15 to 150 micrograms per minute) would predict the development of increased proteinuria in Type I diabetes. We also studied the influence of glomerular filtration rate, renal blood flow, and blood pressure on the later...... development of proteinuria. Forty-four patients who had had Type I diabetes for at least seven years and who had albumin excretion rates below 150 micrograms per minute were studied from 1969 to 1976, and 43 were restudied in 1983. Of the 14 who initially had albumin excretion rates at or above 15 micrograms...... per minute, 12 had clinically detectable proteinuria (over 500 mg of protein per 24 hours) or an albumin excretion rate above 150 micrograms per minute at the later examination. Of the 29 who initially had albumin excretion rates below 15 micrograms per minute, none had clinically detectable...

  4. The qualitative criterion of transient angle stability

    DEFF Research Database (Denmark)

    Lyu, R.; Xue, Y.; Xue, F.

    2015-01-01

    In almost all the literatures, the qualitative assessment of transient angle stability extracts the angle information of generators based on the swing curve. As the angle (or angle difference) of concern and the threshold value rely strongly on the engineering experience, the validity and robust...... that misjudgment would be taken if an angle (or angle difference) of concern departing from the concept of the controlling mode or a constant threshold value is used in the criterion....

  5. On the hodological criterion for homology

    Directory of Open Access Journals (Sweden)

    Macarena eFaunes

    2015-06-01

    Full Text Available Owen’s pre-evolutionary definition of a homologue as the same organ in different animals under every variety of form and function and its redefinition after Darwin as the same trait in different lineages due to common ancestry entail the same heuristic problem: how to establish sameness. Although different criteria for homology often conflict, there is currently a generalized acceptance of gene expression as the best criterion. This gene-centered view of homology results from a reductionist and preformationist concept of living beings. Here, we adopt an alternative organismic-epigenetic viewpoint, and conceive living beings as systems whose identity is given by the dynamic interactions between their components at their multiple levels of composition. We posit that there cannot be an absolute homology criterion, and instead, homology should be inferred from comparisons at the levels and developmental stages where the delimitation of the compared trait lies. In this line, we argue that neural connectivity, i.e., the hodological criterion, should prevail in the determination of homologies between brain supra-cellular structures, such as the vertebrate pallium.

  6. Social influences on adaptive criterion learning.

    Science.gov (United States)

    Cassidy, Brittany S; Dubé, Chad; Gutchess, Angela H

    2015-07-01

    People adaptively shift decision criteria when given biased feedback encouraging specific types of errors. Given that work on this topic has been conducted in nonsocial contexts, we extended the literature by examining adaptive criterion learning in both social and nonsocial contexts. Specifically, we compared potential differences in criterion shifting given performance feedback from social sources varying in reliability and from a nonsocial source. Participants became lax when given false positive feedback for false alarms, and became conservative when given false positive feedback for misses, replicating prior work. In terms of a social influence on adaptive criterion learning, people became more lax in response style over time if feedback was provided by a nonsocial source or by a social source meant to be perceived as unreliable and low-achieving. In contrast, people adopted a more conservative response style over time if performance feedback came from a high-achieving and reliable source. Awareness that a reliable and high-achieving person had not provided their feedback reduced the tendency to become more conservative, relative to those unaware of the source manipulation. Because teaching and learning often occur in a social context, these findings may have important implications for many scenarios in which people fine-tune their behaviors, given cues from others.

  7. Age Effects in Adaptive Criterion Learning.

    Science.gov (United States)

    Cassidy, Brittany S; Gutchess, Angela H

    2016-11-01

    Although prior work has examined age-related changes to criterion placement and flexibility, no study tested these constructs through a paradigm that employs adaptive feedback to encourage specific criterion changes. The goal of this study was to assess age differences in how young and older adults adapt and shift criteria in recognition memory decisions based on trial-by-trial feedback. Young and older adults completed an adaptive criterion learning paradigm. Over 3 study/test cycles, a biased feedback technique at test encouraged more liberal or strict responding by false-positive feedback toward false alarms or misses. Older adults were more conservative than young, even when feedback first encouraged a liberal response bias, and older adults adaptively placed criteria in response to biased feedback, much like young adults. After first being encouraged to respond conservatively, older adults shifted criteria less than young when feedback encouraged more lenient responding. These findings evidence labile adaptive criteria placement and criteria shifting with age. However, age-related tendencies toward conservative response biases may limit the extent to which criteria can be shifted in a lenient direction. © The Author 2015. 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.

  8. Criterion and Incremental Validity of the Emotion Regulation Questionnaire

    Directory of Open Access Journals (Sweden)

    Christos A. Ioannidis

    2015-03-01

    Full Text Available Although research on emotion regulation (ER is developing, little attention has been paid to the predictive power of ER strategies beyond established constructs. The present study examined the incremental validity of the Emotion Regulation Questionnaire (ERQ; Gross & John, 2003, which measures cognitive reappraisal and expressive suppression, over and above the Big Five personality traits. It also extended the evidence for the measure’s criterion validity to yet unexamined criteria. A university student sample (N = 203 completed the ERQ, a measure of the Big Five, and relevant cognitive and emotion-laden criteria. Cognitive reappraisal predicted positive affect beyond personality, as well as experiential flexibility and constructive self-assertion beyond personality and affect. Expressive suppression explained incremental variance in negative affect beyond personality and in experiential flexibility beyond personality and general affect. No incremental effects were found for worry, social anxiety, rumination, reflection, and preventing negative emotions. Implications for the construct validity and utility of the ERQ are discussed.

  9. Patient-rated health status predicts prognosis following percutaneous coronary intervention with drug-eluting stenting

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Versteeg, Henneke; Denollet, Johan

    2011-01-01

    In patients treated with percutaneous coronary intervention (PCI) with the paclitaxel-eluting stent, we examined whether patient-rated health status predicts adverse clinical events.......In patients treated with percutaneous coronary intervention (PCI) with the paclitaxel-eluting stent, we examined whether patient-rated health status predicts adverse clinical events....

  10. Prospectively screening for eligible patients was inaccurate in predicting patient recruitment of orthopedic randomized trials.

    Science.gov (United States)

    Kooistra, Bauke W; Dijkman, Bernadette G; Guyatt, Gordon H; Sprague, Sheila; Tornetta, Paul; Bhandari, Mohit

    2011-05-01

    To compare the accuracy of estimates of potential recruitment from a prospective 8-week screening study compared with a retrospective chart review across sites participating in two fracture management trials. During the planning phase of two large, multicenter, randomized controlled fracture management trials, 74 clinical sites provided estimates of the annual recruitment rate both retrospectively (based on chart reviews) and prospectively. The prospective estimate was generated by screening, for 8 weeks, all incoming patients for eligibility in the concerning trial, without actually enrolling any patient. We compared these prospective and retrospective estimates with one another (for 74 sites in the two trials) and with actual 1-year recruitment rates in the definitive trial (for nine sites in one trial). There was a median difference of four patients (interquartile range: -14 to 18 patients; P=0.89) between a center's prospective estimate and its retrospective estimate. Both predictions were overestimations of recruitment in the definitive trial; only 31% (95% confidence interval [CI]: 28, 35) of retrospectively estimated patients, and 31% (95% CI: 27, 35) of prospectively estimated patients were recruited in the definitive trials. Compared with relatively simple chart reviews, prospectively screening for eligible patients at clinical sites, which is associated with substantial costs, did not result in more accurate predictions of accrual in large, multicenter, randomized controlled trials. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. Electroencephalogram Predicts Outcome in Patients With Postanoxic Coma During Mild Therapeutic Hypothermia

    NARCIS (Netherlands)

    Cloostermans, M.C.; Hofmeijer, Jeannette; Trof, Ronald J.; Blans, Michiel J.; Beishuizen, Albertus; van Putten, Michel Johannes Antonius Maria

    2015-01-01

    Objective: To assess the value of electroencephalogram for prediction of outcome of comatose patients after cardiac arrest treated with mild therapeutic hypothermia. Design: Prospective cohort study. Setting: Medical ICU. Patients: One hundred forty-two patients with postanoxic encephalopathy after

  12. Plasma mitochondrial DNA at admission can predict the outcome of acute trauma patients admitted to ICU

    Directory of Open Access Journals (Sweden)

    Ahmed Abdalla Mohamed

    2016-10-01

    Conclusion: High at ED admission plasma ccf-mtDNA levels could predict development of additional morbidities during ICU stay of acute trauma patients and showed high sensitivity for prediction of their survival. Very high plasma ccf-mtDNA levels could predict patients liable to develop ARDS.

  13. Failure Study of Composite Materials by the Yeh-Stratton Criterion

    Science.gov (United States)

    Yeh, Hsien-Yang; Richards, W. Lance

    1997-01-01

    The newly developed Yeh-Stratton (Y-S) Strength Criterion was used to study the failure of composite materials with central holes and normal cracks. To evaluate the interaction parameters for the Y-S failure theory, it is necessary to perform several biaxial loading tests. However, it is indisputable that the inhomogeneous and anisotropic nature of composite materials have made their own contribution to the complication of the biaxial testing problem. To avoid the difficulties of performing many biaxial tests and still consider the effects of the interaction term in the Y-S Criterion, a simple modification of the Y-S Criterion was developed. The preliminary predictions by the modified Y-S Criterion were relatively conservative compared to the testing data. Thus, the modified Y-S Criterion could be used as a design tool. To further understand the composite failure problem, an investigation of the damage zone in front of the crack tip coupled with the Y-S Criterion is imperative.

  14. Model selection criterion in survival analysis

    Science.gov (United States)

    Karabey, Uǧur; Tutkun, Nihal Ata

    2017-07-01

    Survival analysis deals with time until occurrence of an event of interest such as death, recurrence of an illness, the failure of an equipment or divorce. There are various survival models with semi-parametric or parametric approaches used in medical, natural or social sciences. The decision on the most appropriate model for the data is an important point of the analysis. In literature Akaike information criteria or Bayesian information criteria are used to select among nested models. In this study,the behavior of these information criterion is discussed for a real data set.

  15. An improved criterion for Kapitza's pendulum stability

    Science.gov (United States)

    Butikov, Eugene I.

    2011-07-01

    An enhanced and more exact criterion for dynamic stabilization of the parametrically driven inverted pendulum is obtained: the boundaries of stability are determined with greater precision and are valid in a wider region of the system parameters than previous results. The lower boundary of stability is associated with the phenomenon of subharmonic resonances in this system. The relationship of the upper limit of dynamic stabilization of the inverted pendulum with ordinary parametric resonance (i.e. with destabilization of the lower equilibrium position) is established. Computer simulation of the physical system aids the analytical investigation and proves the theoretical results.

  16. The double high tide at Port Ellen: Doodson's criterion revisited

    Directory of Open Access Journals (Sweden)

    H. A. M. Byrne

    2017-07-01

    Full Text Available Doodson proposed a minimum criterion to predict the occurrence of double high (or double low waters when a higher-frequency tidal harmonic is added to the semi-diurnal tide. If the phasing of the harmonic is optimal, the condition for a double high water can be written bn2∕a > 1 where b is the amplitude of the higher harmonic, a is the amplitude of the semi-diurnal tide, and n is the ratio of their frequencies. Here we expand this criterion to allow for (i a phase difference ϕ between the semi-diurnal tide and the harmonic and (ii the fact that the double high water will disappear in the event that b∕a becomes large enough for the higher harmonic to be the dominant component of the tide. This can happen, for example, at places or times where the semi-diurnal tide is very small. The revised parameter is br2∕a, where r is a number generally less than n, although equal to n when ϕ = 0. The theory predicts that a double high tide will form when this parameter exceeds 1 and then disappear when it exceeds a value of order n2 and the higher harmonic becomes dominant. We test these predictions against observations at Port Ellen in the Inner Hebrides of Scotland. For most of the data set, the largest harmonic of the semi-diurnal tide is the sixth diurnal component, for which n = 3. The principal lunar and solar semi-diurnal tides are about equal at Port Ellen and so the semi-diurnal tide becomes very small twice a month at neap tides (here defined as the smallest fortnightly tidal range. A double high water forms when br2∕a first exceeds a minimum value of about 1.5 as neap tides are approached and then disappears as br2∕a then exceeds a second limiting value of about 10 at neap tides in agreement with the revised criterion.

  17. Serum metabolites predict response to angiotensin II receptor blockers in patients with diabetes mellitus

    DEFF Research Database (Denmark)

    Pena, Michelle J; Heinzel, Andreas; Rossing, Peter

    2016-01-01

    BACKGROUND: Individual patients show a large variability in albuminuria response to angiotensin receptor blockers (ARB). Identifying novel biomarkers that predict ARB response may help tailor therapy. We aimed to discover and validate a serum metabolite classifier that predicts albuminuria response...

  18. 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.

  19. Usefulness of Clinical Prediction Rules, D-dimer, and Arterial Blood Gas Analysis to Predict Pulmonary Embolism in Cancer Patients

    Science.gov (United States)

    Karamat, Asifa; Awan, Shazia; Hussain, Muhammad Ghazanfar; Al Hameed, Fahad; Butt, Faheem; Wahla, Ali Saeed

    2017-01-01

    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. PMID:28439386

  20. Factors Influencing the Predictive Power of Models for Predicting Mortality and/or Heart Failure Hospitalization in Patients With Heart Failure

    NARCIS (Netherlands)

    Ouwerkerk, Wouter; Voors, Adriaan A.; Zwinderman, Aeilko H.

    2014-01-01

    The present paper systematically reviews and compares existing prediction models in order to establish the strongest variables, models, and model characteristics in patients with heart failure predicting outcome. To improve decision making accurately predicting mortality and heart-failure

  1. Preoperative Joint Space Width Predicts Patient-Reported Outcomes After Total Hip Arthroplasty in Young Patients.

    Science.gov (United States)

    Stambough, Jeffrey B; Xiong, Ao; Baca, Geneva R; Wu, Ningying; Callaghan, John J; Clohisy, John C

    2016-02-01

    In a new health care economy, there is an emerging need to understand and quantify predictors of total hip arthroplasty (THA) outcomes. We investigated the association between preoperative radiographic disease (as measured quantitatively by joint space width [JSW]) and patient-reported function, activity, pain, and quality of life after THA. We retrospectively analyzed 146 patients (146 hips) 55 years or younger with a diagnosis of osteoarthritis who underwent cementless THA between January 2009 and December 2010. Preoperative pelvic radiographs were measured by 1 author blinded to clinical outcomes to establish JSW, defined as the shortest distance between the femoral head margin and the superolateral weight-bearing portion of the acetabulum. The JSW value was treated as a continuous variable when applied to statistical modeling. The relationship between the JSW and the improvement of clinical outcome was examined via a general linear modeling approach with adjustments for patients' age, body mass index, and sex. We identified an inverse relationship between preoperative JSW and improvements in functional, activity, pain, and quality of life. We found that, as JSW decreased by 1 mm, the outcome measure improvements were modified Harris Hip Score of 6.3 (pjoint space have less predictable improvement in terms of function, pain relief, and activity. These findings suggest that THA in young patients with a JSW less than 1.5 to 2 mm provides more predictable improvements in pain and functional outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. EVALUATION OF AIRWAY AND PREDICTING DIFFICULT ENDOTRACHEAL INTUBATION IN DIABETIC PATIENTS- A COMPARISON WITH NONDIABETIC PATIENTS

    Directory of Open Access Journals (Sweden)

    Sachin Ramesh Gondane

    2017-01-01

    Full Text Available BACKGROUND The aim of this study is to evaluate the various clinical parameters of airway assessment and their ability to predict difficult laryngoscopy and intubation in diabetic patients as compared to nondiabetic patients. MATERIALS AND METHODS Out of 120 patients, 60 diabetics (group-D and 60 nondiabetics (group-N were studied preoperatively for various airway indices such as the modified Mallampati Test (MPC, Thyromental Distance (TMD, Degree of Head Extension (HE, the Palm Print Index (PP and the Prayer Sign (PS and their corresponding Cormack-Lehane scores (CL were noted. The two groups were studied using chi-square tests. p<0.05 was considered statistically significant. RESULTS The incidence of difficult laryngoscopy as indicated by CL grade III and IV in diabetic patients was 43.33%, while that in the nondiabetic group was 20%. In diabetics group, MPC as a predictor was more sensitive (80.77% while PP index was more specific (97.06%. PP index also had maximum positive predictive value and odds ratio. In nondiabetic group, MPC had maximum sensitivity (75.00% while PP index, PS and TMD were showed equal specificity (95.83%. CONCLUSION MPC as a predictor was more sensitive in both groups while PP index was more specific in group D.

  3. Reviewing Employee Turnover: Focusing on Proximal Withdrawal States and an Expanded Criterion

    Science.gov (United States)

    Hom, Peter W.; Mitchell, Terence R.; Lee, Thomas W.; Griffeth, Rodger W.

    2012-01-01

    We reconceptualize employee turnover to promote researchers' understanding and prediction of why employees quit or stay in employing institutions. A literature review identifies shortcomings with prevailing turnover dimensions. In response, we expand the conceptual domain of the turnover criterion to include multiple types of turnover (notably,…

  4. Criterion-related validity op Dutch police-selection measures and differences between ethnic groups.

    NARCIS (Netherlands)

    L.A.L. de Meijer (Lonneke); M.Ph. Born (Marise); G. Terlouw (Gert); H.T. van der Molen (Henk)

    2008-01-01

    textabstractThis study investigated the criterion-related validity of cognitive ability as well as non-cognitive ability measures and differences between ethnic majority (N = 2,365) and minority applicants (N = 682) in Dutch police officer selection. Findings confirmed the relatively low predictive

  5. Modelling and simulation of A-segregates in steel castings using a thermal criterion function

    DEFF Research Database (Denmark)

    Kotas, Petr; Hattel, Jesper Henri

    2012-01-01

    simulation software package. It is then used for predicting A segregates inside a large steel casting, i.e. a forging ram. In part I, experimental data obtained from a foundry serve to validate the given criterion and to evaluate the critical value for A segregate initiation for one alloy composition...

  6. Use of spatial information to predict multidrug resistance in tuberculosis patients, Peru

    National Research Council Canada - National Science Library

    Lin, Hsien-Ho; Shin, Sonya S; Contreras, Carmen; Asencios, Luis; Paciorek, Christopher J; Cohen, Ted

    2012-01-01

    To determine whether spatiotemporal information could help predict multidrug resistance at the time of tuberculosis diagnosis, we investigated tuberculosis patients who underwent drug susceptibility...

  7. Transformational leadership in primary care: Clinicians' patterned approaches to care predict patient satisfaction and health expectations.

    Science.gov (United States)

    Huynh, Ho Phi; Sweeny, Kate; Miller, Tricia

    2016-11-01

    Clinicians face the complex challenge of motivating their patients to achieve optimal health while also ensuring their satisfaction. Inspired by transformational leadership theory, we proposed that clinicians' motivational behaviors can be organized into three patient care styles (transformational, transactional, and passive-avoidant) and that these styles differentially predict patient health outcomes. In two studies using patient-reported data and observer ratings, we found that transformational patient care style positively predicted patients' satisfaction and health expectations above and beyond transactional and passive-avoidant patient care style. These findings provide initial support for the patient care style approach and suggest novel directions for the study of clinicians' motivational behaviors.

  8. Which patient-reported factors predict referral to spinal surgery? A cohort study among 4987 chronic low back pain patients.

    NARCIS (Netherlands)

    van Dongen, J.M.; van Hooff, M.L.; Spruit, M.; de Kleuver, M.; Ostelo, Raymond

    2017-01-01

    PURPOSE: It is unknown which chronic low back pain (CLBP) patients are typically referred to spinal surgery. The present study, therefore, aimed to explore which patient-reported factors are predictive of spinal surgery referral among CLBP patients. METHODS: CLBP patients were consecutively

  9. Discriminant Validity Assessment: Use of Fornell & Larcker criterion versus HTMT Criterion

    Science.gov (United States)

    Hamid, M. R. Ab; Sami, W.; Mohmad Sidek, M. H.

    2017-09-01

    Assessment of discriminant validity is a must in any research that involves latent variables for the prevention of multicollinearity issues. Fornell and Larcker criterion is the most widely used method for this purpose. However, a new method has emerged for establishing the discriminant validity assessment through heterotrait-monotrait (HTMT) ratio of correlations method. Therefore, this article presents the results of discriminant validity assessment using these methods. Data from previous study was used that involved 429 respondents for empirical validation of value-based excellence model in higher education institutions (HEI) in Malaysia. From the analysis, the convergent, divergent and discriminant validity were established and admissible using Fornell and Larcker criterion. However, the discriminant validity is an issue when employing the HTMT criterion. This shows that the latent variables under study faced the issue of multicollinearity and should be looked into for further details. This also implied that the HTMT criterion is a stringent measure that could detect the possible indiscriminant among the latent variables. In conclusion, the instrument which consisted of six latent variables was still lacking in terms of discriminant validity and should be explored further.

  10. Clinical prediction model to identify vulnerable patients in ambulatory surgery: towards optimal medical decision-making

    NARCIS (Netherlands)

    H. Mijderwijk (Herjan); R.J. Stolker (Robert); H.J. Duivenvoorden (Hugo); M. Klimek (Markus); E.W. Steyerberg (Ewout)

    2016-01-01

    markdownabstract__Background:__ Ambulatory surgery patients are at risk of adverse psychological outcomes such as anxiety, aggression, fatigue, and depression. We developed and validated a clinical prediction model to identify patients who were vulnerable to these psychological outcome parameters.

  11. Can we predict agitation in patients with suicide attempts in the ...

    African Journals Online (AJOL)

    ED) after suicide attempts is common and an important problem. Objective: To establish whether we can predict agitated patients among suicide attempt patients in ED. Methods: This is a cross-sectional observational study of adult suicide ...

  12. CAN PROSTATE CANCER BE PREDICTED IN BPH PATIENTS WITH

    African Journals Online (AJOL)

    Objective To define a predictor of prostate cancer in BPH patients with an inter- mediate PSA (4.1-10 ng/ml) and a negative initial sextant biopsy. Patients and Methods During 1999, 193 BPH patients with an intermediate PSA (4.1-10 ng/ml) underwent TRUS and sextant bi- opsy. The patients whose initial biopsies.

  13. Nursing intuition as an assessment tool in predicting severity of injury in trauma patients.

    Science.gov (United States)

    Cork, Lora L

    2014-01-01

    Emergency nurses assess patients using objective and subjective data. When the charge nurse takes report from a paramedic, another form of assessment occurs. By eliciting apt data and using trauma-scoring criteria, a decision to enact a "trauma code" occurs. Considering the cost and staff utilization, it is important for the charge nurse to make sound decisions when activating a trauma code. The objective of this study is to explore the validity of nurses' use of intuition in patients to predict the severity of their injuries, and whether it impacts their choice to institute a trauma code.The study design was a descriptive, quantitative, cross-sectional record review and cohort analysis. The setting was a rural Trauma Level III emergency department (ED) located 80 miles from the nearest Level I trauma center. Phase I was a convenience cluster sample of all charge nurses in an ED. Phase II was a collection of all trauma records from June 2010 to May 2012. The inclusion criterion for Phase I subjects was that all participants were currently working as ED charge nurses. Analysis for Phase I data consisted of evaluating demographic information provided in questions 1 through 6 in a questionnaire. For Phase II data, a power analysis using Cohen's d was performed to determine the sample size to be evaluated. On the basis of the 2012 trauma data, a total of 419 records needed to be assessed (confidence interval, 0.164; P nurses responded. Results showed an average of greater than 10 years of experience as an ED registered nurse, certification was equally yes and no, and highest level of education was at the BSN level. Phase II consisted of a review of 393 eligible medical files during the specified period. Because of the lack of sufficient data, 33 records were excluded. A total of 360 files remained with 109 in the "gut instinct" and 251 in the "other" category. A t test was performed using a 2-tailed test with an α value of .05. Results were a t-score of 0.02, and the

  14. Focusing criterion in DHM image reconstruction

    Science.gov (United States)

    Mihailescu, M.; Mihale, N.; Popescu, R. C.; Acasandrei, A.; Paun, I. A.; Dinescu, M.; Scarlat, E.

    2015-02-01

    This study is presenting the theoretical approach and the practical results of a precise activity involved in the hologram reconstruction in order to find the optimally focused image of MG63 osteoblast-like cells cultivated on polymeric flat substrates. The morphology and dynamic of the cell is investigated by digital holographic microscopy (DHM) technique. The reconstruction is digitally performed using an algorithm based on the scalar theory of diffraction in the Fresnel approximation. The quality of the 3D images of the cells is crucially depending on the focusing capability of the reconstruction chain to fit the parameters of the optical recorder, particularly the focusing value. Our proposal to find the focused image is based on the images decomposition on gray levels and their histogram analysis. More precisely the focusing criterion is based on the evaluation of the form of this distribution.

  15. The criterion C in a parton model

    Energy Technology Data Exchange (ETDEWEB)

    Braun, M.; Pajares, C. (Dept. de Particulas Elementales, Univ. de Santiago de Compostela (Spain))

    1991-10-07

    There are certain classes of events which are screened in nuclei only by themselves. They satisfy some requirements denoted by criterion C. These events are studied in the framework of a general parton model. It is shown that, depending of the type of events, the cross section for them have contributions which do not depend only on the elementary C hadron-nucleon cross section but also on the total hadron-nucleon cross section. These corrections are proportional to the probability to have one of the spectator partons of the projectile in the phase-space region of the selected events. In this way, it is possible to explain the dependence on A of different processes like J/{psi} production, pA{yields}pX, hard processes and non-diffractive cross sections. (orig.).

  16. Extended equal areas criterion: foundations and applications

    Energy Technology Data Exchange (ETDEWEB)

    Yusheng, Xue [Nanjim Automation Research Institute, Nanjim (China)

    1994-12-31

    The extended equal area criterion (EEAC) provides analytical expressions for ultra fast transient stability assessment, flexible sensitivity analysis, and means to preventive and emergency controls. Its outstanding performances have been demonstrated by thousands upon thousands simulations on more than 50 real power systems and by on-line operation records in an EMS environment of Northeast China Power System since September 1992. However, the researchers have mainly based on heuristics and simulations. This paper lays a theoretical foundation of EEAC and brings to light the mechanism of transient stability. It proves true that the dynamic EEAC furnishes a necessary and sufficient condition for stability of multi machine systems with any detailed models, in the sense of the integration accuracy. This establishes a new platform for further advancing EEAC and better understanding of problems. An overview of EEAC applications in China is also given in this paper. (author) 30 refs.

  17. Nash equilibrium and multi criterion aerodynamic optimization

    Science.gov (United States)

    Tang, Zhili; Zhang, Lianhe

    2016-06-01

    Game theory and its particular Nash Equilibrium (NE) are gaining importance in solving Multi Criterion Optimization (MCO) in engineering problems over the past decade. The solution of a MCO problem can be viewed as a NE under the concept of competitive games. This paper surveyed/proposed four efficient algorithms for calculating a NE of a MCO problem. Existence and equivalence of the solution are analyzed and proved in the paper based on fixed point theorem. Specific virtual symmetric Nash game is also presented to set up an optimization strategy for single objective optimization problems. Two numerical examples are presented to verify proposed algorithms. One is mathematical functions' optimization to illustrate detailed numerical procedures of algorithms, the other is aerodynamic drag reduction of civil transport wing fuselage configuration by using virtual game. The successful application validates efficiency of algorithms in solving complex aerodynamic optimization problem.

  18. Failure criterion for notched fiber-dominated composite laminates

    Science.gov (United States)

    Vaidya, Rajesh Suresh

    1997-12-01

    Predicting the residual strength of composite laminates in the presence of flaws such as cracks has been an important research problem for the last two decades. Most existing models for predicting notched residual strength are of a 'curve fit' nature, wherein the model parameters, e.g., characteristic distance or damage zone size are chosen so as to fit the experimental data. Such parameters have been shown to depend on notch size and laminate orientation, and as such, cannot be considered material constants for the composite system. In the present research, a new model is proposed for predicting residual strength or fracture toughness of notched fiber dominated composite laminates under pure Mode I or mixed-mode loading conditions. The fracture toughness of such laminates is related to the fracture toughness of the principal load bearing plies within them. A new material parameter is introduced to predict laminate fracture toughness, and it is shown to be independent of laminate orientation. Experimental results indicate that the model can successfully predict the failure stress for notched laminates with arbitrary crack orientations (mixed-mode loading). The effect of ply thickness on notched strength of cross-ply and quasi-isotropic laminates is also investigated in this study. Results indicate that the ply thickness effect is more significant in cross-ply laminate configurations. A 2D finite element analysis is conducted to study the effect of crack tip damage in the form of splitting and delamination on the stress distribution near the crack tip. The experimentally observed damage zones in cross-ply laminates are modeled, and a criterion is established to predict the growth of matrix cracks in the 0sp° layer. It is shown that the matrix crack growth is controlled by the Mode II strain energy release rate. The effect of matrix damage on stress relaxation and subsequent failure is investigated and conclusions are drawn to establish the regime where the failure

  19. Prognostic role of Sokolow-Lyon criterion in further development of the left ventricular concentric hypertrophy in adolescents with arterial hypertension

    Directory of Open Access Journals (Sweden)

    O. G. Ivanko

    2017-02-01

    Full Text Available Objective – to determine the possibility of Sokolow-Lyon criterion for forecast of the concentric Left Ventricular Hypertrophy (LVH development in young hypertensive patients. The investigation has been organized as a prospective support of teenagers aged 16-17 yr within 3 years. Materials and Methods. Methods of the study were multiple office blood pressure measurements, daily blood pressure monitoring with electronic device, ECG and ultrasound. 47 males and females teens with firstly diagnosed primary arterial hypertension not treated before were enrolled. Primary labile hypertension diagnosed in 10 males and 11 females and 18 males and 8 females had stable hypertension. For all patients the electrocardiographic study was performed. The positive Sokolow-Lyon criterion was considered as a sum in height of S1 and R5 or R6 waves in standard chest leads excessed34 mm. Watching teens conducted during 3 years. Results. Sokolow-Lyon criterion >34 mm (3.4 mV was identified as positive in 8 males with a stable and 6 with a labile hypertension, also it was the same in 6 females, all of them had stable hypertension. Morphological and functional left ventricular parameters in patients were minimal and appeared only as a mild thickening of the myocardial wall of the left ventricle. Only one girl who was positive by Sokolow-Lyon criterion had LVH and was excluded from the study. Repeated clinical and instrumental examination was carried out in 46 persons over 3 years to the age of 21 years. New ultrasound investigation showed the left ventricular hypertrophy development in 18 young men and 5 women with stable hypertension. The odds ratio for the development of concentric hypertrophy of the left ventricle during 3 years of the young people with diagnosed in adolescence index Sokolow-Lyon >34 mm was 8.906 with a 95% confidence interval 2.24-35.33 (p < 0.05. The sensitivity of Sokolow-Lyon criterion in predicting of the left ventricular hypertrophy during 3

  20. A nonlinear flow-transition criterion for the onset of slugging in horizontal channels and pipes

    Science.gov (United States)

    Campbell, Bryce K.; Liu, Yuming

    2016-08-01

    In this work, the interfacial instability and transition of a two-fluid flow from a stratified state to large amplitude waves or slugs is considered. By combining an asymptotic approximation of the linear Orr-Sommerfeld analysis with nonlinear resonant wave interaction theory, a novel nonlinear slug-transition criterion is derived. This criterion corresponds to a bounding condition on the upper fluid's velocity in order to limit the amount of energy (provided by the linear instability) which is transferred to long waves through resonant wave interactions. It is proposed that such a condition can predict the formation of large-amplitude long waves and/or slugs. Quantitative comparisons of the onset of slugging are made between the prediction by the nonlinear transition criterion and the experimental measurements carried out in a horizontal square channel. Good agreement is observed. An additional heuristic model is developed which generalizes the transition criterion to flow through horizontal pipes. Comparisons are made for flows through different pipe diameters and over a wide range of fluid properties. Good agreement between the present theoretical predictions and the experimental measurements is also observed.

  1. Chromosomal instability predicts metastatic disease in patients with insulinomas

    NARCIS (Netherlands)

    Jonkers, YMH; Claessen, SMH; Perren, A; Schmid, S; Komminoth, P; Verhofstad, AA; Hofland, LJ; de Krijger, RR; Slootweg, PJ; Ramaekers, FCS; Speel, EJM

    Endocrine pancreatic tumors (EPTs) comprise a highly heterogeneous group of tumors with different clinical behavior and genetic makeup. Insulinomas represent the predominant syndromic subtype of EPTs. The metastatic potential of insulinomas can frequently not be predicted using histopathological

  2. Low serum leptin predicts mortality in patients with chronic kidney disease stage 5

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Rattensperger, Dirk; Zidek, Walter

    2007-01-01

    Leptin, secreted from adipose tissue, regulates food intake, energy expenditure, and immune function. It is unknown whether leptin predicts mortality in patients with chronic kidney disease stage 5 on hemodialysis therapy.......Leptin, secreted from adipose tissue, regulates food intake, energy expenditure, and immune function. It is unknown whether leptin predicts mortality in patients with chronic kidney disease stage 5 on hemodialysis therapy....

  3. Low expression of thiosulfate sulfurtransferase (rhodanese) predicts mortality in hemodialysis patients

    DEFF Research Database (Denmark)

    Krueger, Katharina; Koch, Kathrin; Jühling, Anja

    2010-01-01

    To test the hypothesis that impaired expression of the thiosulfate sulfurtransferase rhodanese is associated with oxidative stress and may predict mortality in hemodialysis patients.......To test the hypothesis that impaired expression of the thiosulfate sulfurtransferase rhodanese is associated with oxidative stress and may predict mortality in hemodialysis patients....

  4. Serum HER-2: Sensitivity, specificity, and predictive values for detecting metastatic recurrence in breast cancer patients

    DEFF Research Database (Denmark)

    Sørensen, Patricia Diana; Jakobsen, Erik Hugger; Madsen, Jonna Skov

    2013-01-01

    The aim of this study was to determine the sensitivity, specificity, and predictive values of serum HER-2 for detecting metastatic recurrence in breast cancer patients.......The aim of this study was to determine the sensitivity, specificity, and predictive values of serum HER-2 for detecting metastatic recurrence in breast cancer patients....

  5. NT-ProBNP Independently Predicts Long-Term Mortality in Patients Admitted for Coronary Angiography

    DEFF Research Database (Denmark)

    Ruwald, Martin Huth; Goetze, Jens Peter; Bech, Jan

    2014-01-01

    Recently, research interests are focussed on biomarkers to predict the outcome in patients with coronary artery disease (CAD). We examined whether the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) could predict outcome in patients who underwent elective or acute coronary...

  6. The danger of dangerousness: why we must remove the dangerousness criterion from our mental health acts.

    Science.gov (United States)

    Large, M M; Ryan, C J; Nielssen, O B; Hayes, R A

    2008-12-01

    The mental health legislation of most developed countries includes either a dangerousness criterion or an obligatory dangerousness criterion (ODC). A dangerousness criterion holds that mentally ill people may be given treatment without consent if they are deemed to be a risk to themselves or others. An ODC holds that mentally ill people may be given treatment without consent only if they are deemed to be a risk to themselves or others. This paper argues that the dangerousness criterion is unnecessary, unethical and, in the case of the ODC, potentially harmful to mentally ill people and to the rest of the community. We examine the history of the dangerousness criterion, and provide reasoned argument and empirical evidence in support of our position. Dangerousness criteria are not required to balance the perceived loss of autonomy arising from mental health legislation. Dangerousness criteria unfairly discriminate against the mentally ill, as they represent an unreasonable barrier to treatment without consent, and they spread the burden of risk that any mentally ill person might become violent across large numbers of mentally ill people who will never become violent. Mental health legislation that includes an ODC is associated with a longer duration of untreated psychosis, and probably contributes to a poorer prognosis and an increase risk of suicide and violence in patients in their first episode of psychosis. Dangerousness criteria should be removed from mental health legislation and be replaced by criteria that focus on a patient's capacity to refuse treatment.

  7. Evaluation of a Consensus-Based Criterion Standard Definition of Trauma Center Need for Use in Field Triage Research.

    Science.gov (United States)

    Willenbring, Brian D; Lerner, E Brooke; Brasel, Karen; Cushman, Jeremy T; Guse, Clare E; Shah, Manish N; Swor, Robert

    2016-01-01

    Research on field triage of injured patients is limited by the lack of a widely used criterion standard for defining trauma center need. Injury Severity Score (ISS) >15 has been a commonly used outcome measure in research for determining trauma center need that has never been validated. A multidisciplinary team recently published a consensus-based criterion standard definition of trauma center need, but this measure has not yet been validated. The objective was to determine if the consensus-based criterion standard can be obtained by medical record review and compare patients identified as needing a trauma center by the consensus-based criterion standard vs. ISS >15. A subanalysis of data collected during a 2-year prospective cohort study of 4,528 adult trauma patients transported by EMS to a single trauma center was conducted. These data included ICD-9-CM codes, treatment times, and other patient care data. Presence of the consensus-based criterion standard was determined for each patient. ISS was calculated based on ICD-9-CM codes assigned for billing. The consensus-based criterion standard could be applied to 4,471 (98.7%) cases. ISS could be determined for 4,506 (99.5%) cases. Based on an ISS >15, 8.9% of cases were identified as needing a trauma center. Of those, only 48.2% met the consensus-based criterion standard. Almost all patients that did not meet the consensus-based criterion standard, but had an ISS >15 were diagnosed with chest (rib fractures (100/205 cases)/pneumothorax (57/205 cases), closed head (without surgical intervention 88/205 cases), vertebral (without spinal cord injury 45/205 cases), and/or extremity injuries (39/205 cases). There were 4,053 cases with an ISS <15. 5.0% of those with an ISS <15 met the consensus-based criterion standard with the majority requiring surgery (139/203 cases) or a blood transfusion (60/203 cases). The kappa coefficient of agreement for ISS and the consensus-based criterion standard was 0.43. We determined that

  8. [EVALUATION OF QUALITY INDICATORS OF LIFE AS A CRITERION OF THE EFFICIENCY OF TREATMENT FOR LIQUIDATORS OF THE ACCIDENT AT CHERNOBYL AEROSPHORUS, PATIENTS WITH HYPERTENSION DISEASE COMORBID WITH GASTROESOPHAGEAL REFLUX DISEASE].

    Science.gov (United States)

    Synelnik, V; Oparin, A

    2017-04-01

    In order to assess the quality of life of liquidators of the accident at the Chernobyl nuclear power plant (CHPP) of patients with hypertensive comorbid disease with gastroesophageal reflux disease, 52 patients aged 46 to 71 years (mean age 57.5±0, 8 years old) who were on inpatient treatment in the therapeutic department of the Regional Clinical Specialized Dispensary for Radiation Protection of the Population of Kharkov from January 2016 to December 2016. The men among the examined were 44 (84.6%), women - 8 (15.4 All patients were divided into 2 groups, Group I patients received standard therapy, Group II patients, in addition to standard therapy, respectively nosology, received additionally the drug Actovegin ® Takeda Austria GmbH. All quality of life indicators were evaluated before the treatment and after In group I patients, after the standard treatment of GB comorbid with GERD, statistically significantly reduced the limitations on the scale of body pain (BP), therefore, in points, on the contrary, to 18.8±2.8 points increased, indicating a decrease in pain after treatment In patients. In patients with group II GB comorbid with GERD after standard treatment with additional use of Actovegin ®, the daily activity limitations associated with the disease on the scales of physical functioning (PF), role activity (RP), physical pain (BP), Vitality (VT), emotional state (RE).

  9. Prediction and assessment of depression rates in patients with ...

    African Journals Online (AJOL)

    The aim of the study is to assess, in advanced lung cancer patients, the frequency of depression and the related demographic and biomedical factors before diagnosis and after the initial treatment period. Seventy-nine patients from among 105 advanced lung cancer patients diagnosed between July 1994 and April 2003 in ...

  10. Factors predicting walking intolerance in patients with peripheral ...

    African Journals Online (AJOL)

    Objective. To determine which physiological variables conduce to walking intolerance in patients with peripheral arterial disease (PAD). Design. The physiological response to a graded treadmill exercise test (GTT) in patients with PAD was characterised. Setting. Patients were recruited from the Department of. Vascular ...

  11. The role of socio demographic variables in predicting patients ...

    African Journals Online (AJOL)

    Background: Radiological examination remains a vital and integral aspect of health services delivery and patient satisfaction with radiological service remains beneficial both to patients and hospitals. Aim: To evaluate the influence of patient's socio demographic variables on satisfaction with radiological services. Subjects ...

  12. Direct numerical simulations of non-premixed ethylene-air flames: Local flame extinction criterion

    KAUST Repository

    Lecoustre, Vivien R.

    2014-11-01

    Direct Numerical Simulations (DNS) of ethylene/air diffusion flame extinctions in decaying two-dimensional turbulence were performed. A Damköhler-number-based flame extinction criterion as provided by classical large activation energy asymptotic (AEA) theory is assessed for its validity in predicting flame extinction and compared to one based on Chemical Explosive Mode Analysis (CEMA) of the detailed chemistry. The DNS code solves compressible flow conservation equations using high order finite difference and explicit time integration schemes. The ethylene/air chemistry is simulated with a reduced mechanism that is generated based on the directed relation graph (DRG) based methods along with stiffness removal. The numerical configuration is an ethylene fuel strip embedded in ambient air and exposed to a prescribed decaying turbulent flow field. The emphasis of this study is on the several flame extinction events observed in contrived parametric simulations. A modified viscosity and changing pressure (MVCP) scheme was adopted in order to artificially manipulate the probability of flame extinction. Using MVCP, pressure was changed from the baseline case of 1 atm to 0.1 and 10 atm. In the high pressure MVCP case, the simulated flame is extinction-free, whereas in the low pressure MVCP case, the simulated flame features frequent extinction events and is close to global extinction. Results show that, despite its relative simplicity and provided that the global flame activation temperature is correctly calibrated, the AEA-based flame extinction criterion can accurately predict the simulated flame extinction events. It is also found that the AEA-based criterion provides predictions of flame extinction that are consistent with those provided by a CEMA-based criterion. This study supports the validity of a simple Damköhler-number-based criterion to predict flame extinction in engineering-level CFD models. © 2014 The Combustion Institute.

  13. Systemic inflammation response index (SIRI) predicts prognosis in hepatocellular carcinoma patients

    Science.gov (United States)

    Xu, Litao; Yu, Shulin; Zhuang, Liping; Wang, Peng; Shen, Yehua; Lin, Junhua; Meng, Zhiqiang

    2017-01-01

    The systemic inflammation response index (SIRI) is a useful tool for predicting prognosis in some types of cancer. In this retrospective study, we evaluated the efficacy of SIRI in predicting overall survival in hepatocellular carcinoma (HCC) patients following local or systemic therapy. A cutoff value of 1.05 was identified for SIRI using ROC analysis in a training patient cohort. In the validation cohort, survival analysis revealed that median overall survival was longer in HCC patients with SIRI scores SIRI was associated with overall survival and was more predictive of overall survival that the AFP level or Child-Pugh score. However, SIRI and Barcelona Clinic Liver Cancer (BCLC) stage were equally effective for predicting survival. In addition, HCC patients with BCLC stage C had higher SIRI scores and poorer overall survival. SIRI also correlated with liver function parameters. Thus SIRI may be a convenient, low cost and reliable tumor marker for predicting prognosis in HCC patients. PMID:28430597

  14. Unitary Evolution as a Uniqueness Criterion

    Science.gov (United States)

    Cortez, J.; Mena Marugán, G. A.; Olmedo, J.; Velhinho, J. M.

    2015-01-01

    It is well known that the process of quantizing field theories is plagued with ambiguities. First, there is ambiguity in the choice of basic variables describing the system. Second, once a choice of field variables has been made, there is ambiguity concerning the selection of a quantum representation of the corresponding canonical commutation relations. The natural strategy to remove these ambiguities is to demand positivity of energy and to invoke symmetries, namely by requiring that classical symmetries become unitarily implemented in the quantum realm. The success of this strategy depends, however, on the existence of a sufficiently large group of symmetries, usually including time-translation invariance. These criteria are therefore generally insufficient in non-stationary situations, as is typical for free fields in curved spacetimes. Recently, the criterion of unitary implementation of the dynamics has been proposed in order to select a unique quantization in the context of manifestly non-stationary systems. Specifically, the unitarity criterion, together with the requirement of invariance under spatial symmetries, has been successfully employed to remove the ambiguities in the quantization of linearly polarized Gowdy models as well as in the quantization of a scalar field with time varying mass, propagating in a static background whose spatial topology is either of a d-sphere (with d = 1, 2, 3) or a three torus. Following Ref. 3, we will see here that the symmetry and unitarity criteria allows for a complete removal of the ambiguities in the quantization of scalar fields propagating in static spacetimes with compact spatial sections, obeying field equations with an explicitly time-dependent mass, of the form ddot φ - Δ φ + s(t)φ = 0 . These results apply in particular to free fields in spacetimes which, like e.g. in the closed FRW models, are conformal to a static spacetime, by means of an exclusively time-dependent conformal factor. In fact, in such

  15. Improving the prediction of mortality and the need for life-saving interventions in trauma patients using standard vital signs with heart-rate variability and complexity.

    Science.gov (United States)

    Liu, Nehemiah T; Holcomb, John B; Wade, Charles E; Salinas, Jose

    2015-06-01

    The goal of this study was to determine the effectiveness of using traditional and new vital signs (heart rate variability and complexity [HRV, HRC]) for predicting mortality and the need for life-saving interventions (LSIs) in prehospital trauma patients. Our hypothesis was that statistical regression models using traditional and new vital signs would be superior in predictive performance over models using standard vital signs alone. This study involved 108 prehospital trauma patients transported from the point of injury via helicopter. Heart rate variability and HRC were calculated using criterion standard R-R interval sequences manually verified from the patients' electrocardiograms. Means and standard deviations for vital signs, HRV, HRC, and Glasgow coma scale (GCS) scores were obtained for nonsurvivors versus survivors and LSI versus non-LSI patient groups and then compared using Wilcoxon statistical tests. Receiver-operating characteristic curves were also obtained to compare different regression models for predicting mortality and the need for LSIs. Seventeen patients (16%) died. Eighty-two patients (76%) received a total of 142 LSIs. Receiver-operating characteristic curves demonstrated better prediction of mortality and LSI needs using heart rate and HRC (area under the curve [AUC]; AUCs, 0.86 and 0.86) than using heart rate alone (AUCs, 0.79 and 0.57). Likewise, receiver-operating characteristic curves demonstrated better prediction using total GCS score and HRC (AUCs, 0.82 and 0.97) than using total GCS score (AUCs, 0.81 and 0.91). Similar results were obtained for heart rate and HRV (AUCs, 0.86 and 0.73). The major implication of this study was that traditional and new vital signs (HRV and HRC) should be used simultaneously to improve prediction of mortality and the need for LSIs in prehospital trauma patients during all echelons of trauma care. Improvements in the timely use and diagnostic accuracy of transportable vital signs monitors will require

  16. Application of the PredictAD Software Tool to Predict Progression in Patients with Mild Cognitive Impairment

    DEFF Research Database (Denmark)

    Simonsen, Anja H; Mattila, Jussi; Hejl, Anne-Mette

    2012-01-01

    diagnosis of Alzheimer's disease. Methods: Baseline data from 140 patients with mild cognitive impairment were selected from the Alzheimer's Disease Neuroimaging Study. Three clinical raters classified patients into 6 categories of confidence in the prediction of early Alzheimer's disease, in 4 phases...... of incremental data presentation using the software tool. A 5th phase was done with all available patient data presented on paper charts. Classifications by the clinical raters were compared to the clinical diagnoses made by the Alzheimer's Disease Neuroimaging Initiative investigators. Results: A statistical...... significant trend (p dropped significantly from 70.0 to 63.2%. Conclusion: Best...

  17. {sup 18}F-FDG PET predicts survival after pretargeted radioimmunotherapy in patients with progressive metastatic medullary thyroid carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Salaun, Pierre-Yves; Robin, Philippe [University Hospital, Nuclear Medicine Department, Brest (France); Campion, Loic [ICO-Gauducheau Cancer Institute, Statistical Department, Nantes (France); Ansquer, Catherine; Mathieu, Cedric [University Hospital, Nuclear Medicine Department, Nantes (France); Frampas, Eric [University Hospital, Radiology Department, Nantes (France); Universite de Nantes, Nantes-Angers Cancer Research Center, Inserm, U 892, CNRS, UMR 6299, Nantes (France); Bournaud, Claire [University Hospital, Nuclear Medicine Department, Lyon (France); Vuillez, Jean-Philippe [University Hospital, Nuclear Medicine Department, Grenoble (France); Taieb, David [University Hospital, Nuclear Medicine Department, Marseille (France); Rousseau, Caroline [Universite de Nantes, Nantes-Angers Cancer Research Center, Inserm, U 892, CNRS, UMR 6299, Nantes (France); ICO-Rene Gauducheau, Nuclear Medicine Department, Nantes (France); Drui, Delphine [University Hospital, Endocrinology Department, Nantes (France); Mirallie, Eric [University Hospital, Surgery Department, Nantes (France); Borson-Chazot, Francoise [University Hospital, Endocrinology Department, Lyon (France); Goldenberg, David M. [IBC Pharmaceuticals, Inc., and Immunomedics, Inc., Morris Plains, NJ (United States); Center for Molecular Medicine and Immunology, Garden State Cancer Center, Morris Plains, NJ (United States); Chatal, Jean-Francois [GIP ARRONAX, Saint-Herblain (France); Barbet, Jacques [Universite de Nantes, Nantes-Angers Cancer Research Center, Inserm, U 892, CNRS, UMR 6299, Nantes (France); GIP ARRONAX, Saint-Herblain (France); Kraeber-Bodere, Francoise [University Hospital, Nuclear Medicine Department, Nantes (France); Universite de Nantes, Nantes-Angers Cancer Research Center, Inserm, U 892, CNRS, UMR 6299, Nantes (France); ICO-Rene Gauducheau, Nuclear Medicine Department, Nantes (France); Hotel Dieu University Hospital, Nuclear Medicine Department, Nantes (France)

    2014-08-15

    PET is a powerful tool for assessing targeted therapy. Since {sup 18}F-FDG shows a potential prognostic value in medullary thyroid carcinoma (MTC), this study evaluated {sup 18}F-FDG PET alone and combined with morphological and biomarker evaluations as a surrogate marker of overall survival (OS) in patients with progressive metastatic MTC treated with pretargeted anti-CEA radioimmunotherapy (pRAIT) in a phase II clinical trial. Patients underwent PET associated with morphological imaging (CT and MRI) and biomarker evaluations, before and 3 and 6 months, and then every 6 months, after pRAIT for 36 months. A combined evaluation was performed using anatomic, metabolic and biomarker methods. The prognostic value of the PET response was compared with demographic parameters at inclusion including age, sex, RET mutation, time from initial diagnosis, calcitonin and CEA concentrations and doubling times (DT), SUV{sub max}, location of disease and bone marrow involvement, and with response using RECIST, biomarker concentration variation, impact on DT, and combined methods. Enrolled in the study were 25 men and 17 women with disease progression. The median OS from pRAIT was 3.7 years (0.2 to 6.5 years) and from MTC diagnosis 10.9 years (1.7 to 31.5 years). After pRAIT, PET/CT showed 1 patient with a complete response, 4 with a partial response and 24 with disease stabilization. The combined evaluation showed 20 responses. For OS from pRAIT, univariate analysis showed the prognostic value of biomarker DT (P = 0.011) and SUV{sub max} (P = 0.038) calculated before pRAIT and impact on DT (P = 0.034), RECIST (P = 0.009), PET (P = 0.009), and combined response (P = 0.004) measured after pRAIT. PET had the highest predictive value with the lowest Akaike information criterion (AIC 74.26) as compared to RECIST (AIC 78.06), biomarker variation (AIC 81.94) and impact on DT (AIC 79.22). No benefit was obtained by combining the methods (AIC 78.75). This result was confirmed by the

  18. Transverse strain predicts exercise capacity in systemic right ventricle patients.

    Science.gov (United States)

    Di Salvo, Giovanni; Pacileo, Giuseppe; Rea, Alessandra; Limongelli, Giuseppe; Baldini, Luca; D'Andrea, Antonello; D'Alto, Michele; Sarubbi, Berardo; Russo, Maria Giovanna; Calabrò, Raffaele

    2010-11-19

    Because transposition of great arteries (TGA) patients who underwent atrial switch repair (AS) remain asymptomatic for decades before development of symptomatic heart failure, there may be some clinical value to preclinical detection of ventricular dysfunction. Detection of systemic right ventricular (RV) dysfunction in patients who are asymptomatic may prompt early initiation of heart failure therapy and more frequent clinical follow-up. The objective of this study was to characterize longitudinal and transverse systolic function of the systemic RV using two-dimensional (2D) strain in patients with TGA after AS repair and to correlate these parameters with their exercise capacity. The study population consisted of 26 patients (20±6 years) with TGA after AS operation. Conventional echocardiography and bidimensional strain were performed on consecutive patients reporting to the out patient congenital heart disease clinic. Twenty-four healthy, age-matched individuals were used as control subjects. Analysis was performed on the non-systemic RVs of the control group. All the studied patients underwent treadmill exercise testing according to the Bruce II protocol. RV longitudinal 2D-strain in controls showed a base to apex gradient, while in patients was homogeneously reduced. Also RV transverse strain (i.e the radial deformation assessed by the apical 4 chamber view) showed a base to apex gradient in controls, while in patients was significantly increased in the mid and apical segments. In the systemic RV free wall, transverse strain was greater than longitudinal strain (pexercise capacity (page, degree of tricuspid regurgitation, TAPSE, RV area fractional change, RV visually estimated ejection fraction, RV global longitudinal strain and RV global transverse strain) the best predictor of exercise capacity in AS-TGA patients was transverse 2D strain (pexercise capacity of these patients. In the follow up of AS-TGA patients the monitoring of RV transverse myocardial

  19. Modified maximum tangential stress criterion for fracture behavior of zirconia/veneer interfaces.

    Science.gov (United States)

    Mirsayar, M M; Park, P

    2016-06-01

    The veneering porcelain sintered on zirconia is widely used in dental prostheses, but repeated mechanical loadings may cause a fracture such as edge chipping or delamination. In order to predict the crack initiation angle and fracture toughness of zirconia/veneer bi-layered components subjected to mixed mode loadings, the accuracy of a new and traditional fracture criteria are investigated. A modified maximum tangential stress criterion considering the effect of T-stress and critical distance theory is introduced, and compared to three traditional fracture criteria. Comparisons to the recently published fracture test data show that the traditional fracture criteria are not able to properly predict the fracture initiation conditions in zirconia/veneer bi-material joints. The modified maximum tangential stress criterion provides more accurate predictions of the experimental results than the traditional fracture criteria. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Patient misunderstanding of the academic hierarchy is prevalent and predictable.

    Science.gov (United States)

    Kravetz, Amanda J; Anderson, Cheryl I; Shaw, Darcy; Basson, Marc D; Gauvin, Jeffrey M

    2011-12-01

    Medical personnel introduce themselves to patients using titles that reflect their level of training, although these titles may not be inherently obvious to the patient. This study explored patient understanding of commonly used physician and student titles. A survey was developed asking patients to match six mutually exclusive medical titles to six levels of training. Categories included attending physician, chief resident, resident, intern, medical student, and pre-medical student. Respondent age, gender, medical training, employment in a healthcare field, educational level, income, and number of visits to a physician per y were requested. A brief intervention was then performed in which a second group of patients were advised of the designations and then asked to match the same categories. A total of 365 surveys were collected from the first group and 102 from the second group. Respondents accurately identified the level of training required for all six titles in only 44.5% of surveys collected, and in 52.0% after the intervention. Patients with at least some college education or income>$50,000 per y were more likely to answer correctly (P$100,000 per y had difficulty correctly identifying the training of all team members. Patients do not understand the distinctions in training of surgical team members, especially those patients with decreased income or education; therefore, clinicians may wish to pay particular attention to these introductions. The survey did identify this as being important to patients. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. A new self-report inventory of dyslexia for students: criterion and construct validity.

    Science.gov (United States)

    Tamboer, Peter; Vorst, Harrie C M

    2015-02-01

    The validity of a Dutch self-report inventory of dyslexia was ascertained in two samples of students. Six biographical questions, 20 general language statements and 56 specific language statements were based on dyslexia as a multi-dimensional deficit. Dyslexia and non-dyslexia were assessed with two criteria: identification with test results (Sample 1) and classification using biographical information (both samples). Using discriminant analyses, these criteria were predicted with various groups of statements. All together, 11 discriminant functions were used to estimate classification accuracy of the inventory. In Sample 1, 15 statements predicted the test criterion with classification accuracy of 98%, and 18 statements predicted the biographical criterion with classification accuracy of 97%. In Sample 2, 16 statements predicted the biographical criterion with classification accuracy of 94%. Estimations of positive and negative predictive value were 89% and 99%. Items of various discriminant functions were factor analysed to find characteristic difficulties of students with dyslexia, resulting in a five-factor structure in Sample 1 and a four-factor structure in Sample 2. Answer bias was investigated with measures of internal consistency reliability. Less than 20 self-report items are sufficient to accurately classify students with and without dyslexia. This supports the usefulness of self-assessment of dyslexia as a valid alternative to diagnostic test batteries. Copyright © 2015 John Wiley & Sons, Ltd.

  2. Predicting referral practices of traditional healers of their patients ...

    African Journals Online (AJOL)

    Objective: Although many studies indicate that traditional healers are willing to collaborate with Western practitioners in South Africa, none focus specifically on mental health care, and none use a theory of health behaviour to explain their findings. The present study applies the Theory of Planned Behaviour (TPB) to predict ...

  3. The Predictive Value of Germline Polymorphisms in Patients with NSCLC

    DEFF Research Database (Denmark)

    Nygaard, Anneli Dowler; Spindler, Karen-Lise Garm; Andersen, Rikke Fredslund

    2010-01-01

    -Small Celled Lung Cancer (NSCLC), referred to palliative chemotherapy (Carboplatin and Vinorelbine) at the Department of Oncology, Vejle Hospital, between 2007 and 2010. Eighty-seven patients were included in a test cohort, and 161 patients in an independent validation cohort. A panel of 107 SNPs in the EGF...

  4. Serological Prediction of infections in Diabetic Patients with ...

    African Journals Online (AJOL)

    Purpose: To determine the prevalence and predictors of infection in diabetic patients with diabetic ketoacidosis (DKA) who were .18 years. Methods: A retrospective cohort design was adopted for this study. A total of 967 diabetes ketoacidosis patients from Hospital Pulau Pinang for the 3-year period, Jan 2008 - Dec 2010, ...

  5. Nonlinear viscoelasticity and generalized failure criterion for biopolymer gels

    Science.gov (United States)

    Divoux, Thibaut; Keshavarz, Bavand; Manneville, Sébastien; McKinley, Gareth

    2016-11-01

    Biopolymer gels display a multiscale microstructure that is responsible for their solid-like properties. Upon external deformation, these soft viscoelastic solids exhibit a generic nonlinear mechanical response characterized by pronounced stress- or strain-stiffening prior to irreversible damage and failure, most often through macroscopic fractures. Here we show on a model acid-induced protein gel that the nonlinear viscoelastic properties of the gel can be described in terms of a 'damping function' which predicts the gel mechanical response quantitatively up to the onset of macroscopic failure. Using a nonlinear integral constitutive equation built upon the experimentally-measured damping function in conjunction with power-law linear viscoelastic response, we derive the form of the stress growth in the gel following the start up of steady shear. We also couple the shear stress response with Bailey's durability criteria for brittle solids in order to predict the critical values of the stress σc and strain γc for failure of the gel, and how they scale with the applied shear rate. This provides a generalized failure criterion for biopolymer gels in a range of different deformation histories. This work was funded by the MIT-France seed fund and by the CNRS PICS-USA scheme (#36939). BK acknowledges financial support from Axalta Coating Systems.

  6. External validation of a prognostic model for predicting survival of cirrhotic patients with refractory ascites.

    Science.gov (United States)

    Guardiola, Jordi; Baliellas, Carme; Xiol, Xavier; Fernandez Esparrach, Glòria; Ginès, Pere; Ventura, Pere; Vazquez, Santiago

    2002-09-01

    Cirrhotic patients with refractory ascites (RA) have a poor prognosis, although individual survival varies greatly. A model that could predict survival for patients with RA would be helpful in planning treatment. Moreover, in cases of potential liver transplantation, a model of these characteristics would provide the bases for establishing priorities of organ allocation and the selection of patients for a living donor graft. Recently, we developed a model to predict survival of patients with RA. The aim of this study was to establish its generalizability for predicting the survival of patients with RA. The model was validated by assessing its performance in an external cohort of patients with RA included in a multicenter, randomized, controlled trial that compared large-volume paracentesis and peritoneovenous shunt. The values for actual and model-predicted survival of three risk groups of patients, established according to the model, were compared graphically and by means of the one-sample log-rank test. The model provided a very good fit to the survival data of the three risk groups in the validation cohort. We also found good agreement between the survival predicted from the model and the observed survival when patients treated with peritoneovenous shunt and with paracentesis were considered separately. Our survival model can be used to predict the survival of patients with RA and may be a useful tool in clinical decision making, especially in deciding priority for liver transplantation.

  7. Predicting patients at risk for pain associated with electrochemotherapy

    DEFF Research Database (Denmark)

    Quaglino, Pietro; Matthiessen, Louise Wichmann; Curatolo, Pietro

    2015-01-01

    BACKGROUND: Electrochemotherapy describes the use of electric pulses to enhance chemotherapy uptake, and has proven highly efficient in treating cutaneous metastases. Patients referred for electrochemotherapy present with diverse clinical pictures, from multiple small lesions to large, ulcerated...... lesions. Post-electrochemotherapy pain has been observed in some patients. The objectives of this study were to evaluate pain scores before and after electrochemotherapy, and to investigate if patients at risk of post-procedure pain could be identified. METHODS: Seven cancer centres in the International...... patients 39% had metastatic melanoma, 18% squamous cell carcinoma, 16% breast cancer, 13% basal-cell carcinoma, and 14% other malignancies. Median size of the largest nodules was 2.3 cm (range 0.3-40 cm). A majority of patients presented with low pain scores, and this continued through follow-up (74...

  8. Factors predicting prolonged empirical antifungal treatment in critically ill patients.

    Science.gov (United States)

    Zein, Mohamed; Parmentier-Decrucq, Erika; Kalaoun, Amer; Bouton, Olivier; Wallyn, Frédéric; Baranzelli, Anne; Elmanser, Dia; Sendid, Boualem; Nseir, Saad

    2014-03-11

    To determine the incidence, risk factors, and impact on outcome of prolonged empirical antifungal treatment in ICU patients. Retrospective observational study performed during a one-year period. Patients who stayed in the ICU >48 h, and received empirical antifungal treatment were included. Patients with confirmed invasive fungal disease were excluded. Prolonged antifungal treatment was defined as percentage of days in the ICU with antifungals > median percentage in the whole cohort of patients. Among the 560 patients hospitalized for >48 h, 153 (27%) patients received empirical antifungal treatment and were included in this study. Fluconazole was the most frequently used antifungal (46% of study patients). Median length of ICU stay was 19 days (IQR 8, 34), median duration of antifungal treatment was 8 days (IQR 3, 16), and median percentage of days in the ICU with antifungals was 48% (IQR 25, 80). Seventy-seven patients (50%) received prolonged empirical antifungal treatment. Chemotherapy (OR [95% CI] 2.6 [1.07-6.69], p = 0.034), and suspected infection at ICU admission (3.1 [1.05-9.48], p = 0.041) were independently associated with prolonged empirical antifungal treatment. Duration of mechanical ventilation and ICU stay were significantly shorter in patients with prolonged empirical antifungal treatment compared with those with no prolonged empirical antifungal treatment. However, ICU mortality was similar in the two groups (46 versus 52%, p = 0.62). Empirical antifungal treatment was prescribed in a large proportion of study patients. Chemotherapy, and suspicion of infection at ICU admission are independently associated with prolonged empirical antifungal treatment.

  9. Criterion Related Validity of Karate Specific Aerobic Test (KSAT)

    Science.gov (United States)

    Chaabene, Helmi; Hachana, Younes; Franchini, Emerson; Tabben, Montassar; Mkaouer, Bessem; Negra, Yassine; Hammami, Mehrez; Chamari, Karim

    2015-01-01

    Background: Karate is one the most popular combat sports in the world. Physical fitness assessment on a regular manner is important for monitoring the effectiveness of the training program and the readiness of karatekas to compete. Objectives: The aim of this research was to examine the criterion related to validity of the karate specific aerobic test (KSAT) as an indicator of aerobic level of karate practitioners. Patients and Methods: Cardiorespiratory responses, aerobic performance level through both treadmill laboratory test and YoYo intermittent recovery test level 1 (YoYoIRTL1) as well as time to exhaustion in the KSAT test (TE’KSAT) were determined in a total of fifteen healthy international karatekas (i.e. karate practitioners) (means ± SD: age: 22.2 ± 4.3 years; height: 176.4 ± 7.5 cm; body mass: 70.3 ± 9.7 kg and body fat: 13.2 ± 6%). Results: Peak heart rate obtained from KSAT represented ~99% of maximal heart rate registered during the treadmill test showing that KSAT imposes high physiological demands. There was no significant correlation between KSAT’s TE and relative (mL/min kg) treadmill maximal oxygen uptake (r = 0.14; P = 0.69; [small]). On the other hand, there was a significant relationship between KSAT’s TE and the velocity associated with VO2max (vVO2max) (r = 0.67; P = 0.03; [large]) as well as the velocity at VO2 corresponding to the second ventilatory threshold (vVO2 VAT) (r = 0.64; P = 0.04; [large]). Moreover, significant relationship was found between TE’s KSAT and both the total distance covered and parameters of intermittent endurance measured through YoYoIRTL1. Conclusions: The KSAT has not proved to have indirect criterion related validity as no significant correlations have been found between TE’s KSAT and treadmill VO2max. Nevertheless, as correlated to other aerobic fitness variables, KSAT can be considered as an indicator of karate specific endurance. The establishment of the criterion related validity of the KSAT

  10. Nutritional Risk Screening Predicts Tumor Response in Lung Cancer Patients.

    Science.gov (United States)

    Illa, Petr; Tomiskova, Marcela; Skrickova, Jana

    2015-01-01

    Malnutrition in cancer patients may be associated with poor tolerance of chemotherapy and lower response rate after oncological treatment. Nutritional Risk Screening 2002 (NRS) adapted for oncological patients was used to assess the risk of undernutrition in a group of 188 patients with lung cancer. The risk was evaluated on a 6-point scale according to common signs of nutritional status (weight loss, body mass index, and dietary intake), tumor, and its treatment risk factors. A score of 3 or more (called "nutritional risk") means significant risk of malnutrition and poor outcome. Acceptable NRS score was found in 50.6%, and in 45.3% a score of 3-5 suggested the risk of malnutrition (nutritional risk). Unexpectedly, the toxicity of anticancer treatment was not significantly different between the subgroups (acceptable score vs nutritional risk). The rate of treatment response evaluated by imaging techniques was significantly higher in patients with an acceptable score compared to nutritional risk. Overall survival rate was significantly higher in cytostatically treated patients with lung cancer with an acceptable score. Nutritional risk screening is a significant predictor of tumor response in patients with lung cancer. Early detection of malnutrition is important to determine the prognosis of cancer patients as well as to plan effective supportive care.

  11. Does obesity predict bipolarity in major depressive patients?

    Science.gov (United States)

    Vannucchi, Giulia; Toni, Cristina; Maremmani, Icro; Perugi, Giulio

    2014-02-01

    Differential association of obesity in bipolar and unipolar Major Depressive Episode (MDE) has not been systematically studied. We explore the relationships between obesity and history of manic and hypomanic symptoms in a large national clinical sample of MDE patients. The sample comprised 571 consecutive patients with a DSM-IV diagnosis of MDE enrolled in a 7 months period. The study involved 30 psychiatric facilities for outpatients, distributed throughout Italy. Diagnosis was formulated by psychiatrists with extensive clinical experience in the diagnosis and treatment of mood disorders. In all patients height (meters) and weight (kilograms) were systematically measured at the moment of the clinical evaluation. The severity of depressive and anxious symptomatology was self-evaluated by the means of Zung's questionnaires for depression and anxiety. For the evaluation of lifetime manic or hypomanic features, Hypomania Check List-32 was also administered. Obese and Non-Obese subgroups were identified on the basis of a >30 BMI cut off point. BMI ≤30 was observed in 86 (15.1%) of our MDE patients. The Obese and Non-Obese subgroups did not report differences as regards to age and gender distribution. Obese patients reported a lower number of years of education in comparison with Non-Obese patients. As regards to marital status, Obese patients were more frequently married in comparison with the Non-Obese patients. Obese patients were more frequently belonging to the bipolar group than Non-Obese patients. Obese subjects also reported more frequently than Non-Obese an HCL total score >14. The effect of educational level, marital status and bipolar-unipolar distinction on the probability of Obese group membership was analyzed by stepwise logistic regression. Bipolar subtype resulted to be the strongest predictor of Obesity. Pharmacological treatments and co-morbidity with other psychiatric disorders are not explored and accounted for in our analyses. Obesity in our

  12. Cardiovascular risk prediction in chronic kidney disease patients

    Directory of Open Access Journals (Sweden)

    Santiago Cedeño Mora

    2017-05-01

    Conclusion: The cardiovascular risk scores (FRS-CVD and ASCVD [AHA/ACC 2013] can estimate the probability of atherosclerotic cardiovascular events in patients with CKD regardless of renal function, albuminuria and previous cardiovascular events.

  13. Suboptimal Criterion Learning in Static and Dynamic Environments.

    Directory of Open Access Journals (Sweden)

    Elyse H Norton

    2017-01-01

    Full Text Available Humans often make decisions based on uncertain sensory information. Signal detection theory (SDT describes detection and discrimination decisions as a comparison of stimulus "strength" to a fixed decision criterion. However, recent research suggests that current responses depend on the recent history of stimuli and previous responses, suggesting that the decision criterion is updated trial-by-trial. The mechanisms underpinning criterion setting remain unknown. Here, we examine how observers learn to set a decision criterion in an orientation-discrimination task under both static and dynamic conditions. To investigate mechanisms underlying trial-by-trial criterion placement, we introduce a novel task in which participants explicitly set the criterion, and compare it to a more traditional discrimination task, allowing us to model this explicit indication of criterion dynamics. In each task, stimuli were ellipses with principal orientations drawn from two categories: Gaussian distributions with different means and equal variance. In the covert-criterion task, observers categorized a displayed ellipse. In the overt-criterion task, observers adjusted the orientation of a line that served as the discrimination criterion for a subsequently presented ellipse. We compared performance to the ideal Bayesian learner and several suboptimal models that varied in both computational and memory demands. Under static and dynamic conditions, we found that, in both tasks, observers used suboptimal learning rules. In most conditions, a model in which the recent history of past samples determines a belief about category means fit the data best for most observers and on average. Our results reveal dynamic adjustment of discrimination criterion, even after prolonged training, and indicate how decision criteria are updated over time.

  14. Personalized mortality prediction driven by electronic medical data and a patient similarity metric.

    Science.gov (United States)

    Lee, Joon; Maslove, David M; Dubin, Joel A

    2015-01-01

    Clinical outcome prediction normally employs static, one-size-fits-all models that perform well for the average patient but are sub-optimal for individual patients with unique characteristics. In the era of digital healthcare, it is feasible to dynamically personalize decision support by identifying and analyzing similar past patients, in a way that is analogous to personalized product recommendation in e-commerce. Our objectives were: 1) to prove that analyzing only similar patients leads to better outcome prediction performance than analyzing all available patients, and 2) to characterize the trade-off between training data size and the degree of similarity between the training data and the index patient for whom prediction is to be made. We deployed a cosine-similarity-based patient similarity metric (PSM) to an intensive care unit (ICU) database to identify patients that are most similar to each patient and subsequently to custom-build 30-day mortality prediction models. Rich clinical and administrative data from the first day in the ICU from 17,152 adult ICU admissions were analyzed. The results confirmed that using data from only a small subset of most similar patients for training improves predictive performance in comparison with using data from all available patients. The results also showed that when too few similar patients are used for training, predictive performance degrades due to the effects of small sample sizes. Our PSM-based approach outperformed well-known ICU severity of illness scores. Although the improved prediction performance is achieved at the cost of increased computational burden, Big Data technologies can help realize personalized data-driven decision support at the point of care. The present study provides crucial empirical evidence for the promising potential of personalized data-driven decision support systems. With the increasing adoption of electronic medical record (EMR) systems, our novel medical data analytics contributes to

  15. Personalized Mortality Prediction Driven by Electronic Medical Data and a Patient Similarity Metric

    Science.gov (United States)

    Lee, Joon; Maslove, David M.; Dubin, Joel A.

    2015-01-01

    Background Clinical outcome prediction normally employs static, one-size-fits-all models that perform well for the average patient but are sub-optimal for individual patients with unique characteristics. In the era of digital healthcare, it is feasible to dynamically personalize decision support by identifying and analyzing similar past patients, in a way that is analogous to personalized product recommendation in e-commerce. Our objectives were: 1) to prove that analyzing only similar patients leads to better outcome prediction performance than analyzing all available patients, and 2) to characterize the trade-off between training data size and the degree of similarity between the training data and the index patient for whom prediction is to be made. Methods and Findings We deployed a cosine-similarity-based patient similarity metric (PSM) to an intensive care unit (ICU) database to identify patients that are most similar to each patient and subsequently to custom-build 30-day mortality prediction models. Rich clinical and administrative data from the first day in the ICU from 17,152 adult ICU admissions were analyzed. The results confirmed that using data from only a small subset of most similar patients for training improves predictive performance in comparison with using data from all available patients. The results also showed that when too few similar patients are used for training, predictive performance degrades due to the effects of small sample sizes. Our PSM-based approach outperformed well-known ICU severity of illness scores. Although the improved prediction performance is achieved at the cost of increased computational burden, Big Data technologies can help realize personalized data-driven decision support at the point of care. Conclusions The present study provides crucial empirical evidence for the promising potential of personalized data-driven decision support systems. With the increasing adoption of electronic medical record (EMR) systems, our

  16. Personalized mortality prediction driven by electronic medical data and a patient similarity metric.

    Directory of Open Access Journals (Sweden)

    Joon Lee

    Full Text Available Clinical outcome prediction normally employs static, one-size-fits-all models that perform well for the average patient but are sub-optimal for individual patients with unique characteristics. In the era of digital healthcare, it is feasible to dynamically personalize decision support by identifying and analyzing similar past patients, in a way that is analogous to personalized product recommendation in e-commerce. Our objectives were: 1 to prove that analyzing only similar patients leads to better outcome prediction performance than analyzing all available patients, and 2 to characterize the trade-off between training data size and the degree of similarity between the training data and the index patient for whom prediction is to be made.We deployed a cosine-similarity-based patient similarity metric (PSM to an intensive care unit (ICU database to identify patients that are most similar to each patient and subsequently to custom-build 30-day mortality prediction models. Rich clinical and administrative data from the first day in the ICU from 17,152 adult ICU admissions were analyzed. The results confirmed that using data from only a small subset of most similar patients for training improves predictive performance in comparison with using data from all available patients. The results also showed that when too few similar patients are used for training, predictive performance degrades due to the effects of small sample sizes. Our PSM-based approach outperformed well-known ICU severity of illness scores. Although the improved prediction performance is achieved at the cost of increased computational burden, Big Data technologies can help realize personalized data-driven decision support at the point of care.The present study provides crucial empirical evidence for the promising potential of personalized data-driven decision support systems. With the increasing adoption of electronic medical record (EMR systems, our novel medical data analytics

  17. Predicting and managing sepsis in burn patients: current perspectives

    Directory of Open Access Journals (Sweden)

    Nunez Lopez O

    2017-08-01

    Full Text Available Omar Nunez Lopez,1,2 Janos Cambiaso-Daniel,1–3 Ludwik K Branski,1,2 William B Norbury,1,2 David N Herndon1,2,4 1Department of Surgery, University of Texas Medical Branch, 2Shriners Hospitals for Children, Galveston, TX, USA; 3Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; 4Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA Abstract: Modern burn care has led to unprecedented survival rates in burn patients whose injuries were fatal a few decades ago. Along with improved survival, new challenges have emerged in the management of burn patients. Infections top the list of the most common complication after burns, and sepsis is the leading cause of death in both adult and pediatric burn patients. The diagnosis and management of sepsis in burns is complex as a tremendous hypermetabolic response secondary to burn injury can be superimposed on systemic infection, leading to organ dysfunction. The management of a septic burn patient represents a challenging scenario that is commonly encountered by providers caring for burn patients despite preventive efforts. Here, we discuss the current perspectives in the diagnosis and treatment of sepsis and septic shock in burn patients. Keywords: burn injury, thermal injury, burn sepsis, procalcitonin, antibiotics, biomarkers, cytokines

  18. Immune phenotypes predict survival in patients with glioblastoma multiforme

    Directory of Open Access Journals (Sweden)

    Haouraa Mostafa

    2016-09-01

    Full Text Available Abstract Background Glioblastoma multiforme (GBM, a common primary malignant brain tumor, rarely disseminates beyond the central nervous system and has a very bad prognosis. The current study aimed at the analysis of immunological control in individual patients with GBM. Methods Immune phenotypes and plasma biomarkers of GBM patients were determined at the time of diagnosis using flow cytometry and ELISA, respectively. Results Using descriptive statistics, we found that immune anomalies were distinct in individual patients. Defined marker profiles proved highly relevant for survival. A remarkable relation between activated NK cells and improved survival in GBM patients was in contrast to increased CD39 and IL-10 in patients with a detrimental course and very short survival. Recursive partitioning analysis (RPA and Cox proportional hazards models substantiated the relevance of absolute numbers of CD8 cells and low numbers of CD39 cells for better survival. Conclusions Defined alterations of the immune system may guide the course of disease in patients with GBM and may be prognostically valuable for longitudinal studies or can be applied for immune intervention.

  19. Hypoalbuminaemia predicts outcome in adult patients with congenital heart disease

    Science.gov (United States)

    Kempny, Aleksander; Diller, Gerhard-Paul; Alonso-Gonzalez, Rafael; Uebing, Anselm; Rafiq, Isma; Li, Wei; Swan, Lorna; Hooper, James; Donovan, Jackie; Wort, Stephen J; Gatzoulis, Michael A; Dimopoulos, Konstantinos

    2015-01-01

    Background In patients with acquired heart failure, hypoalbuminaemia is associated with increased risk of death. The prevalence of hypoproteinaemia and hypoalbuminaemia and their relation to outcome in adult patients with congenital heart disease (ACHD) remains, however, unknown. Methods Data on patients with ACHD who underwent blood testing in our centre within the last 14 years were collected. The relation between laboratory, clinical or demographic parameters at baseline and mortality was assessed using Cox proportional hazards regression analysis. Results A total of 2886 patients with ACHD were included. Mean age was 33.3 years (23.6–44.7) and 50.1% patients were men. Median plasma albumin concentration was 41.0 g/L (38.0–44.0), whereas hypoalbuminaemia (disease complexity, hypoalbuminaemia remained a significant predictor of death. Conclusions Hypoalbuminaemia is common in patients with ACHD and is associated with a threefold increased risk of risk of death. Hypoalbuminaemia, therefore, should be included in risk-stratification algorithms as it may assist management decisions and timing of interventions in the growing ACHD population. PMID:25736048

  20. Cardiac autonomic neuropathy predicts cardiovascular morbidity and mortality in type 1 diabetic patients with diabetic nephropathy

    DEFF Research Database (Denmark)

    Astrup, Anne Sofie; Tarnow, Lise; Rossing, Peter

    2006-01-01

    Cardiac autonomic neuropathy (CAN) has been associated with a poor prognosis in patients with diabetes. Because CAN is common in patients with diabetic nephropathy, we evaluated the predictive value of CAN in type 1 diabetic patients with and without diabetic nephropathy....

  1. Prediction of peri-procedural myocardial injury in patients undergoing percutaneous coronary intervention by syntax score

    Directory of Open Access Journals (Sweden)

    Ahmed Fathy

    2014-03-01

    Conclusion: Syntax score has the ability to predict the occurrence of PMI with accepted sensitivity. It can assess the patient risk for development of PMI which could help to rationalize the use of adjunctive therapies as distal embolic protection devices in high risk patients. Also, diabetic patients have higher incidence of complicated coronary lesions, higher syntax score and they are more labile for PMI.

  2. Predicting mortality in Hepatitis-C patients using an artificial neural ...

    African Journals Online (AJOL)

    We have developed an artificial neural network that is capable of predicting whether a patient suffering from the hepatitis-C virus is likely to live or die. With test data, the system achieved 70% accuracy in determining when a patient would live and 60% accurate in determining when a patient would die. It is hoped that with ...

  3. The role of criterion A2 in the DSM-IV diagnosis of posttraumatic stress disorder.

    Science.gov (United States)

    Karam, Elie George; Andrews, Gavin; Bromet, Evelyn; Petukhova, Maria; Ruscio, Ayelet Meron; Salamoun, Mariana; Sampson, Nancy; Stein, Dan J; Alonso, Jordi; Andrade, Laura Helena; Angermeyer, Matthias; Demyttenaere, Koen; de Girolamo, Giovanni; de Graaf, Ron; Florescu, Silvia; Gureje, Oye; Kaminer, Debra; Kotov, Roman; Lee, Sing; Lépine, Jean-Pierre; Medina-Mora, Maria Elena; Oakley Browne, Mark A; Posada-Villa, José; Sagar, Rajesh; Shalev, Arieh Y; Takeshima, Tadashi; Tomov, Toma; Kessler, Ronald C

    2010-09-01

    Controversy exists about the utility of DSM-IV posttraumatic stress disorder (PTSD) criterion A2 (A2): that exposure to a potentially traumatic experience (PTE; PTSD criterion A1) is accompanied by intense fear, helplessness, or horror. Lifetime DSM-IV PTSD was assessed with the Composite International Diagnostic Interview in community surveys of 52,826 respondents across 21 countries in the World Mental Health Surveys. Of 28,490 representative PTEs reported by respondents, 37.6% met criterion A2, a proportion higher than the proportions meeting other criteria (B-F; 5.4%-9.6%). Conditional prevalence of meeting all other criteria for a diagnosis of PTSD given a PTE was significantly higher in the presence (9.7%) than absence (.1%) of A2. However, as only 1.4% of respondents who met all other criteria failed A2, the estimated prevalence of PTSD increased only slightly (from 3.64% to 3.69%) when A2 was not required for diagnosis. Posttraumatic stress disorder with or without criterion A2 did not differ in persistence or predicted consequences (subsequent suicidal ideation or secondary disorders) depending on presence-absence of A2. Furthermore, as A2 was by far the most commonly reported symptom of PTSD, initial assessment of A2 would be much less efficient than screening other criteria in quickly ruling out a large proportion of noncases. Removal of A2 from the DSM-IV criterion set would reduce the complexity of diagnosing PTSD, while not substantially increasing the number of people who qualify for diagnosis. Criterion A2 should consequently be reconceptualized as a risk factor for PTSD rather than as a diagnostic requirement. Copyright 2010 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  4. Evidence for the criterion validity and clinical utility of the Pathological Narcissism Inventory

    Science.gov (United States)

    Thomas, Katherine M.; Wright, Aidan G.C.; Lukowitsky, Mark R.; Donnellan, M. Brent; Hopwood, Christopher J.

    2012-01-01

    In this study we evaluated aspects of criterion validity and clinical utility of the grandiosity and vulnerability components of the Pathological Narcissism Inventory (PNI) using two undergraduate samples (Ns = 299, 500). Criterion validity was assessed by evaluating the correlations of narcissistic grandiosity and narcissistic vulnerability with established indices of normal personality traits, psychopathology and clinical concerns, and pathological personality traits. Overall, the pattern of correlations supported the convergent and discriminate validity of grandiose and vulnerable conceptualizations of pathological narcissism as measured by the PNI. Clinical utility was assessed by evaluating the extent to which clinicians without specific training in pathological narcissism as well as clinicians with expertise in pathological narcissism could accurately predict the correlates of PNI grandiosity and vulnerability with normal and pathological personality traits and psychopathology. The rcontrast-cv coefficient (Westen & Rosenthal, 2003) provided a global index of accuracy in clinicians’ predictions that was more fully elaborated by examining systematic discrepancies across groups. Overall, novice and expert clinicians were generally able to predict criterion correlations, with some exceptions (e.g., counter to predictions, pathological narcissism was negatively associated with treatment resistance). These results provide further evidence regarding the validity and utility of the narcissistic grandiosity and narcissistic vulnerability constructs as measured by the PNI. PMID:22315481

  5. Accuracy of SOFA score in prediction of 30-day outcome of critically ill patients.

    Science.gov (United States)

    Safari, Saeed; Shojaee, Majid; Rahmati, Farhad; Barartloo, Alireza; Hahshemi, Behrooz; Forouzanfar, Mohammad Mehdi; Mohammadi, Elham

    2016-12-01

    Researchers have attempted to design various scoring systems to determine the severity and predict the outcome of critically ill patients. The present study aimed to evaluate the accuracy of SOFA score in predicting 1-month outcome of these patients in emergency department. The present study is a prospective cross-sectional study of >18 year old non-trauma critically ill patients presented to EDs of 3 hospitals, Tehran, Iran, during October 2014 to October 2015. Baseline characteristics, SOFA score variables, and 1-month outcome of patients were recorded and screening performance characteristics of the score were calculated using STATA 11 software. 140 patients with the mean age of 68.36 ± 18.62 years (18-95) were included (53.5% male). The most common complaints were decrease in level of consciousness (76.43%) and sepsis (60.0%), were the most frequent final diagnoses. Mean SOFA score of the patients was 7.13 ± 2.36 (minimum 2 and maximum 16). 72 (51.43%) patients died during the following 30 days and 16 (11.43%) patients were affected with multiple organ failure. Area under the ROC curve of SOFA score in predicting mortality of studied patients was 0.73 (95%CI: 0.65-0.81) (Fig. 2). Table 2 depicts screening performance characteristics of this scale in prediction of 1-month mortality in the best cut-off point of ≥7. At this cut-off point, sensitivity and specificity of SOFA in predicting 1-month mortality were 75% and 63.23%, respectively. Findings of the present study showed that SOFA scoring system has fair accuracy in predicting 1-month mortality of critically ill patients. However, until a more reliable scoring system is developed, SOFA might be useful for narrative prediction of patient outcome considering its acceptable likelihood ratios.

  6. Coupling of EIT with computational lung modeling for predicting patient-specific ventilatory responses.

    Science.gov (United States)

    Roth, Christian J; Becher, Tobias; Frerichs, Inéz; Weiler, Norbert; Wall, Wolfgang A

    2017-04-01

    Providing optimal personalized mechanical ventilation for patients with acute or chronic respiratory failure is still a challenge within a clinical setting for each case anew. In this article, we integrate electrical impedance tomography (EIT) monitoring into a powerful patient-specific computational lung model to create an approach for personalizing protective ventilatory treatment. The underlying computational lung model is based on a single computed tomography scan and able to predict global airflow quantities, as well as local tissue aeration and strains for any ventilation maneuver. For validation, a novel "virtual EIT" module is added to our computational lung model, allowing to simulate EIT images based on the patient's thorax geometry and the results of our numerically predicted tissue aeration. Clinically measured EIT images are not used to calibrate the computational model. Thus they provide an independent method to validate the computational predictions at high temporal resolution. The performance of this coupling approach has been tested in an example patient with acute respiratory distress syndrome. The method shows good agreement between computationally predicted and clinically measured airflow data and EIT images. These results imply that the proposed framework can be used for numerical prediction of patient-specific responses to certain therapeutic measures before applying them to an actual patient. In the long run, definition of patient-specific optimal ventilation protocols might be assisted by computational modeling.NEW & NOTEWORTHY In this work, we present a patient-specific computational lung model that is able to predict global and local ventilatory quantities for a given patient and any selected ventilation protocol. For the first time, such a predictive lung model is equipped with a virtual electrical impedance tomography module allowing real-time validation of the computed results with the patient measurements. First promising results

  7. Criterion-referenced measurement: Its main applications, problems and findings

    NARCIS (Netherlands)

    van der Linden, Willem J.

    1982-01-01

    The need for criterion-referenced measurements has mainly arisen from the introduction of instructional programs organized according to modern principles from educational technology. Some of these programs are discussed, and it is indicated for what purposes criterion-referenced measurements are

  8. Criterion-Related Validity: Assessing the Value of Subscores

    Science.gov (United States)

    Davison, Mark L.; Davenport, Ernest C., Jr.; Chang, Yu-Feng; Vue, Kory; Su, Shiyang

    2015-01-01

    Criterion-related profile analysis (CPA) can be used to assess whether subscores of a test or test battery account for more criterion variance than does a single total score. Application of CPA to subscore evaluation is described, compared to alternative procedures, and illustrated using SAT data. Considerations other than validity and reliability…

  9. Confinement criterion for gauge theories with matter fields

    Science.gov (United States)

    Greensite, Jeff; Matsuyama, Kazue

    2017-11-01

    A generalization of the Wilson loop area-law criterion, which is applicable to gauge theories with matter in the fundamental representation of the gauge group, is proposed. This new criterion, like the area law, is stronger than the statement that asymptotic particle states are massive color singlets, which holds even for theories described by the Brout-Englert-Higgs mechanism.

  10. Some necessary and sufficient conditions for Hypercyclicity Criterion

    Indian Academy of Sciences (India)

    R. Narasimhan (Krishtel eMaging) 1461 1996 Oct 15 13:05:22

    This criterion has been used to show that certain classes of composition operators [6], weighted shifts [21], adjoints of multiplication operators [7], and adjoints of subnormal and hyponor- mal operators [5], are hypercyclic. Hypercyclicity has also been established in various other settings by means of this criterion [1,4,6,8,12 ...

  11. Criterion I: Soil and water conservation on rangelands [Chapter 2

    Science.gov (United States)

    Michael G. (Sherm) Karl; Paul T. Tueller; Gerald E. Schuman; Mark R. Vinson; James L. Fogg; Ronald W. Shafer; David A. Pyke; D. Terrance Booth; Steven J. Borchard; William G. Ypsilantis; Richard H. Barrett

    2010-01-01

    The Sustainable Rangelands Roundtable (SRR) has explicitly included conservation and maintenance of soil and water resources as a criterion of rangeland sustainability. Within the soil/water criterion, 10 indicators ­ five soil-based and five water-based - were developed through the expert opinions of rangeland scientists, rangeland management agency personnel, non-...

  12. Predicting Bleeding Risk by Platelet Function Testing in Patients Undergoing Heart Surgery.

    Science.gov (United States)

    Kuliczkowski, Wiktor; Sliwka, Joanna; Kaczmarski, Jacek; Zysko, Dorota; Zembala, Michal; Steter, Damian; Zembala, Marian; Fortmann, Seth; Serebruany, Victor

    2015-11-01

    Predicting bleeding events in patients with coronary artery bypass grafting (CABG) represents an unmet medical need that may improve CABG outcomes. To assess the potential link between platelet function testing and bleeding risk in patients undergoing CABG. Platelet aggregation and clinical outcomes in 478 patients treated with aspirin and/or clopidogrel were retrospectively analyzed. Platelet activity was assessed prior to CABG with arachidonic acid (ASPI Test), and adenosine diphosphate(ADP Test) utilizing multiple-electrode aggregometry. In the study group of 478 patients, mean age was 65.2±15.2 years; 138 were women. The majority of patients (n = 198) underwent on-pump surgery, with 162 undergoing off-pump and 30 undergoing minimally invasive surgery. Forty-eight patients received artificial valve implantation alone, and 40 received valve implantation in combination with CABG. The analysis of the entire pool revealed that an ASPI test value <407 area under curve per minute (AUC*min) may be useful in predicting postoperative drainage. In CABG patients only, an ASPI test value <271 AUC*min predicted the need for red blood cell concentrate transfusion following surgery. In patients who stopped clopidogrel for up to 5 days before surgery, the ADP test failed to exhibit prognostic utility for predicting bleeding risk. In patients undergoing heart surgery, an ASPI test value <407 AUC*min may predict higher postoperative drainage, whereas <271 AUC*min may be linked to postoperative use of red blood cell concentrate. © 2015 Wiley Periodicals, Inc.

  13. Accuracy of patient's turnover time prediction using RFID technology in an academic ambulatory surgery center.

    Science.gov (United States)

    Marchand-Maillet, Florence; Debes, Claire; Garnier, Fanny; Dufeu, Nicolas; Sciard, Didier; Beaussier, Marc

    2015-02-01

    Patients flow in outpatient surgical unit is a major issue with regards to resource utilization, overall case load and patient satisfaction. An electronic Radio Frequency Identification Device (RFID) was used to document the overall time spent by the patients between their admission and discharge from the unit. The objective of this study was to evaluate how a RFID-based data collection system could provide an accurate prediction of the actual time for the patient to be discharged from the ambulatory surgical unit after surgery. This is an observational prospective evaluation carried out in an academic ambulatory surgery center (ASC). Data on length of stay at each step of the patient care, from admission to discharge, were recorded by a RFID device and analyzed according to the type of surgical procedure, the surgeon and the anesthetic technique. Based on these initial data (n = 1520), patients were scheduled in a sequential manner according to the expected duration of the previous case. The primary endpoint was the difference between actual and predicted time of discharge from the unit. A total of 414 consecutive patients were prospectively evaluated. One hundred seventy four patients (42%) were discharged at the predicted time ± 30 min. Only 24% were discharged behind predicted schedule. Using an automatic record of patient's length of stay would allow an accurate prediction of the discharge time according to the type of surgery, the surgeon and the anesthetic procedure.

  14. Abdominal aortic calcifications predict survival in peritoneal dialysis patients

    DEFF Research Database (Denmark)

    Mäkelä, Satu M; Asola, Markku; Hadimeri, Henrik

    2018-01-01

    BACKGROUND: Peripheral arterial disease and vascular calcifications contribute significantly to the outcome of dialysis patients. The aim of this study was to evaluate the prognostic role of severity of abdominal aortic calcifications and peripheral arterial disease on outcome of peritoneal...... dialysis (PD) patients using methods easily available in everyday clinical practice. METHODS: We enrolled 249 PD patients (mean age 61 years, 67% male) in this prospective, observational, multicenter study from 2009 to 2013. The abdominal aortic calcification score (AACS) was assessed using lateral lumbar...... [CI] 1.94 - 24.46) for aortic calcification (AACS ≥ 7), 2.14 for diabetes (yes/no), 0.93 for albumin (per 1 g/L), and 1.04 for age (per year). A low or high ABI were not independently associated with mortality. CONCLUSIONS: Severe aortic calcification was a strong predictor of all-cause mortality...

  15. Predictive factors for relapse in patients on buprenorphine maintenance.

    Science.gov (United States)

    Ferri, Michael; Finlayson, Alistair J Reid; Wang, Li; Martin, Peter R

    2014-01-01

    Despite the dramatic increase in the use of buprenorphine for the treatment of opioid dependence, clinical outcomes of this treatment approach continue to need evaluation. This study examines factors associated with relapse and retention during buprenorphine treatment in a sample of opioid dependent outpatients. In a retrospective chart review of 62 patients with opioid dependence, relapse was determined by self-report, urine toxicology screens, and by checking the state controlled substance monitoring database. Data was analyzed using two-way tests of association and logistic regression. Patients with comorbid anxiety disorders, active benzodiazepine use (contrary to clinic policy), or active alcohol abuse, were significantly more likely to relapse. Patients who relapsed were also more likely to be on a higher buprenorphine maintenance dose. This study identifies relapse risk factors during buprenorphine treatment for opioid dependence. Future research is needed to determine whether modifying these factors may lead to improved treatment outcomes. © American Academy of Addiction Psychiatry.

  16. Factors predicting language lateralization in patients with perisylvian vascular malformations

    Science.gov (United States)

    Lee, Darrin J.; Pouratian, Nader; Bookheimer, Susan Y.; Martin, Neil A.

    2017-01-01

    Object The authors conducted a study to determine the factors associated with right-sided language dominance in patients with cerebrovascular malformations. Methods Twenty-two patients with either arteriovenous malformations (AVMs [15 cases]) or cavernous malformations (7 cases) underwent functional MR (fMR) imaging studies of language function; a 3.0-T head-only unit was used. Lateralization indices were calculated separately for Broca and Wernicke areas. Lesion size, Spetzler-Martin grade, and the distance between the lesion and anatomically defined language cortex were calculated for each patient. Results Right-sided language dominance occurred in 5 patients, all of whom had AVMs within 10 mm of canonical language areas. Three patients had right-sided language dominance in the Wernicke area alone whereas 2 had right-sided language dominance in both Broca and Wernicke areas. Wada testing and intraoperative electrocortical stimulation were performed as clinically indicated to corroborate fMR imaging findings. Conclusions The primary factor associated with right-sided language dominance was the AVM being within 10 mm of anatomically defined language areas. The lesion size and the Spetzler-Martin grade were not significant factors. Anomalous fMR imaging laterality was typically confined to the language area proximate to the lesion, with the distal language area remaining in the left hemisphere dominant. This study emphasizes the need to map each case individually in patients with left perisylvian AVMs. Assumptions about eloquent cortex based on anatomical landmarks (a key component of Spetzler-Martin grading) may have to be reconsidered. PMID:20302390

  17. Malnutrition Predicts Clinical Outcome in Patients with Neuroendocrine Neoplasia.

    Science.gov (United States)

    Maasberg, Sebastian; Knappe-Drzikova, Barbora; Vonderbeck, Dorothée; Jann, Henning; Weylandt, Karsten H; Grieser, Christian; Pascher, Andreas; Schefold, Jörg C; Pavel, Marianne; Wiedenmann, Bertram; Sturm, Andreas; Pape, Ulrich-Frank

    2017-01-01

    Malnutrition is a common problem in oncological diseases, influencing treatment outcomes, treatment complications, quality of life and survival. The potential role of malnutrition has not yet been studied systematically in neuroendocrine neoplasms (NEN), which, due to their growing prevalence and additional therapeutic options, provide an increasing clinical challenge to diagnosis and management. The aim of this cross-sectional observational study, which included a long-term follow-up, was therefore to define the prevalence of malnutrition in 203 patients with NEN using various methodological approaches, and to analyse the short- and long-term outcome of malnourished patients. A detailed subgroup analysis was also performed to define risk factors for poorer outcome. When applying malnutrition screening scores, 21-25% of the NEN patients were at risk of or demonstrated manifest malnutrition. This was confirmed by anthropometric measurements, by determination of serum surrogate parameters such as albumin as well as by bioelectrical impedance analysis (BIA), particularly phase angle α. The length of hospital stay was significantly longer in malnourished NEN patients, while long-term overall survival was highly significantly reduced. Patients with high-grade (G3) neuroendocrine carcinomas, progressive disease and undergoing chemotherapy were at particular risk of malnutrition associated with a poorer outcome. Multivariate analysis confirmed the important and highly significant role of malnutrition as an independent prognostic factor for NEN besides proliferative capacity (G3 NEC). Malnutrition is therefore an underrecognized problem in NEN patients which should systematically be diagnosed by widely available standard methods such as Nutritional Risk Screening (NRS), serum albumin assessment and BIA, and treated to improve both short- and long-term outcomes. © 2015 S. Karger AG, Basel.

  18. Risk Prediction of New Adjacent Vertebral Fractures After PVP for Patients with Vertebral Compression Fractures: Development of a Prediction Model

    Energy Technology Data Exchange (ETDEWEB)

    Zhong, Bin-Yan; He, Shi-Cheng; Zhu, Hai-Dong [Southeast University, Department of Radiology, Medical School, Zhongda Hospital (China); Wu, Chun-Gen [Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Department of Diagnostic and Interventional Radiology (China); Fang, Wen; Chen, Li; Guo, Jin-He; Deng, Gang; Zhu, Guang-Yu; Teng, Gao-Jun, E-mail: gjteng@vip.sina.com [Southeast University, Department of Radiology, Medical School, Zhongda Hospital (China)

    2017-02-15

    PurposeWe aim to determine the predictors of new adjacent vertebral fractures (AVCFs) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCFs) and to construct a risk prediction score to estimate a 2-year new AVCF risk-by-risk factor condition.Materials and MethodsPatients with OVCFs who underwent their first PVP between December 2006 and December 2013 at Hospital A (training cohort) and Hospital B (validation cohort) were included in this study. In training cohort, we assessed the independent risk predictors and developed the probability of new adjacent OVCFs (PNAV) score system using the Cox proportional hazard regression analysis. The accuracy of this system was then validated in both training and validation cohorts by concordance (c) statistic.Results421 patients (training cohort: n = 256; validation cohort: n = 165) were included in this study. In training cohort, new AVCFs after the first PVP treatment occurred in 33 (12.9%) patients. The independent risk factors were intradiscal cement leakage and preexisting old vertebral compression fracture(s). The estimated 2-year absolute risk of new AVCFs ranged from less than 4% in patients with neither independent risk factors to more than 45% in individuals with both factors.ConclusionsThe PNAV score is an objective and easy approach to predict the risk of new AVCFs.

  19. Modified Schur-Cohn Criterion for Stability of Delayed Systems

    Directory of Open Access Journals (Sweden)

    Juan Ignacio Mulero-Martínez

    2015-01-01

    Full Text Available A modified Schur-Cohn criterion for time-delay linear time-invariant systems is derived. The classical Schur-Cohn criterion has two main drawbacks; namely, (i the dimension of the Schur-Cohn matrix generates some round-off errors eventually resulting in a polynomial of s with erroneous coefficients and (ii imaginary roots are very hard to detect when numerical errors creep in. In contrast to the classical Schur-Cohn criterion an alternative approach is proposed in this paper which is based on the application of triangular matrices over a polynomial ring in a similar way as in the Jury test of stability for discrete systems. The advantages of the proposed approach are that it halves the dimension of the polynomial and it only requires seeking real roots, making this modified criterion comparable to the Rekasius substitution criterion.

  20. Cardiopulmonary exercise factors predict survival in patients with advanced interstitial lung disease referred for lung transplantation.

    Science.gov (United States)

    Layton, Aimee M; Armstrong, Hilary F; Kim, Hanyoung P; Meza, Kimbery S; D'Ovidio, Frank; Arcasoy, Selim M

    2017-05-01

    The purpose of this work was to determine if parameters assessed during Cardiopulmonary Exercise Testing (CPET) while using supplemental oxygen can independently predict one-year transplant-free survival in patients with Interstitial Lung Disease (ILD) referred for lung transplant evaluation. We performed a chart review of patients with ILD who completed CPET with 30% FiO2 and gathered spirometry, pulmonary hemodynamic, six-minute walk, and CPET data. The primary end-point was death or lung transplantation within one-year of CPET. The final data set included 192 patients. 79 patients died/underwent transplant, 113 survived transplant-free. Multivariable Cox regression revealed peak workload % predicted, nadir CPET SpO2, and FVC% predicted as independent predictors of one-year transplant-free survival. Of the independent predictors of survival, receiver operating characteristics analysis revealed peak workload %predicted cutoff of 35% to be highly discriminatory, more so than nadir CPET SpO2 or FVC % predicted in identifying patients at risk for one-year mortality or transplant (peak workload % predicted < 35% HR = 4.71, 95% CI = 2.64-8.38 and area under the curve (AUC) = 0.740, nadir CPET SpO2 < 86% HR = 2.27, 95%CI = 1.41-3.68, AUC = 0.645, FVC %predicted <45% HR = 1.82, 95% CI = 1.15-2.87, AUC = 0.624). Peak workload % predicted, nadir CPET SpO2, and FVC% predicted in ILD patients referred for lung transplant evaluation are independently predictive of one-year mortality or need for transplant. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Obesity-Related Adipokines Predict Patient-Reported Shoulder Pain

    Directory of Open Access Journals (Sweden)

    Rajiv Gandhi

    2013-12-01

    Full Text Available Background/Aims: Increasingly, an inflammatory modulating effect of adipokines within synovial joints is being recognized. To date, there has been no work examining a potential association between the presence of adipokines in the shoulder and patient-reported outcomes. This study undertakes an investigation assessing these potential links. Methods: 50 osteoarthritis patients scheduled for shoulder surgery completed a pre-surgery questionnaire capturing demographic information including validated, patient-reported function (Disabilities of the Arm, Shoulder, and Hand questionnaire and pain (Short Form McGill Pain Questionnaire measures. Synovial fluid (SF samples were analyzed for leptin, adiponectin, and resistin levels using Milliplex MAP assays. Linear regression modeling was used to assess the association between adipokine levels and patient-reported outcomes, adjusted for age, sex, BMI, and disease severity. Results: 54% of the cohort was female (n = 27. The mean age (SD of the sample was 62.9 (9.9 years and the mean BMI (SD was 28.1 (5.4 kg/m2. From regression analyses, greater SF leptin and adiponectin levels, but not regarding resistin, were found to be associated with greater pain (p Conclusions: The identified association between shoulder-derived SF leptin and adiponectin and shoulder pain is likely explained by the pro-inflammatory characteristics of the adipokines and represents potentially important therapeutic targets.

  2. EEG arousal prediction via hypoxemia indicator in patients with ...

    African Journals Online (AJOL)

    Obstructive sleep apnea syndrome (OSAS) is a sleep breathing disorder characterized by recurrent airflow obstruction caused by a total or partial collapse of the upper airway. OSAS is a common affliction suffered by millions. The arousal index (ArI) is the best predictor of daytime somnolence for patients with OSAS, ...

  3. Serological Prediction of infections in Diabetic Patients with ...

    African Journals Online (AJOL)

    cellulitis), rapid streptococcal testing, culture and/or radiographs, during the entire hospital course, were defined as having no infection. Patients with the documentations of symptoms, signs and/or radiographs consistent with upper and/or lower respiratory tract infections, for which no antibiotics were given, were defined as ...

  4. IGFBP2 expression predicts IDH-mutant glioma patient survival.

    Science.gov (United States)

    Huang, Lin Eric; Cohen, Adam L; Colman, Howard; Jensen, Randy L; Fults, Daniel W; Couldwell, William T

    2017-01-03

    Mutations of the isocitrate dehydrogenase (IDH) 1 and 2 genes occur in ~80% of lower-grade (WHO grade II and grade III) gliomas. Mutant IDH produces (R)-2-hydroxyglutarate, which induces DNA hypermethylation and presumably drives tumorigenesis. Interestingly, IDH mutations are associated with improved survival in glioma patients, but the underlying mechanism for the difference in survival remains unclear. Through comparative analyses of 286 cases of IDH-wildtype and IDH-mutant lower-grade glioma from a TCGA data set, we report that IDH-mutant gliomas have increased expression of tumor-suppressor genes (NF1, PTEN, and PIK3R1) and decreased expression of oncogenes(AKT2, ARAF, ERBB2, FGFR3, and PDGFRB) and glioma progression genes (FOXM1, IGFBP2, and WWTR1) compared with IDH-wildtype gliomas. Furthermore, each of these genes is prognostic in overall gliomas; however, within the IDH-mutant group, none remains prognostic except IGFBP2 (encodinginsulin-like growth factor binding protein 2). Through validation in an independent cohort, we show that patients with low IGFBP2 expressiondisplay a clear advantage in overall and disease-free survival, whereas those with high IGFBP2 expressionhave worse median survival than IDH-wildtype patients. These observations hold true across different histological and molecular subtypes of lower-grade glioma. We propose therefore that an unexpected biological consequence of IDH mutations in glioma is to ameliorate patient survival by promoting tumor-suppressor signaling while inhibiting that of oncogenes, particularly IGFBP2.

  5. A Predictive Model for Massive Transfusion in Combat Casualty Patients

    Science.gov (United States)

    2008-02-01

    addition to acute hemorrhage, hypothermia, acido - sis, and coagulopathy have been demonstrated to perpetu- ate the ongoing cycle of bleeding.17 Recent...massively transfused trauma patient: hypothermia and acidoses revisited. J Trauma. 1997;42:857–862. 18. Brohi K, Singh J, Heron M, Coats T. Acute

  6. Avascular necrosis in sickle cell (homozygous S) patients: Predictive ...

    African Journals Online (AJOL)

    The steady state white cell count, platelet count, frequency of bone pain crisis and hematocrit, was compared in patients that develop AVN and those who had not ... with a raised steady state platelet count may have a higher tendency to develop AVN and may require closer orthopedic review and prophylactic intervention.

  7. Predictive factors in epithelial ovarian cancer: Towards individualized patient care

    NARCIS (Netherlands)

    Rutten, M.J.

    2015-01-01

    Ovarian cancer is a disease with a high mortality. Most patients with epithelial ovarian cancer (EOC) present with advanced stage disease with multiple tumour deposits in the peritoneal cavity. Survival of early stages is high, yet, survival of advanced stage disease is low with a five year survival

  8. Proton MRS may predict AED response in patients with TLE.

    Science.gov (United States)

    Campos, Bruno A G; Yasuda, Clarissa L; Castellano, Gabriela; Bilevicius, Elizabeth; Li, Li M; Cendes, Fernando

    2010-05-01

    To compare relative N-acetylaspartate (NAA) measurements in temporal lobe epilepsy (TLE) patients with good response to the first trial of antiepileptic drugs (AEDs) (an important prognostic factor) to TLE patients who failed the first AED monotherapy and required further AED trials with monotherapy or polytherapy. We studied 25 consecutive TLE patients who responded to first AED (responders) and 21 who did not (failure-group), as well as 27 controls. Patients were seen regularly in our Epilepsy Service and underwent electroencephalography (EEG) investigation, high-resolution magnetic resonance imaging (MRI), and single-voxel proton MR spectroscopy. Voxels were tailored to the medial temporal region on each side and involved the anterior hippocampus. Analysis of variance (ANOVA) demonstrated significant variation of NAA/creatine (NAA/Cr) values in both hippocampi, ipsilateral and contralateral to the EEG focus (p AED have significantly less evidence of neuronal and axonal damage/dysfunction compared to those who are refractory to the first AED trial.

  9. Prediction of Poor Outcome in Patients with Acute Liver Failure-Systematic Review of Prediction Models

    NARCIS (Netherlands)

    Wlodzimirow, Kama A.; Eslami, Saeid; Chamuleau, Robert A. F. M.; Nieuwoudt, Martin; Abu-Hanna, Ameen

    2012-01-01

    Introduction: Acute liver failure is a rare disease with high mortality and liver transplantation is the only life saving therapy. Accurate prognosis of ALF is crucial for proper intervention. Aim: To identify and characterize newly developed prognostic models of mortality for ALF patients, assess

  10. Patient characteristics do not predict poor glycaemic control in type 2 diabetes patients treated in primary care

    NARCIS (Netherlands)

    Goudswaard, AN; Stolk, RP; Zuithoff, P; Rutten, GEHM

    Many diabetic patients in general practice do not achieve good glycaemic control. The aim of this study was to assess which characteristics of type 2 diabetes patients treated in primary care predict poor glycaemic control (HbA(1c) greater than or equal to7%). Data were collected from the medical

  11. Blood transfusions in severe burn patients: Epidemiology and predictive factors.

    Science.gov (United States)

    Wu, Guosheng; Zhuang, Mingzhu; Fan, Xiaoming; Hong, Xudong; Wang, Kangan; Wang, He; Chen, Zhengli; Sun, Yu; Xia, Zhaofan

    2016-12-01

    Blood is a vital resource commonly used in burn patients; however, description of blood transfusions in severe burns is limited. The purpose of this study was to describe the epidemiology of blood transfusions and determine factors associated with increased transfusion quantity. This is a retrospective study of total 133 patients with >40% total body surface area (TBSA) burns admitted to the burn center of Changhai hospital from January 2008 to December 2013. The study characterized blood transfusions in severe burn patients. Univariate and Multivariate regression analyses were used to evaluate the association of clinical variables with blood transfusions. The overall transfusion rate was 97.7% (130 of 133). The median amount of total blood (RBC and plasma), RBC and plasma transfusions was 54 units (Interquartile range (IQR), 20-84), 19 units (IQR, 4-37.8) and 28.5 units (IQR, 14.8-51.8), respectively. The number of RBC transfusion in and outside operation room was 7 (0, 14) and 11 (2, 20) units, and the number of plasma was 6 (0.5, 12) and 21 (11.5, 39.3) units. A median of one unit of blood was transfused per TBSA and an average of 4 units per operation was given in the series. The consumption of plasma is higher than that of RBC. On multivariate regression analysis, age, full-thickness TBSA and number of operations were significant independent predictors associated with the number of RBC transfusion, and coagulopathy and ICU length showed a trend toward RBC consumption. Predictors for increased plasma transfusion were female, high full-thickness TBSA burn and more operations. Severe burn patients received an ample volume of blood transfusions. Fully understanding of predictors of blood transfusions will allow physicians to better optimize burn patients during hospitalization in an effort to use blood appropriately. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  12. Prediction of everyday verbal communicative ability of aphasic stroke patients after inpatient rehabilitation

    NARCIS (Netherlands)

    Blom-Smink, Marieke R M A; van de Sandt-Koenderman, Mieke W M E; Kruitwagen, Cas L J J; El Hachioui, Hanane; Visch-Brink, Evy G.; Ribbers, Gerard M.

    2017-01-01

    Background: Early accurate prediction of verbal communicative ability at discharge from inpatient rehabilitation is essential for rehabilitation professionals to provide reliable prognostic information to the aphasic patient and family, and to make appropriate treatment decisions. Aims: To develop a

  13. Applying machine learning to predict patient-specific current CD 4 ...

    African Journals Online (AJOL)

    Applying machine learning to predict patient-specific current CD4 cell count in order to determine the progression of human immunodeficiency virus (HIV) infection. Yashik Singh, Nitesh Narsai, Maurice Mars ...

  14. Probiotic treatment with Probioflora in patients with predicted severe acute pancreatitis without organ failure

    NARCIS (Netherlands)

    Baal, M.C. van; Kohout, P.; Besselink, M.G.; Santvoort, H.C. van; Benes, Z.; Zazula, R.; Rijkers, G.T.; Gooszen, H.G.

    2012-01-01

    BACKGROUND: We previously demonstrated that probiotic prophylaxis, in patients with predicted severe pancreatitis, did not prevent infectious complications but unexpectedly increased the risk of bowel ischemia and mortality. The suggestion that these negative findings are only observed in the

  15. Predictive value of stroke discharge diagnoses in the Danish National Patient Register

    DEFF Research Database (Denmark)

    Lühdorf, Pernille; Overvad, Kim; Schmidt, Erik B

    2017-01-01

    AIMS: To determine the positive predictive values for stroke discharge diagnoses, including subarachnoidal haemorrhage, intracerebral haemorrhage and cerebral infarction in the Danish National Patient Register. METHODS: Participants in the Danish cohort study Diet, Cancer and Health with a stroke...

  16. Brain Imaging Predicts Psychotherapy Success in Patients with Social Anxiety Disorder

    Science.gov (United States)

    ... Brain Imaging Predicts Psychotherapy Success in Patients with Social Anxiety Disorder February 1, 2013 • Science Update Treatment for social anxiety disorder or social phobia has entered the personalized ...

  17. Use of molecular markers for predicting therapy response in cancer patients.

    LENUS (Irish Health Repository)

    Duffy, Michael J

    2012-02-01

    Predictive markers are factors that are associated with upfront response or resistance to a particular therapy. Predictive markers are important in oncology as tumors of the same tissue of origin vary widely in their response to most available systemic therapies. Currently recommended oncological predictive markers include both estrogen and progesterone receptors for identifying patients with breast cancers likely to benefit from hormone therapy, HER-2 for the identification of breast cancer patients likely to benefit from trastuzumab, specific K-RAS mutations for the identification of patients with advanced colorectal cancer unlikely to benefit from either cetuximab or panitumumab and specific EGFR mutations for selecting patients with advanced non-small-cell lung cancer for treatment with tyrosine kinase inhibitors such as gefitinib and erlotinib. The availability of predictive markers should increase drug efficacy and decrease toxicity, thus leading to a more personalized approach to cancer treatment.

  18. One- and 2-Year Mortality Prediction for Patients Starting Chronic Dialysis

    Directory of Open Access Journals (Sweden)

    Mikko Haapio

    2017-11-01

    Discussion: Mortality prediction algorithms could be more widely implemented into management of ESRD patients. The presented models are practical with only a limited number of variables and fairly good performance.

  19. Characterization and Predictive Value of Segmental Curve Flexibility in Adolescent Idiopathic Scoliosis Patients

    DEFF Research Database (Denmark)

    Yao, Guanfeng; Cheung, Jason P Y; Shigematsu, Hideki

    2017-01-01

    STUDY DESIGN: A prospective radiographic analysis of adolescent idiopathic scoliosis (AIS) patients managed with alternate-level pedicle screw fixation was performed. OBJECTIVE: The objective of this study was to characterize segmental curve flexibility and to determine its predictive value...

  20. Distinct anatomical correlates of discriminability and criterion setting in verbal recognition memory revealed by lesion-symptom mapping.

    Science.gov (United States)

    Biesbroek, J Matthijs; van Zandvoort, Martine J E; Kappelle, L Jaap; Schoo, Linda; Kuijf, Hugo J; Velthuis, Birgitta K; Biessels, Geert Jan; Postma, Albert

    2015-04-01

    Recognition memory, that is, the ability to judge whether an item has been previously encountered in a particular context, depends on two factors: discriminability and criterion setting. Discriminability draws on memory processes while criterion setting (i.e., the application of a threshold resulting in a yes/no response) is regarded as a process of cognitive control. Discriminability and criterion setting are assumed to draw on distinct anatomical structures, but definite evidence for this assumption is lacking. We applied voxel-based and region of interest-based lesion-symptom mapping to 83 patients in the acute phase of ischemic stroke to determine the anatomical correlates of discriminability and criterion setting in verbal recognition memory. Recognition memory was measured with the Rey Auditory Verbal Learning Test. Signal-detection theory was used to calculate measures for discriminability and criterion setting. Lesion-symptom mapping revealed that discriminability draws on left medial temporal and temporo-occipital structures, both thalami and the right hippocampus, while criterion setting draws on the right inferior frontal gyrus. Lesions in the right inferior frontal gyrus were associated with liberal response bias. These findings indicate that discriminability and criterion setting indeed depend on distinct anatomical structures and provide new insights in the anatomical correlates of these cognitive processes that underlie verbal recognition memory. © 2014 Wiley Periodicals, Inc.

  1. [GSH fermentation process modeling using entropy-criterion based RBF neural network model].

    Science.gov (United States)

    Tan, Zuoping; Wang, Shitong; Deng, Zhaohong; Du, Guocheng

    2008-05-01

    The prediction accuracy and generalization of GSH fermentation process modeling are often deteriorated by noise existing in the corresponding experimental data. In order to avoid this problem, we present a novel RBF neural network modeling approach based on entropy criterion. It considers the whole distribution structure of the training data set in the parameter learning process compared with the traditional MSE-criterion based parameter learning, and thus effectively avoids the weak generalization and over-learning. Then the proposed approach is applied to the GSH fermentation process modeling. Our results demonstrate that this proposed method has better prediction accuracy, generalization and robustness such that it offers a potential application merit for the GSH fermentation process modeling.

  2. [Probiotic prophylaxis in patients with predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial

    NARCIS (Netherlands)

    Besselink, M.G.; Santvoort, H.C. van; Buskens, E.; Boermeester, M.A.; Goor, H. van; Timmerman, H.M.; Nieuwenhuijs, V.B.; Bollen, T.L.; Ramshorst, B. van; Witteman, B.J.M.; Rosman, C.; Ploeg, R.J.; Brink, M.; Schaapherder, A.F.; Dejong, C.H.; Wahab, P.J.; Laarhoven, C.J.H.M. van; Harst, E. van der; Eijck, C.H. van; Cuesta, M.A.; Akkermans, L.M.; Gooszen, H.G.

    2008-01-01

    OBJECTIVE: To evaluate whether enteral prophylaxis with probiotics in patients with predicted severe acute pancreatitis prevents infectious complications. DESIGN: Multicentre, randomised, double-blind, placebo-controlled trial. METHOD: A total of 296 patients with predicted severe acute pancreatitis

  3. A novel predictive model using routinely clinical parameters to predict liver fibrosis in patients with chronic hepatitis B.

    Science.gov (United States)

    Wang, Jian; Yan, Xiaomin; Yang, Yue; Chang, Haiyan; Jia, Bei; Zhao, Xiang-An; Chen, Guangmei; Xia, Juan; Liu, Yong; Chen, Yuxin; Wang, Guiyang; Wang, Li; Zhang, Zhaoping; Ding, Weimao; Huang, Rui; Wu, Chao

    2017-08-29

    Noninvasive models have been established for the assessment of liver fibrosis in patients with chronic hepatitis B(CHB). However, the predictive performance of these established models remains inconclusive. We aimed to develop a novel predictive model for liver fibrosis in CHB based on routinely clinical parameters. Platelets(PLT), the standard deviation of red blood cell distribution width(RDW-SD), alkaline phosphatase(ALP) and globulin were independent predictors of significant fibrosis by multivariable analysis. Based on these parameters, a new predictive model namely APRG(ALP/PLT/RDW-SD/globulin) was proposed. The areas under the receiver-operating characteristic curves(AUROCs) of APRG index in predicting significant fibrosis(≥F2), advanced fibrosis(≥F3) and liver cirrhosis(≥F4) were 0.757(95%CI 0.699 to 0.816), 0.763(95%CI 0.711 to 0.816) and 0.781(95%CI 0.728 to 0.835), respectively. The AUROCs of the APRG were significantly higher than that of aspartate transaminase(AST) to PLT ratio index(APRI), RDW to PLT ratio(RPR) and AST to alanine aminotransferase ratio(AAR) to predict significant fibrosis, advanced fibrosis and cirrhosis. The AUROCs of the APRG were also significantly higher than fibrosis-4 score (FIB-4) (0.723, 95%CI 0.663 to 0.783) for cirrhosis(P=0.034) and better than gamma-glutamyl transpeptidase(GGT) to PLT ratio(GPR) (0.657, 95%CI 0.590 to 0.724) for significant fibrosis(P=0.001). 308 CHB patients who underwent liver biopsy were enrolled. The diagnostic values of the APRG for liver fibrosis with other noninvasive models were compared. The APRG has a better diagnostic value than conventionally predictive models to assess liver fibrosis in CHB patients. The application of APRG may reduce the need for liver biopsy in CHB patients in clinical practice.

  4. Transient elastography for predicting liver-related events in cirrhotic HIV-infected patients

    OpenAIRE

    Montes-Ramírez, M. L.; Berenguer, Juan; J.M. Miró; Quereda, Carmen; Hernando Jeréz, María Asunción; Sanz, J.; Ortega, E.; Tural, Cristina; Wichmann, M. A.; Zamora, F. X.; González García, J. J.

    2017-01-01

    We assessed liver stiffness measurement (LSM) for the prediction of mortality and decompensation in HIVinfected patients with compensated liver cirrhosis. A prospective cohort study of HIV-infected patients with confirmed liver cirrhosis from 9 hospitals in Spain. LSM was undertaken for each patient; clinical events were collected prospectively after the baseline visit, and patients were followed until death or the censoring date. We used univariate/multivariate Cox proportional haz...

  5. Prediction of two month modified Rankin Scale with an ordinal prediction model in patients with aneurysmal subarachnoid haemorrhage

    Directory of Open Access Journals (Sweden)

    Sneade Mary

    2010-09-01

    Full Text Available Abstract Background Aneurysmal subarachnoid haemorrhage (aSAH is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH. Methods We studied patients enrolled in the International Subarachnoid Aneurysm Trial (ISAT, a randomized multicentre trial to compare coiling and clipping in aSAH patients. Several models were explored to estimate a patient's outcome according to the modified Rankin Scale (mRS at two months after aSAH. Our final model was validated internally with bootstrapping techniques. Results The study population comprised of 2,128 patients of whom 159 patients died within 2 months (8%. Multivariable proportional odds analysis identified World Federation of Neurosurgical Societies (WFNS grade as the most important predictor, followed by age, sex, lumen size of the aneurysm, Fisher grade, vasospasm on angiography, and treatment modality. The model discriminated moderately between those with poor and good mRS scores (c statistic = 0.65, with minor optimism according to bootstrap re-sampling (optimism corrected c statistic = 0.64. Conclusion We presented a calibrated and internally validated ordinal prognostic model to predict two month mRS in aSAH patients who survived the early stage up till a treatment decision. Although generalizability of the model is limited due to the selected population in which it was developed, this model could eventually be used to support clinical decision making after external validation. Trial Registration International Standard Randomised Controlled Trial, Number ISRCTN49866681

  6. Prostate MRSI predicts outcome in radical prostatectomy patients.

    Science.gov (United States)

    Zakian, Kristen L; Hatfield, William; Aras, Omer; Cao, Kun; Yakar, Derya; Goldman, Debra A; Moskowitz, Chaya S; Shukla-Dave, Amita; Tehrani, Yousef Mazaheri; Fine, Samson; Eastham, James; Hricak, Hedvig

    2016-06-01

    New non-invasive methods are needed for sub-stratifying high-risk prostate cancer patients. Magnetic resonance spectroscopic imaging (MRSI) maps metabolites in prostate cancer, providing information on tumor aggressiveness and volume. To investigate the correlation between MRSI and treatment failure (TF) after radical prostatectomy (RP). Two-hundred sixty-two patients who underwent endorectal MRI/MRSI followed by RP at our institution from 2003 to 2007 were studied. MRI stage, number of voxels in the MRSI index lesion (NILV), number of high-grade voxels (NHGV), and number of voxels containing undetectable polyamines (NUPV) were derived. Clinical outcome was followed until August, 2014. Treatment failure was defined as 1) biochemical recurrence (BCR), 2) persistently detectable PSA after RP, or 3) adjuvant therapy initiated in the absence of BCR. MRI/MRSI features and clinical parameters were compared to TF by univariate Cox Proportional Hazards Regression. After backward selection, each MRSI parameter was included in a separate regression model adjusted for NCCN-based clinical risk score (CRS), number of biopsy cores positive (NPC), and MRI stage. In univariate analysis, all clinical variables were associated with TF in addition to MRI stage, NILV, NHGV, and NUPV. In multivariate analysis, NILV, NHGV, and NUPV were also significant risk factors for TF (p=0.016, p=0.002, p=0.006, respectively). The association between the number of tumor voxels with undetectable polyamines and the probability of treatment failure has not been previously reported. The number of MRSI cancer voxels correlated with extracapsular extension (ECE) (pmodels adjusted for the number of positive biopsy cores and clinical risk score. This is the first report that in radical prostatectomy patients MRSI has an association with treatment failure independent of the number of positive biopsy cores. MRSI may help the clinician determine whether patients with high risk disease who undergo RP are

  7. Pre-Biopsy Psychological Factors Predict Patient Biopsy Experience

    Science.gov (United States)

    Miller, S. J.; Schnur, J. B.; Margolies, L.; Bolno, J.; Szabo, J.; Hermann, G.; Montgomery, G. H.; Sohl, S. J.

    2013-01-01

    Purpose Excisional/surgical breast biopsy has been related to anticipatory emotional distress, and anticipatory distress has been associated with worse biopsy-related outcomes (e.g., pain, physical discomfort). The present study was designed to investigate: a) whether anticipatory distress before an image-guided breast biopsy would correlate with biopsy-related outcomes (pain and physical discomfort during the biopsy); and b) whether type of distress (i.e., general anxiety, worry about the procedure, worry about biopsy results) would differentially relate to biopsy-related outcomes. Methods 50 image-guided breast biopsy patients (mean age = 44.4 years) were administered questionnaires pre- and post-biopsy. Pre-biopsy, patients completed the Profile of Mood States-Tension/Anxiety subscale and two Visual Analog Scale items (worry about the biopsy procedure, worry about the biopsy results). Post-biopsy, patients completed two Visual Analog Scale items (pain and physical discomfort at their worst during the procedure). Results 1) Pre-biopsy worry about the procedure was significantly related to both pain (r=0.38, p=0.006) and physical discomfort (r=0.31, p=0.026); 2) Pre-biopsy general anxiety was significantly related to pain (r=0.36, p=0.009), but not to physical discomfort; and 3) Pre-biopsy worry about the biopsy results did not significantly relate to pain or physical discomfort. Conclusions Worry about the procedure was the only variable found to be significantly correlated with both biopsy-related outcomes (pain and physical discomfort). From a clinical perspective, this item could be used as a brief screening tool to identify patients who might be at risk for poorer biopsy experiences, and who might benefit from brief interventions to reduce pre-biopsy worry. PMID:23065421

  8. Predictive Factors of Patient Satisfaction with Pharmacy Services in South Korea: A Cross-Sectional Study of National Level Data

    National Research Council Canada - National Science Library

    Lee, Sunkyung; Godwin, Onyeka Peter; Kim, Kyungah; Lee, Euni

    2015-01-01

    .... To assess the predictive factors for patient satisfaction with pharmacy services, an ordinal logistic regression model was conducted adjusting for patient characteristics, clinical comorbiditi...

  9. Radiographic sarcopenia predicts postoperative infectious complications in patients undergoing pancreaticoduodenectomy.

    Science.gov (United States)

    Takagi, Kosei; Yoshida, Ryuichi; Yagi, Takahito; Umeda, Yuzo; Nobuoka, Daisuke; Kuise, Takashi; Fujiwara, Toshiyoshi

    2017-05-26

    Recently, skeletal muscle depletion (sarcopenia) has been reported to influence postoperative outcomes after certain procedures. This study investigated the impact of sarcopenia on postoperative outcomes following pancreaticoduodenectomy (PD). We performed a retrospective study of consecutive patients (n = 219) who underwent PD at our institution between January 2007 and May 2013. Sarcopenia was evaluated using preoperative computed tomography. We evaluated postoperative outcomes and the influence of sarcopenia on short-term outcomes, especially infectious complications. Subsequently, multivariate analysis was used to assess the impact of prognostic factors (including sarcopenia) on postoperative infections. The mortality, major complication, and infectious complication rates for all patients were 1.4%, 16.4%, and 47.0%, respectively. Fifty-five patients met the criteria for sarcopenia. Sarcopenia was significantly associated with a higher incidence of in-hospital mortality (P = 0.004) and infectious complications (P sarcopenia (odds ratio = 3.43; P Sarcopenia is an independent preoperative predictor of infectious complications after PD. Clinical assessment combined with sarcopenia may be helpful for understanding the risk of postoperative outcomes and determining perioperative management strategies.

  10. Overweight predicts poorer exercise capacity in congenital heart disease patients.

    Science.gov (United States)

    Kuehl, Karen; Tucker, Alicia; Khan, Munziba; Goldberg, Paula; Anne Greene, E; Smith, Megan

    2015-12-07

    Overweight (OW) and obesity (OB) are endemic in the United States and affect adolescents and adults with congenital heart disease (ACHD). Defining the burden of excess weight on the cardiovascular system in ACHD is the goal of this study. Limitation of exercise capacity due to overweight or obesity might be reversible with weight loss and improve quality of life for ACHD adults. Exercise tests performed using a Bruce protocol and measurement of maximum oxygen consumption were retrospectively reviewed on 418 CHD patients. OW and OB were defined as the 85-95 or > 95 percentile respectively for age and gender or by adult criteria. Severity of CHD was assigned based on criteria published in standard guidelines. 63 patients had mild, 198 moderate, and 157 severe heart disease. Each ACHD group was 32 to 34% OW or OB. Measured exercise time (ET) of CHD patients with moderate or severe heart disease was less than that of controls in each weight categories. However, OB or OW people have shorter ET than their normal weight peers with CHD. Multiple regression using ET as the dependent variable finds that female sex, relative BMI, and VE/VCO2 at peak exercise are all associated with lesser ET with high significance. Peak heart rate is associated with greater ET, with borderline significance. Severity of heart disease is not independently associated with ET. OW and OB are strongly associated with reduced ET in persons with congenital heart disease. Losing weight may improve exercise capacity in ACHD.

  11. Method for evaluating prediction models that apply the results of randomized trials to individual patients

    Directory of Open Access Journals (Sweden)

    Kattan Michael W

    2007-06-01

    Full Text Available Abstract Introduction The clinical significance of a treatment effect demonstrated in a randomized trial is typically assessed by reference to differences in event rates at the group level. An alternative is to make individualized predictions for each patient based on a prediction model. This approach is growing in popularity, particularly for cancer. Despite its intuitive advantages, it remains plausible that some prediction models may do more harm than good. Here we present a novel method for determining whether predictions from a model should be used to apply the results of a randomized trial to individual patients, as opposed to using group level results. Methods We propose applying the prediction model to a data set from a randomized trial and examining the results of patients for whom the treatment arm recommended by a prediction model is congruent with allocation. These results are compared with the strategy of treating all patients through use of a net benefit function that incorporates both the number of patients treated and the outcome. We examined models developed using data sets regarding adjuvant chemotherapy for colorectal cancer and Dutasteride for benign prostatic hypertrophy. Results For adjuvant chemotherapy, we found that patients who would opt for chemotherapy even for small risk reductions, and, conversely, those who would require a very large risk reduction, would on average be harmed by using a prediction model; those with intermediate preferences would on average benefit by allowing such information to help their decision making. Use of prediction could, at worst, lead to the equivalent of an additional death or recurrence per 143 patients; at best it could lead to the equivalent of a reduction in the number of treatments of 25% without an increase in event rates. In the Dutasteride case, where the average benefit of treatment is more modest, there is a small benefit of prediction modelling, equivalent to a reduction of

  12. Using Exit Charts to Develop an Early Stopping Criterion for Turbo Decoding

    OpenAIRE

    Potman, J.; Hoeksema, F.W.; Slump, Cornelis H.

    2004-01-01

    Early stopping criteria are used to determine when additional decoder iterations result in little or no improvement in the bit- error-rate (BER) at the output of a Turbo decoder. This paper proposes a stopping criterion based on Extrinsic Information Transfer (EXIT) charts. The generation and properties of EXIT charts are discussed. Convergence and BER predictions obtained using EXIT charts are compared to results obtained using Turbo decoder simulation. Finally this paper describes the use o...

  13. Lack of contextual-word predictability during reading in patients with mild Alzheimer disease.

    Science.gov (United States)

    Fernández, Gerardo; Manes, Facundo; Rotstein, Nora P; Colombo, Oscar; Mandolesi, Pablo; Politi, Luis E; Agamennoni, Osvaldo

    2014-09-01

    In the present work we analyzed the effect of contextual word predictability on the eye movement behavior of patients with mild Alzheimer disease (AD) compared to age-matched controls, by using the eyetracking technique and lineal mixed models. Twenty AD patients and 40 age-matched controls participated in the study. We first evaluated gaze duration during reading low and highly predictable sentences. AD patients showed an increase in gaze duration, compared to controls, both in sentences of low or high predictability. In controls, highly predictable sentences led to shorter gaze durations; by contrary, AD patients showed similar gaze durations in both types of sentences. Similarly, gaze duration in controls was affected by the cloze predictability of word N and N+1, whereas it was the same in AD patients. In contrast, the effects of word frequency and word length were similar in controls and AD patients. Our results imply that contextual-word predictability, whose processing is proposed to require memory retrieval, facilitated reading behavior in healthy subjects, but this facilitation was lost in early AD patients. This loss might reveal impairments in brain areas such as those corresponding to working memory, memory retrieval, and semantic memory functions that are already present at early stages of AD. In contrast, word frequency and length processing might require less complex mechanisms, which were still retained by AD patients. To the best of our knowledge, this is the first study measuring how patients with early AD process well-defined words embedded in sentences of high and low predictability. Evaluation of the resulting changes in eye movement behavior might provide a useful tool for a more precise early diagnosis of AD. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Prediction of atopy by skin prick tests in patients with asthma and/or persistent rhinitis.

    Science.gov (United States)

    Karakaya, G; Ozturk, A B; Kalyoncu, A F

    2012-01-01

    Patient history gives important clues about the likelihood of atopy. However, the accuracy of assessment of atopy based on detailed allergy history is low. The objective of this survey was to determine the successful prediction rate of atopy by a questionnaire and the effect of various factors on the successful prediction. A standard questionnaire including detailed allergy history was filled in by two experienced allergists for 169 patients having bronchial asthma and/or persistent rhinitis symptoms. Skin prick test (SPT) results were predicted based on the clinical data obtained by a questionnaire. Final diagnosis was made after SPT. Sensitivity and specificity analysis of SPT results prediction was investigated using two different cut-off values (3mm and 5mm) for positive tests, and factors associated with successful atopy prediction were analysed. SPT was predicted to be positive in 42.6% and was positive in 36.1%. Depending on SPT results with the cut-off value 3mm, prediction sensitivity was 77%, specificity was 65.3%, positive predictive value was 65%, and negative predictive value was 86%. Successful positive atopy prediction was associated with age; true negative prediction was also associated with age and high education. With the threshold of 5mm for a positive test, sensitivity, specificity, positive and negative predicted values were 91%, 61%, 14% and 99%, respectively. It seems that the success rate of detailed history is high for negative prediction. However, detailed history alone does not seem to be efficient for atopy prediction. Copyright © 2010 SEICAP. Published by Elsevier Espana. All rights reserved.

  15. Controllability, not chaos, key criterion for ocean state estimation

    Science.gov (United States)

    Gebbie, Geoffrey; Hsieh, Tsung-Lin

    2017-07-01

    The Lagrange multiplier method for combining observations and models (i.e., the adjoint method or 4D-VAR) has been avoided or approximated when the numerical model is highly nonlinear or chaotic. This approach has been adopted primarily due to difficulties in the initialization of low-dimensional chaotic models, where the search for optimal initial conditions by gradient-descent algorithms is hampered by multiple local minima. Although initialization is an important task for numerical weather prediction, ocean state estimation usually demands an additional task - a solution of the time-dependent surface boundary conditions that result from atmosphere-ocean interaction. Here, we apply the Lagrange multiplier method to an analogous boundary control problem, tracking the trajectory of the forced chaotic pendulum. Contrary to previous assertions, it is demonstrated that the Lagrange multiplier method can track multiple chaotic transitions through time, so long as the boundary conditions render the system controllable. Thus, the nonlinear timescale poses no limit to the time interval for successful Lagrange multiplier-based estimation. That the key criterion is controllability, not a pure measure of dynamical stability or chaos, illustrates the similarities between the Lagrange multiplier method and other state estimation methods. The results with the chaotic pendulum suggest that nonlinearity should not be a fundamental obstacle to ocean state estimation with eddy-resolving models, especially when using an improved first-guess trajectory.

  16. Controllability, not chaos, key criterion for ocean state estimation

    Directory of Open Access Journals (Sweden)

    G. Gebbie

    2017-07-01

    Full Text Available The Lagrange multiplier method for combining observations and models (i.e., the adjoint method or 4D-VAR has been avoided or approximated when the numerical model is highly nonlinear or chaotic. This approach has been adopted primarily due to difficulties in the initialization of low-dimensional chaotic models, where the search for optimal initial conditions by gradient-descent algorithms is hampered by multiple local minima. Although initialization is an important task for numerical weather prediction, ocean state estimation usually demands an additional task – a solution of the time-dependent surface boundary conditions that result from atmosphere–ocean interaction. Here, we apply the Lagrange multiplier method to an analogous boundary control problem, tracking the trajectory of the forced chaotic pendulum. Contrary to previous assertions, it is demonstrated that the Lagrange multiplier method can track multiple chaotic transitions through time, so long as the boundary conditions render the system controllable. Thus, the nonlinear timescale poses no limit to the time interval for successful Lagrange multiplier-based estimation. That the key criterion is controllability, not a pure measure of dynamical stability or chaos, illustrates the similarities between the Lagrange multiplier method and other state estimation methods. The results with the chaotic pendulum suggest that nonlinearity should not be a fundamental obstacle to ocean state estimation with eddy-resolving models, especially when using an improved first-guess trajectory.

  17. O-POSSUM score predicts morbidity and mortality in patients undergoing hip fracture surgery.

    Science.gov (United States)

    Blay-Domínguez, Elena; Lajara-Marco, Francisco; Bernáldez-Silvetti, Pablo Federico; Veracruz-Gálvez, Eva María; Muela-Pérez, Beatriz; Palazón-Banegas, Miguel Ángel; Salinas-Gilabert, José Eduardo; Lozano-Requena, Juan Antonio

    2017-11-27

    The aim of this study is to evaluate the O-POSSUM score capacity to predict the morbidity and mortality of patients undergoing hip fracture surgery. We retrospectively reviewed the clinical records of patients older than 65years old, operated on for hip fractures between January 2012 and December 2013. Of 229 patients, the mean age was 82.3years and 170 were women. We collected comorbidities, type of surgery, and expected morbidity and mortality O-POSSUM values. After a minimum follow up of one year, 38 deaths were reported and 77 patients had complications. The expected mortality according to the O-POSSUM was 35 patients and expected morbidity 132. By comparing the observed results with those predicted, the O-POSSUM scale is reliable in predicting mortality and overestimates morbidity. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. A patient-centered methodology that improves the accuracy of prognostic predictions in cancer.

    Directory of Open Access Journals (Sweden)

    Mohammed Kashani-Sabet

    Full Text Available Individualized approaches to prognosis are crucial to effective management of cancer patients. We developed a methodology to assign individualized 5-year disease-specific death probabilities to 1,222 patients with melanoma and to 1,225 patients with breast cancer. For each cancer, three risk subgroups were identified by stratifying patients according to initial stage, and prediction probabilities were generated based on the factors most closely related to 5-year disease-specific death. Separate subgroup probabilities were merged to form a single composite index, and its predictive efficacy was assessed by several measures, including the area (AUC under its receiver operating characteristic (ROC curve. The patient-centered methodology achieved an AUC of 0.867 in the prediction of 5-year disease-specific death, compared with 0.787 using the AJCC staging classification alone. When applied to breast cancer patients, it achieved an AUC of 0.907, compared with 0.802 using the AJCC staging classification alone. A prognostic algorithm produced from a randomly selected training subsample of 800 melanoma patients preserved 92.5% of its prognostic efficacy (as measured by AUC when the same algorithm was applied to a validation subsample containing the remaining patients. Finally, the tailored prognostic approach enhanced the identification of high-risk candidates for adjuvant therapy in melanoma. These results describe a novel patient-centered prognostic methodology with improved predictive efficacy when compared with AJCC stage alone in two distinct malignancies drawn from two separate populations.

  19. The ABCD(2) Score is Highly Predictive of Stroke in Minor Ischemic Stroke Patients.

    Science.gov (United States)

    Ghandehari, Kavian; Ahmadi, Fahimeh; Ebrahimzadeh, Saeed; Shariatinezhad, Keyvan; Ghandehari, Kosar

    2012-06-01

    Stroke risk prediction scores have been designed to stratify risk of recurrent cerebrovascular events in transient ischemic attack (TIA) and minor ischemic stroke (MIS) patients. Consecutive TIA or MIS patients referred to Ghaem Hospital, Mashhad were enrolled in a prospective cohort study during 2010-2011. Only TIA or MIS patients presenting within 24 h from the onset of symptoms were recruited. MIS was considered as ischemic stroke with NIHSS ABCD(2) scoring system for recurrent stroke or TIA was quantified by the area under the cure (AUC) using the c statistics. Three hundred ninety-three TIA patients (238 males, 155 females) and 118 MIS patients (77 males, 41 females) were enrolled in the study. One hundred seventeen strokes (23.2%), 99 TIA (19.6%), and 11 vascular death (2.2%) occurred within 3 months postevent in the whole of our 511 patients with minor ischemic events. The ABCD(2) score had a weak predictive value for 3 months and 3 days recurrent stroke in our TIA patients (AUC = 0.599, AUC = 0.591), but a high predictive value for 3 months and 3 days recurrent stroke in our MIS patients (AUC = 0.727, AUC = 0.728), respectively. The ABCD(2) score is highly predictive of short-term recurrent stroke in MIS patients but not TIA cases, despite its creation for TIA cohorts.

  20. Nocturnal hypoxemia biomarker predicts sleepiness in patients with severe obstructive sleep apnea.

    Science.gov (United States)

    Uysal, Askin; Liendo, Cesar; McCarty, David E; Kim, Paul Y; Paxson, Chad; Chesson, Andrew L; Marino, Andrew A

    2014-03-01

    This study aims to assess the association between excessive daytime sleepiness (EDS) and variables extracted from the pulse-oximetry signal obtained during overnight polysomnography. A cross-sectional design was used to study the relation between four hypoxemia variables and EDS as determined by Epworth Sleepiness Scale scores (ESSS) in 200 consecutive patients, newly diagnosed with obstructive sleep apnea (OSA), as defined by an apnea-hypopnea index (AHI)≥ 15. Hypoxemia measurements were compared between sleepy (ESSS ≥ 10) and nonsleepy (ESSShypoxemia variable (and for AHI) such that there were 35 (165) patients in each of the corresponding higher (lower) subcohorts. The hypoxemia variables were combined into a biomarker, and its accuracy for predicting sleepiness in individual patients was evaluated. We planned to interpret prediction accuracy above 80 % as evidence that hypoxemia predicted EDS. Hypoxemia was unassociated with sleepiness in OSA patients with AHI in the range of 15 to 50. In patients with AHI>50, the hypoxemia biomarker (but not individual hypoxemia variables) predicted sleepiness with 82 % accuracy. Nocturnal hypoxemia as determined by a polyvariable biomarker reliably predicted EDS in patients with severe OSA (AHI>50), indicating that oxygen fluctuation had a direct role in the development of EDS in patients with severe OSA.

  1. Predictive Factors of Anxiety and Depression in Patients with Acute Coronary Syndrome.

    Science.gov (United States)

    Altino, Denise Meira; Nogueira-Martins, Luiz Antônio; de Barros, Alba Lucia Bottura Leite; Lopes, Juliana de Lima

    2017-12-01

    To identify the predictive factors of anxiety and depression in patients with acute coronary syndrome. Cross-sectional and retrospective study conducted with 120 patients hospitalized with acute coronary syndrome. Factors interfering with anxiety and depression were assessed. Anxiety was related to sex, stress, years of education, and depression, while depression was related to sex, diabetes mellitus, obesity, years of education, and trait-anxiety. Obesity and anxiety were considered predictive factors for depression, while depression and fewer years of education were considered predictive factors for anxiety. Copyright © 2017. Published by Elsevier Inc.

  2. Failure Criterion for Brick Masonry: A Micro-Mechanics Approach

    Directory of Open Access Journals (Sweden)

    Kawa Marek

    2015-02-01

    Full Text Available The paper deals with the formulation of failure criterion for an in-plane loaded masonry. Using micro-mechanics approach the strength estimation for masonry microstructure with constituents obeying the Drucker-Prager criterion is determined numerically. The procedure invokes lower bound analysis: for assumed stress fields constructed within masonry periodic cell critical load is obtained as a solution of constrained optimization problem. The analysis is carried out for many different loading conditions at different orientations of bed joints. The performance of the approach is verified against solutions obtained for corresponding layered and block microstructures, which provides the upper and lower strength bounds for masonry microstructure, respectively. Subsequently, a phenomenological anisotropic strength criterion for masonry microstructure is proposed. The criterion has a form of conjunction of Jaeger critical plane condition and Tsai-Wu criterion. The model proposed is identified based on the fitting of numerical results obtained from the microstructural analysis. Identified criterion is then verified against results obtained for different loading orientations. It appears that strength of masonry microstructure can be satisfactorily described by the criterion proposed.

  3. Prediction of survival in patients with Stage IV kidney cancer

    Directory of Open Access Journals (Sweden)

    L. V. Mirilenko

    2015-01-01

    Full Text Available The efficiency of treatment was evaluated and the predictors of adjusted survival (AS were identified in patients with disseminated kidney cancer treated at the Republican Research and Practical Center for Oncology and Medical Radiology in 1999 to 2011 (A.E. Okeanov, P.I. Moiseev, L.F. Levin. Malignant tumors in Belarus, 2001–2012. Edited by O.G. Sukonko. Seven factors (regional lymph node metastases; distant bone metastases; a high-grade tumor; sarcomatous tumor differentiation; hemoglobin levels of < 125 g/l in women and < 150 g/l in men; an erythrocyte sedimentation rate of 40 mm/h; palliative surgery were found to have an independent, unfavorable impact on AS. A multidimensional model was built to define what risk group low (no more than 2 poor factors, moderate (3–4 poor factors, and high (more than 4 poor factors the patients with Stage IV kidney cancer belonged to. In these groups, the median survival was 34.7, 17.2, and 4.0 months and 3-year AS rates were 48.6, 24.6, and 3.2 %, respectively. 

  4. A Prediction Model for Functional Outcomes in Spinal Cord Disorder Patients Using Gaussian Process Regression.

    Science.gov (United States)

    Lee, Sunghoon Ivan; Mortazavi, Bobak; Hoffman, Haydn A; Lu, Derek S; Li, Charles; Paak, Brian H; Garst, Jordan H; Razaghy, Mehrdad; Espinal, Marie; Park, Eunjeong; Lu, Daniel C; Sarrafzadeh, Majid

    2016-01-01

    Predicting the functional outcomes of spinal cord disorder patients after medical treatments, such as a surgical operation, has always been of great interest. Accurate posttreatment prediction is especially beneficial for clinicians, patients, care givers, and therapists. This paper introduces a prediction method for postoperative functional outcomes by a novel use of Gaussian process regression. The proposed method specifically considers the restricted value range of the target variables by modeling the Gaussian process based on a truncated Normal distribution, which significantly improves the prediction results. The prediction has been made in assistance with target tracking examinations using a highly portable and inexpensive handgrip device, which greatly contributes to the prediction performance. The proposed method has been validated through a dataset collected from a clinical cohort pilot involving 15 patients with cervical spinal cord disorder. The results show that the proposed method can accurately predict postoperative functional outcomes, Oswestry disability index and target tracking scores, based on the patient's preoperative information with a mean absolute error of 0.079 and 0.014 (out of 1.0), respectively.

  5. A priori Prediction of Neoadjuvant Chemotherapy Response and Survival in Breast Cancer Patients using Quantitative Ultrasound

    Science.gov (United States)

    Tadayyon, Hadi; Sannachi, Lakshmanan; Gangeh, Mehrdad J.; Kim, Christina; Ghandi, Sonal; Trudeau, Maureen; Pritchard, Kathleen; Tran, William T.; Slodkowska, Elzbieta; Sadeghi-Naini, Ali; Czarnota, Gregory J.

    2017-04-01

    Quantitative ultrasound (QUS) can probe tissue structure and analyze tumour characteristics. Using a 6-MHz ultrasound system, radiofrequency data were acquired from 56 locally advanced breast cancer patients prior to their neoadjuvant chemotherapy (NAC) and QUS texture features were computed from regions of interest in tumour cores and their margins as potential predictive and prognostic indicators. Breast tumour molecular features were also collected and used for analysis. A multiparametric QUS model was constructed, which demonstrated a response prediction accuracy of 88% and ability to predict patient 5-year survival rates (p = 0.01). QUS features demonstrated superior performance in comparison to molecular markers and the combination of QUS and molecular markers did not improve response prediction. This study demonstrates, for the first time, that non-invasive QUS features in the core and margin of breast tumours can indicate breast cancer response to neoadjuvant chemotherapy (NAC) and predict five-year recurrence-free survival.

  6. Clinically defined chemotherapy-associated bowel syndrome predicts severe complications and death in cancer patients.

    Science.gov (United States)

    Vehreschild, Maria J G T; Meissner, Arne M K; Cornely, Oliver Andreas; Maschmeyer, Georg; Neumann, Silke; von Lilienfeld-Toal, Marie; Karthaus, Meinholf; Wattad, Mohammed; Staib, Peter; Hellmich, Martin; Christ, Hildegard; Vehreschild, Jörg Janne

    2011-12-01

    Neutropenic patients are at risk of abdominal complications and yet the incidence and impact of these complications on patients' morbidity and mortality have not been sufficiently evaluated. We aimed to assess a clinical rule for early detection of abdominal complications leading to death or transfer to intensive care in patients with chemotherapy-associated neutropenia. This observational multicenter study was carried out in seven German hematology-oncology departments. For inclusion, neutropenia of at least 5 consecutive days was required. Risk factors for "transfer to intensive care" and "death" were assessed by backward-stepwise binary logistic regression analyses. Chemotherapy-associated bowel syndrome was defined as a combination of fever (T ≥37.8 °C) and abdominal pain and/or lack of bowel movement for 72 hours or more. Five hundred and twenty-one neutropenic episodes were documented in 359 patients. The incidence of chemotherapy-associated bowel syndrome was 126/359 (35%) in first episodes of neutropenia. Transfer to intensive care occurred in 41/359 (11%) and death occurred in 17/359 (5%) first episodes. Chemotherapy-associated bowel syndrome and duration of neutropenia were identified as risk factors for transfer to intensive care (PChemotherapy-associated bowel syndrome and mitoxantrone administration were identified as risk factors for death (P=0.005; OR 4.611; 95% CI 1.573-13.515 and P=0.026; OR 3.628; 95% CI 1.169-11.256). The occurrence of chemotherapy-associated bowel syndrome has a significant impact on patients' outcome. In future interventional clinical trials, this definition might be used as a selection criterion for early treatment of patients at risk of severe complications.

  7. MTR-18 Predictive Biomarkers Of Bevacizumab Response In Recurrent Glioblastoma Patients

    DEFF Research Database (Denmark)

    Urup, Thomas; Michaelsen, Signe Regner; Olsen, Lars Rønn

    2015-01-01

    with the proneural GBM subtype have a survival benefit when treated with BEV in combination with standard treatment. However, no validated biomarkers able to predict BEV response have been identified and the biology reflecting a clinical BEV response is poorly understood. The primary objective of this study...... was to evaluate the predictive and prognostic value of GBM subtypes in recurrent GBM patients treated with BEV therapy. The secondary objective was to identify biomarkers able to predict response to BEV therapy in recurrent GBM patients. METHODS: A total of 90 recurrent GBM patients treated with BEV combination...... and multifocal disease. RESULTS: Molecular subtypes were not associated with response or survival. However, two independent predictive biomarkers (gene1 down-regulated and gene2 up-regulated in responders, respectively) of BEV response and survival were identified. Results will be presented....

  8. Predictions of the Pharmacokinetics in Burn Injury Patients using Regression Models - Case Study with Levofloxacin.

    Science.gov (United States)

    Srinivas, N R

    2016-10-01

    Owing to its excellent safety, tolerability, pharmacokinetic and pharmacodynamic profile levofloxacin is widely used. Although pharmacokinetics of levofloxacin was somewhat more variable in burn injury patients, it appeared to be comparable to healthy subjects or other patients. Linear regression model was established for Cmax or Cmin vs. [AUCtau, CL and Vd] of levofloxacin using individual values from burn injury patients. Appropriate regression lines for Cmax or Cmin were subjected to internal and external validation on the ability to predict CL, Vd and AUCtau parameters. The mean absolute error (MAE) and root mean square error (RMSE) of the predictions were used to judge the appropriateness of either Cmax or Cmin models. Cmax models developed for levofloxacin showed moderate to strong correlations with the various parameters such as CL, Vd and AUCtau. The Cmin models showed strong correlation for CL and AUCtau but not for Vd where the correlation was weak. Internal validation using data from individual burn patients showed RMSE of 13.47-25.42% for various predictions. External validation that used mean data from healthy subjects showed RMSE of 13.86-27.13%. Despite the pharmacokinetic variability, linear regression models using either Cmax or Cmin were established for levofloxacin rendering predictions of several key pharmacokinetic parameters. Although there was limitation of Cmin model for predicting Vd, both models may be used as a prospective tool for the prediction of levofloxacin pharmacokinetics in burn care patients. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Robust Hammerstein Adaptive Filtering under Maximum Correntropy Criterion

    Directory of Open Access Journals (Sweden)

    Zongze Wu

    2015-10-01

    Full Text Available The maximum correntropy criterion (MCC has recently been successfully applied to adaptive filtering. Adaptive algorithms under MCC show strong robustness against large outliers. In this work, we apply the MCC criterion to develop a robust Hammerstein adaptive filter. Compared with the traditional Hammerstein adaptive filters, which are usually derived based on the well-known mean square error (MSE criterion, the proposed algorithm can achieve better convergence performance especially in the presence of impulsive non-Gaussian (e.g., α-stable noises. Additionally, some theoretical results concerning the convergence behavior are also obtained. Simulation examples are presented to confirm the superior performance of the new algorithm.

  10. On the reduction criterion for random quantum states

    Energy Technology Data Exchange (ETDEWEB)

    Jivulescu, Maria Anastasia, E-mail: maria.jivulescu@upt.ro; Lupa, Nicolae, E-mail: nicolae.lupa@upt.ro [Department of Mathematics, Politehnica University of Timişoara, Victoriei Square 2, 300006 Timişoara (Romania); Nechita, Ion, E-mail: nechita@irsamc.ups-tlse.fr [CNRS, Laboratoire de Physique Théorique, IRSAMC, Université de Toulouse, UPS, F-31062 Toulouse (France)

    2014-11-15

    In this paper, we study the reduction criterion for detecting entanglement of large dimensional bipartite quantum systems. We first obtain an explicit formula for the moments of a random quantum state to which the reduction criterion has been applied. We show that the empirical eigenvalue distribution of this random matrix converges strongly to a limit that we compute, in three different asymptotic regimes. We then employ tools from free probability theory to study the asymptotic positivity of the reduction operators. Finally, we compare the reduction criterion with other entanglement criteria, via thresholds.

  11. Microalbuminuria in patients with Type 2 diabetes mellitus from general practice: course and predictive value.

    NARCIS (Netherlands)

    Grauw, W.J.C. de; Lisdonk, E.H. van de; Gerwen, W.H.E.M. van; Verstappen, M.C.H.M.; Hoogen, H.J.M. van den; Willems, J.L.; Weel, C. van

    2001-01-01

    AIMS: To assess the course of microalbuminuria in patients with Type 2 diabetes mellitus in general practice and the predictive value of urinary albumin concentration on all-cause mortality, cardiovascular mortality and cardiovascular morbidity. METHODS: Cohort study in Type 2 diabetic patients

  12. Can the outcome of pelvic-floor rehabilitation in patients with fecal incontinence be predicted?

    NARCIS (Netherlands)

    M.P. Terra (Maaike); M. Deutekom (Marije); A.C. Dobben (Annette); C.G.M.I. Baeten; L.W.M. Janssen (Lucas); G.E. Boeckxstaens (Guy); A.F. Engel (Alexander); R.J.F. Felt-Bersma; J.F.W. Slors; M.F. Gerhards (Michael); A.B. Bijnen (Bart); E. Everhardt; W.R. Schouten (Ruud); B. Berghmans; P.M.M. Bossuyt (Patrick); J. Stoker (Jacob)

    2008-01-01

    textabstractPurpose: Pelvic-floor rehabilitation does not provide the same degree of relief in all fecal incontinent patients. We aimed at studying prospectively the ability of tests to predict the outcome of pelvic-floor rehabilitation in patients with fecal incontinence. Materials and methods: Two

  13. Risk prediction models for mortality in patients with ventilator-associated pneumonia

    DEFF Research Database (Denmark)

    Larsson, Johan E; Itenov, Theis Skovsgaard; Bestle, Morten Heiberg

    2017-01-01

    PURPOSE: Ventilator-associated pneumonia (VAP) is a common and serious complication in patients requiring mechanical ventilation in the intensive care unit. The aims of this study were to identify models used to predict mortality in VAP patients and to assess their prognostic accuracy. METHODS...

  14. The prediction of difficult intubation in obese patients using mirror indirect laryngoscopy: A prospective pilot study.

    Science.gov (United States)

    Budde, Arne O; Desciak, Matthew; Reddy, Venugopal; Falcucci, Octavio A; Vaida, Sonia J; Pott, Leonard M

    2013-04-01

    The incidence of difficult laryngoscopy and intubation in obese patients is higher than in the general population. Classical predictors of difficult laryngoscopy and intubation have been shown to be unreliable. We prospectively evaluated indirect mirror laryngoscopy as a predictor of difficult laryngoscopy in obese patients. 60 patients with a body mass index (BMI) greater than 30, scheduled to undergo general anesthesia, were enrolled. Indirect mirror laryngoscopy was performed and was graded 1-4 according to Cormack and Lehane. A view of grade 3-4 was classified as predicting difficult laryngoscopy. Additional assessments for comparison were the Samsoon and Young modification of the Mallampati airway classification, Wilson Risk Sum Score, neck circumference, and BMI. The view obtained upon direct laryngoscopy after induction of general anesthesia was classified according to Cormack and Lehane as grade 1-4. Sixty patients met the inclusion criteria; however, 8 (13.3%) patients had an excessive gag reflex, and examination of the larynx was not possible. 15.4% of patients who underwent direct laryngoscopy had a Cormack and Lehane grade 3 or 4 view and were classified as difficult. Mirror laryngoscopy had a tendency toward statistical significance in predicting difficult laryngoscopy in these patients. This study is consistent with previous studies, which have demonstrated that no one individual traditional test has proven to be adequate in predicting difficult airways in the obese population. However, the new application of an old test - indirect mirror laryngoscopy - could be a useful additional test to predict difficult laryngoscopy in obese patients.

  15. Emotion regulation predicts change of perceived health in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    van Middendorp, H; Geenen, R; Sorbi, MJ; van Doornen, LJP; Bijlsma, JWJ

    Objectives: To examine whether emotion regulation predicts change of perceived health in patients with rheumatoid arthritis ( RA). Methods: Sixty six patients ( 44 female, 22 male; mean (SD) age 57.7 (11.6) years) participated in a prospective study. Hierarchical regression analysis was used to

  16. Development of a Decision Support System to Predict Physicians' Rehabilitation Protocols for Patients with Knee Osteoarthritis

    Science.gov (United States)

    Hawamdeh, Ziad M.; Alshraideh, Mohammad A.; Al-Ajlouni, Jihad M.; Salah, Imad K.; Holm, Margo B.; Otom, Ali H.

    2012-01-01

    To design a medical decision support system (MDSS) that would accurately predict the rehabilitation protocols prescribed by the physicians for patients with knee osteoarthritis (OA) using only their demographic and clinical characteristics. The demographic and clinical variables for 170 patients receiving one of three treatment protocols for knee…

  17. Can Triage Nurses Accurately Predict Patient Dispositions in the Emergency Department?

    Science.gov (United States)

    Alexander, Danette; Abbott, Lincoln; Zhou, Qiuping; Staff, Ilene

    2016-11-01

    Contemporary emergency departments experience crowded conditions with poor patient outcomes. If triage nurses could accurately predict admission, one theoretical intervention to reduce crowding is to place patients in the admission cue on arrival to the emergency department. The purpose of this study was to determine if triage nurses could accurately predict patient dispositions. This prospective study was conducted in a tertiary academic hospital's emergency department using a data collection tool embedded in the ED electronic information system. Study variables included the predicted and actual disposition, as well as level of care, gender, age, and Emergency Severity Index level. Data were collected for 28 consecutive days from September 17 through October 9, 2013. Sensitivity and specificity, positive and negative predictive values, and accuracy of prediction, as well as the associations between patient characteristics and nurse prediction, were calculated. A total of 5,135 cases were included in the analysis. The triage nurses predicted admissions with a sensitivity of 71.5% and discharges with a specificity of 88.0%. Accuracy was significantly higher for younger patients and for patients at very low or very high severity levels. Although the ability to predict admissions at triage by nurses was not adequate to support a change in the bed procurement process, a specificity of 88.0% could have implications for rapid ED discharges or other low-acuity processes designed within the emergency department. Further studies in additional settings and on alternative interventions are needed. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  18. Emotional Exhaustion and Workload Predict Clinician-Rated and Objective Patient Safety

    Directory of Open Access Journals (Sweden)

    Annalena eWelp

    2015-01-01

    Full Text Available Aims: To investigate the role of clinician burnout, demographic and organizational characteristics in predicting subjective and objective indicators of patient safety. Background: Maintaining clinician health and ensuring safe patient care are important goals for hospitals. While these goals are not independent from each other, the interplay between clinician psychological health, demographic and organizational variables and objective patient safety indicators is poorly understood. The present study addresses this gap. Method: Participants were 1425 physicians and nurses working in intensive care. (Multilevel regression analysis was used to investigate the effect of burnout as an indicator of psychological health, demographic (e.g., professional role and experience and organizational (e.g., workload, predictability characteristics on standardized mortality ratios, length of stay and clinician-rated patient safety. Results: Clinician-rated patient safety were associated with burnout, trainee status, and professional role. Mortality was predicted by emotional exhaustion. Length of stay was predicted by workload. Contrary to our expectations, burnout did not predict length of stay, and workload and predictability did not predict standardized mortality ratios.Conclusion: At least in the short-term, clinicians seem to be able to maintain safety despite high workload and low predictability. Nevertheless, burnout poses a safety risk. Subjectively, burnt-out clinicians rated safety lower, and objectively, units with high emotional exhaustion had higher standardized mortality ratios. In summary, our results indicate that clinician psychological health and patient safety could be managed simultaneously. Further research needs to establish causal relationships between these variables or and support the development of managerial guidelines to ensure clinicians’ psychological health and patients’ safety.

  19. Emotional exhaustion and workload predict clinician-rated and objective patient safety

    Science.gov (United States)

    Welp, Annalena; Meier, Laurenz L.; Manser, Tanja

    2015-01-01

    Aims: To investigate the role of clinician burnout, demographic, and organizational characteristics in predicting subjective and objective indicators of patient safety. Background: Maintaining clinician health and ensuring safe patient care are important goals for hospitals. While these goals are not independent from each other, the interplay between clinician psychological health, demographic and organizational variables, and objective patient safety indicators is poorly understood. The present study addresses this gap. Method: Participants were 1425 physicians and nurses working in intensive care. Regression analysis (multilevel) was used to investigate the effect of burnout as an indicator of psychological health, demographic (e.g., professional role and experience) and organizational (e.g., workload, predictability) characteristics on standardized mortality ratios, length of stay and clinician-rated patient safety. Results: Clinician-rated patient safety was associated with burnout, trainee status, and professional role. Mortality was predicted by emotional exhaustion. Length of stay was predicted by workload. Contrary to our expectations, burnout did not predict length of stay, and workload and predictability did not predict standardized mortality ratios. Conclusion: At least in the short-term, clinicians seem to be able to maintain safety despite high workload and low predictability. Nevertheless, burnout poses a safety risk. Subjectively, burnt-out clinicians rated safety lower, and objectively, units with high emotional exhaustion had higher standardized mortality ratios. In summary, our results indicate that clinician psychological health and patient safety could be managed simultaneously. Further research needs to establish causal relationships between these variables and support to the development of managerial guidelines to ensure clinicians’ psychological health and patients’ safety. PMID:25657627

  20. Infection of exposed patients during norovirus outbreaks: are there predictive parameters?

    Science.gov (United States)

    Kampmeier, S; Pillukat, M H; Kossow, A; Pettke, A; Mellmann, A

    2017-05-01

    Norovirus outbreak management comprises isolation and cohorting of patients. In this context, exposed patients are preferably cohorted separately from symptomatic and unexposed asymptomatic patients, since they potentially develop symptoms of norovirus gastroenteritis. Whether routinely examined clinical or laboratory parameters can help to predict occurrence of gastroenteritis symptoms in those patients has not yet been examined. To evaluate routinely examined clinical and laboratory parameters as predictive values for the development of norovirus symptoms in exposed patients during outbreaks. Exposed patients during norovirus outbreaks were observed throughout a two-year period in the university hospital of Muenster. The development of laboratory-confirmed norovirus gastroenteritis symptoms was examined in exposed patients, and clinical as well as laboratory parameters prior to onset of the outbreak were compared in exposed symptomatic and asymptomatic patients. We detected 42 exposed patients within 10 outbreaks. Of these, 33 remained asymptomatic, whereas nine patients developed norovirus gastroenteritis. Exposed symptomatic patients were significantly older (50±10.51 vs 28±4.68 years), had significantly higher blood sodium concentration (142.5±1.48 vs 138.8±0.47mmol/L) and higher systolic blood pressure (119.3±3.84 vs 108.5±2.41mmHg). Development of symptoms among exposed patients was significantly associated with blood type O (75% vs 20%). In order to minimize patient-to-patient transmission within norovirus outbreaks in hospital, risk stratification of exposed patients is helpful. To achieve this, routinely detected clinical and laboratory parameters can be useful to predict development of symptoms in these patients. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  1. Black Hole Sign: Novel Imaging Marker That Predicts Hematoma Growth in Patients With Intracerebral Hemorrhage.

    Science.gov (United States)

    Li, Qi; Zhang, Gang; Xiong, Xin; Wang, Xing-Chen; Yang, Wen-Song; Li, Ke-Wei; Wei, Xiao; Xie, Peng

    2016-07-01

    Early hematoma growth is a devastating neurological complication after intracerebral hemorrhage. We aim to report and evaluate the usefulness of computed tomography (CT) black hole sign in predicting hematoma growth in patients with intracerebral hemorrhage. Patients with intracerebral hemorrhage were screened for the presence of CT black hole sign on admission head CT performed within 6 hours after onset of symptoms. The black hole sign was defined as hypoattenuatting area encapsulated within the hyperattenuating hematoma with a clearly defined border. The sensitivity, specificity, and positive and negative predictive values of CT black hole sign in predicting hematoma expansion were calculated. Logistic regression analyses were used to assess the presence of the black hole sign and early hematoma growth. A total of 206 patients were enrolled. Black hole sign was found in 30 (14.6%) of 206 patients on the baseline CT scan. The black hole sign was more common in patients with hematoma growth (31.9%) than those without hematoma growth (5.8%; Phole sign in predicting early hematoma growth were 31.9%, 94.1%, 73.3%, and 73.2%, respectively. The time-to-admission CT scan, baseline hematoma volume, and the presence of black hole sign on admission CT independently predict hematoma growth in multivariate model. The CT black hole sign could be used as a simple and easy-to-use predictor for early hematoma growth in patients with intracerebral hemorrhage. © 2016 American Heart Association, Inc.

  2. A study on the instability criterion for the stratified flow in horizontal pipe at cocurrent flow conditions

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Chang Kyung [Korea Electric Power Research Institute, Taejon (Korea, Republic of)

    1997-12-31

    This paper presents a theoretical approach of the instability criterion from stratified to nonstratified flow in horizontal pipe at cocurrent flow conditions. The new theoretical instability criterion for the stratified and nonstratified flow transition in horizontal pipe has been developed by hyperbolic equations in two-phase flow. Critical flow condition criterion and onset of slugging at cocurrent flow condition correspond to zero and imaginary characteristics which occur when the hyperbolicity of a stratified two-phase flow is broken, respectively. Through comparison between results predicted by the present flow is broken, respectively. Through comparison between results predicted by the present theory and the Kukita et al. [1] experimental data of pipes, it is shown that they are in good agreement with data. 4 refs., 2 figs. (Author)

  3. Nurses and physicians in a medical admission unit can accurately predict mortality of acutely admitted patients

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Hallas, Jesper; Knudsen, Torben

    2014-01-01

    BACKGROUND: There exist several risk stratification systems for predicting mortality of emergency patients. However, some are complex in clinical use and others have been developed using suboptimal methodology. The objective was to evaluate the capability of the staff at a medical admission unit......-hospital mortality upon the patients' arrival. We calculated discriminatory power as the area under the receiver-operating-characteristic curve (AUROC) and accuracy of prediction (calibration) by Hosmer-Lemeshow goodness-of-fit test. RESULTS: We had a total of 2,848 admissions (2,463 patients). 89 (3.1%) died while......: Using only clinical intuition, staff in a medical admission unit has a good ability to identify patients at increased risk of dying while admitted. When nursing staff and physicians agreed on their prediction, discriminatory power and calibration were excellent....

  4. Affective and instrumental communication in primary care interactions: predicting the satisfaction of nursing staff and patients.

    Science.gov (United States)

    Haskard, Kelly B; DiMatteo, M Robin; Heritage, John

    2009-01-01

    Verbal and nonverbal communication between nursing staff and patients has received scant research attention. This study examined patients' and nursing staff members' global affective and instrumental communication, mutual influence, and relationship to postvisit satisfaction. This study employed ratings of videotaped primary care visits of 81 nursing staff members with 235 patients, and assessed communication in 2 channels: nonverbal visual and speech including vocal tone. Communication channel differences and prediction of patient satisfaction were examined. The visual and vocal communication of nursing staff members and patients robustly predicted each other's satisfaction and reflected their own satisfaction with the dyadic visit. Affect was communicated more clearly through the speech with vocal tone channel, whereas instrumental communication was stronger in visual nonverbal behavior. Patients' and nursing staff members' behaviors of pleasantness and involvement frequently co-occurred.

  5. Predictive factors for malignancy in incidental pulmonary nodules detected in breast cancer patients at baseline CT

    Energy Technology Data Exchange (ETDEWEB)

    Hammer, Mark M.; Mortani Barbosa, Eduardo J. [University of Pennsylvania, Division of Cardiothoracic Imaging, Department of Radiology, Perelman School of Medicine, Philadelphia, PA (United States)

    2017-07-15

    Pulmonary nodules are commonly encountered at staging CTs in patients with extrathoracic malignancies, but their significance on a per-patient basis remains uncertain. We undertook a retrospective analysis of pulmonary nodules identified in patients with a diagnosis of breast cancer from 2010 - 2015, evaluating nodules present at a baseline CT (i.e. prevalent nodules). We reviewed 211 patients with 248 individual nodules. The rate of malignancy in prevalent nodules is low, approximately 13 %. Variables associated with metastasis include pleural studding, hilar lymphadenopathy and the presence of extrapulmonary metastasis, as well as number of nodules, nodule size and nodule shape. Using a combination of these factors, we have developed an evidence-based multivariate decision tree to predict which nodules are malignant in these patients, which is 91 % accurate and 100 % sensitive for metastasis. We propose a simplified clinical prediction algorithm to guide radiologists and oncologists in managing patients with breast cancer and incidental pulmonary nodules. (orig.)

  6. Development of a neural network for prediction of glucose concentration in type 1 diabetes patients.

    Science.gov (United States)

    Pappada, Scott M; Cameron, Brent D; Rosman, Paul M

    2008-09-01

    A major difficulty in the management of diabetes is the optimization of insulin therapies to avoid occurrences of hypoglycemia and hyperglycemia. Many factors impact glucose fluctuations in diabetes patients, such as insulin dosage, nutritional intake, daily activities and lifestyle (e.g., sleep-wake cycles and exercise), and emotional states (e.g., stress). The overall effect of these factors has not been fully quantified to determine the impact on subsequent glycemic trends. Recent advances in diabetes technology such as continuous glucose monitoring (CGM) provides significant sources of data, such that quantification may be possible. Depending on the CGM technology utilized, the sampling frequency ranges from 1-5 min. In this study, an intensive electronic diary documenting the factors previously described was created. This diary was utilized by 18 patients with insulin-dependent diabetes mellitus in conjunction with CGM. Utilizing this dataset, various neural network models were constructed to predict glucose in these diabetes patients while varying the predictive window from 50-180 min. The predictive capability of each neural network within the fully trained dataset was analyzed as well as the predictive capabilities of the neural networks on unseen data. Neural network models were created using NeuroSolutions software with variable predictive windows of 50, 75, 100, 120, 150, and 180 min. Neural network models were trained using patient datasets ranging from 11-17 patients and evaluated on patient data not included in the neural network formulation. Performance analysis was completed for the neural network models using MATLAB. Performance measures include the calculation of the mean absolute difference percent overall and at hypoglycemic and hyperglycemic extremes, and the percentage of hypoglycemic and hyperglycemic occurrences were predicted. Overall, the neural network models perform adequately at predicting at normal (>70 and or =180 mg/dl); however

  7. Use of APACHE II and SAPS II to predict mortality for hemorrhagic and ischemic stroke patients.

    Science.gov (United States)

    Moon, Byeong Hoo; Park, Sang Kyu; Jang, Dong Kyu; Jang, Kyoung Sool; Kim, Jong Tae; Han, Yong Min

    2015-01-01

    We studied the applicability of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in patients admitted to the intensive care unit (ICU) with acute stroke and compared the results with the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS). We also conducted a comparative study of accuracy for predicting hemorrhagic and ischemic stroke mortality. Between January 2011 and December 2012, ischemic or hemorrhagic stroke patients admitted to the ICU were included in the study. APACHE II and SAPS II-predicted mortalities were compared using a calibration curve, the Hosmer-Lemeshow goodness-of-fit test, and the receiver operating characteristic (ROC) curve, and the results were compared with the GCS and NIHSS. Overall 498 patients were included in this study. The observed mortality was 26.3%, whereas APACHE II and SAPS II-predicted mortalities were 35.12% and 35.34%, respectively. The mean GCS and NIHSS scores were 9.43 and 21.63, respectively. The calibration curve was close to the line of perfect prediction. The ROC curve showed a slightly better prediction of mortality for APACHE II in hemorrhagic stroke patients and SAPS II in ischemic stroke patients. The GCS and NIHSS were inferior in predicting mortality in both patient groups. Although both the APACHE II and SAPS II systems can be used to measure performance in the neurosurgical ICU setting, the accuracy of APACHE II in hemorrhagic stroke patients and SAPS II in ischemic stroke patients was superior. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. A novel threshold criterion in transcranial motor evoked potentials during surgery for gliomas close to the motor pathway.

    Science.gov (United States)

    Abboud, Tammam; Schaper, Miriam; Dührsen, Lasse; Schwarz, Cindy; Schmidt, Nils Ole; Westphal, Manfred; Martens, Tobias

    2016-10-01

    (transient in 4 patients and permanent in 4 patients). In 80 patients no significant change in threshold level was detected, and none of them showed postoperative neurological deterioration. The specificity and sensitivity in this series were estimated at 100%. Postoperative MRI revealed gross-total tumor resection in 56 of 82 patients (68%) in whom complete tumor resection was attainable; territorial ischemia was detected in 4 patients. CONCLUSIONS The novel threshold criterion has made TES-MEP a useful method for predicting postoperative motor deficit in patients who undergo glioma surgery, and has been feasible in patients with preoperative paresis as well as in patients with recurrent glioma. Including contra- and ipsilateral changes in threshold level has led to a high sensitivity and specificity.

  9. Do Patient Characteristics Predict Outcome of Psychodynamic Psychotherapy for Social Anxiety Disorder?

    OpenAIRE

    Wiltink, Jörg; Hoyer, Jürgen; Beutel, Manfred E.; Ruckes, Christian; Herpertz, Stephan; Joraschky, Peter; Koranyi, Susan; Michal, Matthias; Nolting, Björn; Pöhlmann, Karin; Salzer, Simone; Strauss, Bernhard; Leibing, Eric; Leichsenring, Falk

    2016-01-01

    OBJECTIVES: Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT). No study has addressed which patient variables predict outcome of PDT for social anxiety disorder. RESEARCH DESIGN AND METHODS: In the largest multicenter trial on psychotherapy of social anxiety (SA) to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatmen...

  10. Insecure attachment predicts depression and death anxiety in advanced cancer patients.

    Science.gov (United States)

    Scheffold, Katharina; Philipp, Rebecca; Koranyi, Susan; Engelmann, Dorit; Schulz-Kindermann, Frank; Härter, Martin; Mehnert, Anja

    2017-05-15

    The prevalence of depression as well as adjustment and anxiety disorders is high in advanced cancer patients, and research exploring intraindividual factors leading to high psychological distress is underrepresented. Cancer patients' feelings about security and trust in their healthcare providers have a significant influence on how they deal with their disease. The perception of social support is affected by patients' attachment styles and influences their reactions to feelings of dependency and loss of control. We therefore aimed to explore attachment and its association with psychological distress in patients with advanced cancer. We obtained data from the baseline measurements of a randomized controlled trial in advanced cancer patients. Patients were sampled from the university medical centers of Hamburg and Leipzig, Germany. The main outcome measures included the Patient Health Questionnaire, the Death and Dying Distress Scale, the Memorial Symptom Assessment Scale, and the Experience in Close Relationships Scale for assessing attachment insecurity. A total of 162 patients were included. We found that 64% of patients were insecurely attached (fearful-avoidant 31%, dismissing 17%, and preoccupied 16%). A dismissing attachment style was associated with more physical symptoms but did not predict psychological distress. A fearful-avoidant attachment style significantly predicted higher death anxiety and depression, whereas preoccupied attachment predicted higher death anxiety only. Overall, insecure attachment contributed to the prediction of depression (10%) and death anxiety (14%). The concept of attachment plays a relevant role in advanced cancer patients' mental health. Healthcare providers can benefit from knowledge of advanced cancer patients' attachment styles and how they relate to specific mental distress. Developing a better understanding of patients' reactions to feelings of dependency and distressing emotions can help us to develop individually

  11. Practical Performance of the 2015 American Thyroid Association Guidelines for Predicting Tumor Recurrence in Patients with Papillary Thyroid Cancer in South Korea.

    Science.gov (United States)

    Lee, Seul Gi; Lee, Woo Kyung; Lee, Hye Sun; Moon, Jieun; Lee, Cho Rok; Kang, Sang Wook; Jeong, Jong Ju; Nam, Kee-Hyun; Chung, Woong Youn; Jo, Young Suk; Lee, Jandee

    2017-02-01

    The 2015 American Thyroid Association (ATA) management guidelines for adult patients with differentiated thyroid cancer propose the use of the modified initial risk stratification and response to therapy re-stratification systems. This study was conducted to validate the practicality of the revised guidelines for predicting tumor recurrence in patients with differentiated thyroid cancer. Patients with papillary thyroid cancer (n = 2425) who underwent total thyroidectomy with central neck node dissection with or without modified radical neck node dissection at a single institution between October 1985 and July 2009 were retrospectively enrolled. The accuracy of three different risk-stratification strategies for predicting disease-free survival, set out in the 2009 and 2015 ATA management guidelines, was assessed: the initial risk stratification (ATA 2009-RSS), the modified initial risk stratification (ATA 2015-RSS), and the response to therapy re-stratification (ATA 2015-RTR). After applying the ATA 2015-RSS, 258/1913 (13.5%) of patients originally designated as intermediate risk by the ATA 2009-RSS were designated as low risk. This was mainly due to the small number of metastatic lymph nodes. Recurrence was detected in 136 (5.6%) patients during follow-up. Of the 2425 cases examined, 375 were designated as low risk by the ATA 2009-RSS, with a recurrence rate of 1.1%. However, the ATA 2015-RSS designated 633 (26.1%) cases as low risk, with a recurrence rate of 0.9%. Implementing the ATA 2015-RTR predicted an excellent response in 1597 (65.9%) cases, with a recurrence rate of 1.1%. According to the proportion of variance explained (PVE), the Akaike information criterion, Harrell's c index, and integrated area under the curve, comparing the predictive accuracy of the ATA 2009-RSS, ATA 2015-RSS, and ATA 2015-RTR revealed that the ATA 2015-RTR was a superior predictor of recurrence. A proportion of patients designated as intermediate risk by the ATA 2009-RSS were

  12. Breakdown of universal Lindemann criterion in the melting of ...

    Indian Academy of Sciences (India)

    MSD) of a particle of crystalline solid exceeds a threshold value. This is known as the Lindemann criterion, first introduced in the year of 1910 by Lindemann. However, Chakravarty et al., demonstrated that this common wisdom is ...

  13. Frequency-domain criterion for the chaos synchronization of time ...

    Indian Academy of Sciences (India)

    domain criterion for ... Wu1 2 Yun Chen1. College of Electronic Engineering, Naval University of Engineering, Wuhan 430033, People's Republic of China; Guangzhou Naval Marine Academy, Guangzhou 510430, People's Republic of China ...

  14. Early hospital mortality prediction of intensive care unit patients using an ensemble learning approach.

    Science.gov (United States)

    Awad, Aya; Bader-El-Den, Mohamed; McNicholas, James; Briggs, Jim

    2017-12-01

    Mortality prediction of hospitalized patients is an important problem. Over the past few decades, several severity scoring systems and machine learning mortality prediction models have been developed for predicting hospital mortality. By contrast, early mortality prediction for intensive care unit patients remains an open challenge. Most research has focused on severity of illness scoring systems or data mining (DM) models designed for risk estimation at least 24 or 48h after ICU admission. This study highlights the main data challenges in early mortality prediction in ICU patients and introduces a new machine learning based framework for Early Mortality Prediction for Intensive Care Unit patients (EMPICU). The proposed method is evaluated on the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database. Mortality prediction models are developed for patients at the age of 16 or above in Medical ICU (MICU), Surgical ICU (SICU) or Cardiac Surgery Recovery Unit (CSRU). We employ the ensemble learning Random Forest (RF), the predictive Decision Trees (DT), the probabilistic Naive Bayes (NB) and the rule-based Projective Adaptive Resonance Theory (PART) models. The primary outcome was hospital mortality. The explanatory variables included demographic, physiological, vital signs and laboratory test variables. Performance measures were calculated using cross-validated area under the receiver operating characteristic curve (AUROC) to minimize bias. 11,722 patients with single ICU stays are considered. Only patients at the age of 16 years old and above in Medical ICU (MICU), Surgical ICU (SICU) or Cardiac Surgery Recovery Unit (CSRU) are considered in this study. The proposed EMPICU framework outperformed standard scoring systems (SOFA, SAPS-I, APACHE-II, NEWS and qSOFA) in terms of AUROC and time (i.e. at 6h compared to 48h or more after admission). The results show that although there are many values missing in the first few hour of ICU admission

  15. Mood Linked Responses in Medial Prefrontal Cortex Predict Relapse in Patients with Recurrent Unipolar Depression

    Science.gov (United States)

    Farb, Norman A. S.; Anderson, Adam K.; Bloch, Richard T.; Segal, Zindel V.

    2011-01-01

    Background Altered cognitive processing following mood challenge is associated with elevated relapse risk in remitted unipolar depressed patients, but little is known about the neural basis of this reactivity and its link to depressive relapse and prophylaxis. Methods Remitted unipolar depressed participants (n = 16) and healthy controls (n = 16) underwent functional magnetic resonance imaging (fMRI) while viewing sad and neutral film clips. Correlations were determined between emotional reactivity (neural responses to sad vs. neutral films) in remitted patients and subsequent relapse status over an 18 month follow-up period. An ROC analysis was used to determine signal cutoffs for predicting relapse. Emotional reactivity in relapse prognostic areas was compared between groups. Results Within the remitted group, relapse was predicted by medial prefrontal cortical activity (MPFC, BA 32), and contraindicated by visual cortical activity (BA 17). MPFC reactivity predicted rumination, whereas visual cortical reactivity predicted distress tolerance (acceptance). Compared to control participants, remitted depressed patients who sustained remission demonstrated a more pronounced tradeoff between MPFC and visual cortex reactivity. The difference score between MPFC and visual reactivity yielded excellent prediction of depressive relapse. Conclusions Medial prefrontal cortical reactivity to mood provocation in remitted unipolar depressed patients serves as a marker of relapse risk rather than successful emotion regulation. Enduring remission is characterized by a normalization of the MPFC to the level of healthy controls. Further, visual cortex reactivity predicts resilience against depressive relapse, indicating a prophylactic role for sensory rather than ruminative cognitive reactivity in the processing of negative emotion. PMID:21531382

  16. Multiparametric analysis of magnetic resonance images for glioma grading and patient survival time prediction

    Energy Technology Data Exchange (ETDEWEB)

    Garzon, Benjamin (Dept. of Circulation and Medical Imaging, NTNU, Trondheim (Norway)), email: benjamin.garzon@ntnu.no; Emblem, Kyrre E. (The Interventional Center, Rikshospitalet, Oslo Univ. Hospital, Oslo (Norway); Dept. of Radiology, MGH-HST AA Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston (United States)); Mouridsen, Kim (Center of Functionally Integrative Neuroscience, Aarhus Univ., Aarhus (Denmark)); Nedregaard, Baard; Due-Toennessen, Paulina; Nome, Terje; Hald, John K. (Dept. of Radiology and Nuclear Medicine, Rikshospitalet, Oslo Univ. Hospital, Oslo (Norway)); Bjoernerud, Atle (The Interventional Center, Rikshospitalet, Oslo Univ. Hospital, Oslo (Norway)); Haaberg, Asta K. (Dept. of Circulation and Medical Imaging, NTNU, Trondheim (Norway); Dept. of Medical Imaging, St Olav' s Hospital, Trondheim (Norway)); Kvinnsland, Yngve (NordicImagingLab, Bergen (Norway))

    2011-11-15

    Background. A systematic comparison of magnetic resonance imaging (MRI) options for glioma diagnosis is lacking. Purpose. To investigate multiple MR-derived image features with respect to diagnostic accuracy in tumor grading and survival prediction in glioma patients. Material and Methods. T1 pre- and post-contrast, T2 and dynamic susceptibility contrast scans of 74 glioma patients with histologically confirmed grade were acquired. For each patient, a set of statistical features was obtained from the parametric maps derived from the original images, in a region-of-interest encompassing the tumor volume. A forward stepwise selection procedure was used to find the best combinations of features for grade prediction with a cross-validated logistic model and survival time prediction with a cox proportional-hazards regression. Results. Presence/absence of enhancement paired with kurtosis of the FM (first moment of the first-pass curve) was the feature combination that best predicted tumor grade (grade II vs. grade III-IV; median AUC 0.96), with the main contribution being due to the first of the features. A lower predictive value (median AUC = 0.82) was obtained when grade IV tumors were excluded. Presence/absence of enhancement alone was the best predictor for survival time, and the regression was significant (P < 0.0001). Conclusion. Presence/absence of enhancement, reflecting transendothelial leakage, was the feature with highest predictive value for grade and survival time in glioma patients

  17. Predicting post-treatment survivability of patients with breast cancer using Artificial Neural Network methods.

    Science.gov (United States)

    Wang, Tan-Nai; Cheng, Chung-Hao; Chiu, Hung-Wen

    2013-01-01

    In the last decade, the use of data mining techniques has become widely accepted in medical applications, especially in predicting cancer patients' survival. In this study, we attempted to train an Artificial Neural Network (ANN) to predict the patients' five-year survivability. Breast cancer patients who were diagnosed and received standard treatment in one hospital during 2000 to 2003 in Taiwan were collected for train and test the ANN. There were 604 patients in this dataset excluding died not in breast cancer. Among them 140 patients died within five years after their first radiotherapy treatment. The artificial neural networks were created by STATISTICA(®) software. Five variables (age, surgery and radiotherapy type, tumor size, regional lymph nodes, distant metastasis) were selected as the input features for ANN to predict the five-year survivability of breast cancer patients. We trained 100 artificial neural networks and chose the best one to analyze. The accuracy rate is 85% and area under the receiver operating characteristic (ROC) curve is 0.79. It shows that artificial neural network is a good tool to predict the five-year survivability of breast cancer patients.

  18. Robust Deep Network with Maximum Correntropy Criterion for Seizure Detection

    Directory of Open Access Journals (Sweden)

    Yu Qi

    2014-01-01

    Full Text Available Effective seizure detection from long-term EEG is highly important for seizure diagnosis. Existing methods usually design the feature and classifier individually, while little work has been done for the simultaneous optimization of the two parts. This work proposes a deep network to jointly learn a feature and a classifier so that they could help each other to make the whole system optimal. To deal with the challenge of the impulsive noises and outliers caused by EMG artifacts in EEG signals, we formulate a robust stacked autoencoder (R-SAE as a part of the network to learn an effective feature. In R-SAE, the maximum correntropy criterion (MCC is proposed to reduce the effect of noise/outliers. Unlike the mean square error (MSE, the output of the new kernel MCC increases more slowly than that of MSE when the input goes away from the center. Thus, the effect of those noises/outliers positioned far away from the center can be suppressed. The proposed method is evaluated on six patients of 33.6 hours of scalp EEG data. Our method achieves a sensitivity of 100% and a specificity of 99%, which is promising for clinical applications.

  19. Tricuspid flow propagation velocity predicts exercise tolerance and readmission in patients with systemic lupus erythematosus.

    Science.gov (United States)

    Cheng, Chin-Chang; Huang, Wei-Chun; Chiou, Kuan-Rau; Hsiao, Shih-Hung; Lin, Shih-Kai; Lu, Ling-Ying; Tseng, Jui-Cheng; Hu, Jui-Chieh; Mar, Guang-Yuan; Chiou, Chuen-Wang; Lin, Shoa-Lin; Liu, Chun-Peng

    2009-04-01

    Evaluating right ventricular dysfunction, pulmonary artery systolic pressure (PASP), and exercise tolerance is critical in patients with systemic lupus erythematosus (SLE) because of the high mortality rate in such patients with pulmonary arterial hypertension (PAH). The aim of this study was to use the flow propagation velocity (FPV) of early diastolic tricuspid inflow to evaluate exercise tolerance and PAH severity and to predict readmission in patients with SLE. A total of 66 patients with SLE with or without PAH and 30 healthy control subjects were enrolled. Controls were age-matched to patients with SLE and without PAH. All patients completed the 6-minute walking distance (6MWD) test and underwent standard echocardiography. Tricuspid FPV was measured in the modified parasternal short-axis view using the color M-mode technique. PAH was defined as PASP > 35 mm Hg using the tricuspid regurgitant method. Patients with SLE and PAH had significantly lower tricuspid FPVs and 6MWDs than patients in the other 2 groups (both P values or = 35.4 cm/s predicted 6MWD > or = 350 m and a lower 1-year readmission rate with good sensitivity and specificity. The tricuspid FPV technique provides a simple method for predicting exercise tolerance, the severity of PAH, and readmission among patients with SLE.

  20. Mortality Prediction in Patients Admitted in Surgical Intensive Care Unit by Using APACHE IV.

    Science.gov (United States)

    Wetr, Wetwet Wetw; Shoukat, Hassan; Muhammad, Yar; Gondal, Khalid Masood; Aslam, Imran

    2016-11-01

    To predict the mortality by the mean Acute Physiology and Chronic Health Evaluation (APACHE) IV score of all the patients admitted in a Surgical Intensive Care Unit (ICU) and comparing the score of the survivors and non-survivors. Descriptive study. Surgical Intensive Care Unit, Mayo Hospital, Lahore, from June 2013 to November 2014. All adult patients admitted in the Surgical ICU were included in this study. The demographics and other data of the patients were recorded. The APACHE IV scores of all patients were calculated at the time of admission. The scores of the survivors and the non-survivors were compared for prediction of survival and mortality. The age of these patients ranged from 13 to 70 (mean 38.39) years with 86 (55.48%) males and 69 (44.52%) females. The mean APACHE IV score of these patients was 34.96 ±14.93 ranging from 11 to 63 years. Eighty-three (53.55%) patients survived and 72 (46.45%) died. With respect to gender, 41 (47.67%) males out of 86 and 31 (44.92%) females out of 69 did not survive. The mortality increased with an increase in APACHE IV score and all the patients with score more than 39 did not survive. The predicted mortality can be assessed by APACHE IV score, so it is good for application among the surgical ICU patients.

  1. Predicting Outcome in Comatose Patients: The Role of EEG Reactivity to Quantifiable Electrical Stimuli

    Directory of Open Access Journals (Sweden)

    Gang Liu

    2016-01-01

    Full Text Available Objective. To test the value of quantifiable electrical stimuli as a reliable method to assess electroencephalogram reactivity (EEG-R for the early prognostication of outcome in comatose patients. Methods. EEG was recorded in consecutive adults in coma after cardiopulmonary resuscitation (CPR or stroke. EEG-R to standard electrical stimuli was tested. Each patient received a 3-month follow-up by the Glasgow-Pittsburgh cerebral performance categories (CPC or modified Rankin scale (mRS score. Results. Twenty-two patients met the inclusion criteria. In the CPR group, 6 of 7 patients with EEG-R had good outcomes (positive predictive value (PPV, 85.7% and 4 of 5 patients without EEG-R had poor outcomes (negative predictive value (NPV, 80%. The sensitivity and specificity were 85.7% and 80%, respectively. In the stroke group, 6 of 7 patients with EEG-R had good outcomes (PPV, 85.7%; all of the 3 patients without EEG-R had poor outcomes (NPV, 100%. The sensitivity and specificity were 100% and 75%, respectively. Of all patients, the presence of EEG-R showed 92.3% sensitivity, 77.7% specificity, 85.7% PPV, and 87.5% NPV. Conclusion. EEG-R to quantifiable electrical stimuli might be a good positive predictive factor for the prognosis of outcome in comatose patients after CPR or stroke.

  2. Prediction of pressure ulcer development in hospitalized patients: a tool for risk assessment

    Science.gov (United States)

    Schoonhoven, L; Grobbee, D E; Donders, A R T; Algra, A; Grypdonck, M H; Bousema, M T; Schrijvers, A J P; Buskens, E

    2006-01-01

    Objectives To identify independent predictors for development of pressure ulcers in hospitalized patients and to develop a simple prediction rule for pressure ulcer development. Design The Prevention and Pressure Ulcer Risk Score Evaluation (prePURSE) study is a prospective cohort study in which patients are followed up once a week until pressure ulcer occurrence, discharge from hospital, or length of stay over 12 weeks. Data were collected between January 1999 and June 2000. Setting Two large hospitals in the Netherlands. Participants Adult patients admitted to the surgical, internal, neurological and geriatric wards for more than 5 days were eligible. A consecutive sample of 1536 patients was visited, 1431 (93%) of whom agreed to participate. Complete follow up data were available for 1229 (80%) patients. Main outcome measures Occurrence of a pressure ulcer grade 2 or worse during admission to hospital. Results Independent predictors of pressure ulcers were age, weight at admission, abnormal appearance of the skin, friction and shear, and planned surgery in coming week. The area under the curve of the final prediction rule was 0.70 after bootstrapping. At a cut off score of 20, 42% of the patient weeks were identified as at risk for pressure ulcer development, thus correctly identifying 70% of the patient weeks in which a pressure ulcer occurred. Conclusion A simple clinical prediction rule based on five patient characteristics may help to identify patients at increased risk for pressure ulcer development and in need of preventive measures. PMID:16456213

  3. Predicting Outcome in Comatose Patients: The Role of EEG Reactivity to Quantifiable Electrical Stimuli

    Science.gov (United States)

    Liu, Gang; Su, Yingying; Liu, Yifei; Jiang, Mengdi; Zhang, Yan; Zhang, Yunzhou; Gao, Daiquan

    2016-01-01

    Objective. To test the value of quantifiable electrical stimuli as a reliable method to assess electroencephalogram reactivity (EEG-R) for the early prognostication of outcome in comatose patients. Methods. EEG was recorded in consecutive adults in coma after cardiopulmonary resuscitation (CPR) or stroke. EEG-R to standard electrical stimuli was tested. Each patient received a 3-month follow-up by the Glasgow-Pittsburgh cerebral performance categories (CPC) or modified Rankin scale (mRS) score. Results. Twenty-two patients met the inclusion criteria. In the CPR group, 6 of 7 patients with EEG-R had good outcomes (positive predictive value (PPV), 85.7%) and 4 of 5 patients without EEG-R had poor outcomes (negative predictive value (NPV), 80%). The sensitivity and specificity were 85.7% and 80%, respectively. In the stroke group, 6 of 7 patients with EEG-R had good outcomes (PPV, 85.7%); all of the 3 patients without EEG-R had poor outcomes (NPV, 100%). The sensitivity and specificity were 100% and 75%, respectively. Of all patients, the presence of EEG-R showed 92.3% sensitivity, 77.7% specificity, 85.7% PPV, and 87.5% NPV. Conclusion. EEG-R to quantifiable electrical stimuli might be a good positive predictive factor for the prognosis of outcome in comatose patients after CPR or stroke. PMID:27127529

  4. Criterion-referenced measurement for educational evaluation and selection

    OpenAIRE

    Wikström, Christina

    2005-01-01

    In recent years, Sweden has adopted a criterion-referenced grading system, where the grade outcome is used for several purposes, but foremost for educational evaluation on student- and school levels as well as for selection to higher education. This thesis investigates the consequences of using criterion-referenced measurement for both educational evaluation and selection purposes. The thesis comprises an introduction and four papers that empirically investigate school grades and grading prac...

  5. Trace Ratio Criterion for Feature Extraction in Classification

    Directory of Open Access Journals (Sweden)

    Guoqi Li

    2014-01-01

    Full Text Available A generalized linear discriminant analysis based on trace ratio criterion algorithm (GLDA-TRA is derived to extract features for classification. With the proposed GLDA-TRA, a set of orthogonal features can be extracted in succession. Each newly extracted feature is the optimal feature that maximizes the trace ratio criterion function in the subspace orthogonal to the space spanned by the previous extracted features.

  6. Modeling the role of genetic factors in characterizing extra-intestinal manifestations in Crohn's disease patients: does this improve outcome predictions?

    Science.gov (United States)

    Giachino, Daniela F; Regazzoni, Silvia; Bardessono, Marco; De Marchi, Mario; Gregori, Dario

    2007-07-01

    To evaluate to what extent an inefficient statistical model affects the study of genetic factors in extra-intestinal manifestations of Crohn's disease (CD) and how clinical predictions can be improved using more adequate techniques. Extra-intestinal manifestations were studied in 152 CD patients. Three sets of variables were considered: (1) disease characteristics--presentation, behavior, location; (2) generic risk factors--age, gender, smoke and familiarity; and (3) genetic polymorphisms of the NOD2, CD14, TNF, IL12B, and IL1RN genes, whose involvement in CD is known or suspected. Six statistical classifiers and data mining models were applied: (1) logistic regression as a benchmark; (2) generalized additive model; (3) projection pursuit regression; (4) linear discriminant analysis, (5) quadratic discriminant analysis; (6) artificial neural networks one-layer feed forward. Models were selected using the Akaike Information criterion and their accuracy was compared with several indexes. Extra-intestinal manifestations occurred in 75 patients. The model with clinical variables only selected familiarity, gender, presentation, and behavior as significantly associated with extra-intestinal manifestations, whereas when the genetic factors were also included familiarity was no longer significant, being replaced by the NOD2, TNF, and IL12B single nucleotide polymorphisms. The projection pursuit regression performed best in predicting individual outcomes (Kappa statistics 0.078 [SE 0.09] without and 0.108 [SE 0.075] with genetic information). One-layer artificial neural networks did not show any particular improvement in terms of model accuracy over nonlinear techniques. The correct identification of factors associated with extra-intestinal symptoms in CD, in particular the genetic ones, is highly dependent on the model chosen for the analysis. By using the most sophisticated statistical models, the accuracy of prediction can be strengthened by 10-64%, compared with linear

  7. Genomic predictive model for recurrence and metastasis development in head and neck squamous cell carcinoma patients.

    Science.gov (United States)

    Ribeiro, Ilda Patrícia; Caramelo, Francisco; Esteves, Luísa; Menoita, Joana; Marques, Francisco; Barroso, Leonor; Miguéis, Jorge; Melo, Joana Barbosa; Carreira, Isabel Marques

    2017-10-24

    The head and neck squamous cell carcinoma (HNSCC) population consists mainly of high-risk for recurrence and locally advanced stage patients. Increased knowledge of the HNSCC genomic profile can improve early diagnosis and treatment outcomes. The development of models to identify consistent genomic patterns that distinguish HNSCC patients that will recur and/or develop metastasis after treatment is of utmost importance to decrease mortality and improve survival rates. In this study, we used array comparative genomic hybridization data from HNSCC patients to implement a robust model to predict HNSCC recurrence/metastasis. This predictive model showed a good accuracy (>80%) and was validated in an independent population from TCGA data portal. This predictive genomic model comprises chromosomal regions from 5p, 6p, 8p, 9p, 11q, 12q, 15q and 17p, where several upstream and downstream members of signaling pathways that lead to an increase in cell proliferation and invasion are mapped. The introduction of genomic predictive models in clinical practice might contribute to a more individualized clinical management of the HNSCC patients, reducing recurrences and improving patients' quality of life. The power of this genomic model to predict the recurrence and metastases development should be evaluated in other HNSCC populations.

  8. Anomaly Detection Outperforms Logistic Regression in Predicting Outcomes in Trauma Patients.

    Science.gov (United States)

    Dezman, Zachary D W; Gao, Chen; Yang, Shiming; Hu, Peter; Yao, Li; Li, Hsiao-Chi; Chang, Chein-I; Mackenzie, Colin

    2017-01-01

    Recent advancements in trauma resuscitation have shown a great benefit of early identification and control of hemorrhage, which is the most common cause of death in injured patients. We introduce a new analytical approach, anomaly detection (AD), as an alternative method to the traditional logistic regression (LR) method in predicting which injured patients receive transfusions, intensive care, and other interventions. We abstracted routinely collected prehospital vital sign data from patient records (adult patients who survived more than 15 minutes after being directly admitted to a level 1 trauma center). The vital signs of the study cohort were analyzed using both LR and AD methods. Predictions on blood transfusions generated by these approaches were compared with hospital records using the respective areas under the receiver operating characteristic curves (AUROC). Of the patients seen at our trauma center between January 1, 2009, and December 31, 2010, 5,464 were included. AD significantly outperformed LR, identifying which patients would receive transfusions of uncrossmatched blood, transfusion of blood between the time of admission and 6 hours later, the need for intensive care, and in-hospital mortality (mean AUROC = 0.764 and 0.720, respectively). AD and LR provided similar predictions for the patients who would receive massive transfusion. Under the stratified 10 fold times 10 cross-validation test, AD also had significantly lower AUROC variance across subgroups than LR, suggesting AD is a more stable predictions model. AD provides enhanced predictions for clinically relevant outcomes in the trauma patient cohort studied and may assist providers in caring for acutely injured patients in the prehospital arena.

  9. Criterion of sheath formation in magnetized low pressure plasma

    Science.gov (United States)

    Moulick, R.; Adhikari, S.; Goswami, K. S.

    2017-11-01

    A criterion of sheath formation is obtained for magnetized low pressure plasmas. The criterion includes the effect of both collision and the magnetic field. The collision parameter is defined by the ratio of the ionization length to the ion mean free path. The ionization frequency is assumed to be constant. The condition obtained is consistent with the electrostatic case. In the absence of the magnetic field and the collision, it retrieves the Bohm criterion at the sheath edge. For an electrostatic case in the absence of ion neutral collision, the Bohm criterion determines the ion entry speed within the sheath. However, the presence of collision limits the validity of the criterion to a threshold value of the collision parameter. In the magnetized scenario, the validity is found to be dependent on the magnetic field angle besides the collision parameter. Even in a collisionless scenario, the validity is in question depending on the field angle. A critical collision parameter is found for a definite magnetic field strength beyond which there is no more angle dependency on the validity criterion. The effect of the magnetic field on the space charge deposition is highlighted.

  10. TABU SEARCH WITH ASPIRATION CRITERION FOR THE TIMETABLING PROBLEM

    Directory of Open Access Journals (Sweden)

    Oscar Chávez-Bosquez

    2015-01-01

    Full Text Available The aspiration criterion is an imperative element in the Tabu Search, with aspiration-by-default and the aspiration-by-objective the mainly used criteria in the literature. In this paper a new aspiration criterion is proposed in order to implement a probabilistic function when evaluating an element classified as tabu which improves the current solution, the proposal is called Tabu Search with Probabilistic Aspiration Criterion (BT- CAP. The test case used to evaluate the performance of the Probabilistic Aspiration Criterion proposed consists on the 20 instances of the problem described in the First International Timetabling Competition. The results are compared with 2 additional variants of the Tabu Search Algorithm: Tabu Search with Default Aspiration Criterion (BT-CAD and Tabu Search with Objective Aspiration Criterion (BT-CAO. Wilcoxon test was applied to the generated results, and it was proved with 99 % confidence that BT-CAP algorithm gets better solutions than the two other variants of the Tabu Search algorithm.

  11. Defense Mechanisms Reported by Patients with Borderline Personality Disorder and Axis II Comparison Subjects Over 16 Years of Prospective Follow-up: Description and Prediction of Recovery

    Science.gov (United States)

    Zanarini, Mary C.; Frankenburg, Frances R.; Fitzmaurice, Garrett

    2012-01-01

    Objective This study assessed the defensive functioning of 290 borderline patients and compared it to that of 72 patients with other forms of axis II psychopathology over 16 years of prospective follow-up. It also assessed the relationship between time-varying defenses and recovery from borderline personality disorder. Method The Defense Style Questionnaire, a self-report measure with demonstrated criterion validity and internal consistency, was initially administered at study entry. It was readministered at eight contiguous two-year long follow-up periods. Results Borderline patients had significantly lower scores than axis II comparison subjects on one mature defense mechanism (suppression) and significantly higher scores on seven of the other 18 defenses studied. More specifically, borderline patients had significantly higher scores on one neurotic-level defense (undoing), four immature defenses (acting out, emotional hypochondriasis, passive aggression, and projection), and two image-distorting/borderline defenses (projective identification and splitting). In terms of change, borderline patients were found to have had significant improvement on 13 of the 19 defenses studied. More specifically, they had significantly higher scores over time on one mature defense (anticipation) and significantly lower scores on two neurotic defenses (isolation and undoing), all immature defenses, and all image-distorting/borderline defenses except primitive idealization. In addition, four time-varying defense mechanisms were found to predict time-to-recovery: humor, acting out, emotional hypochondriasis, and projection. Conclusions Taken together, the results of this study suggest that the longitudinal defensive functioning of borderline patients is both distinct and improves substantially over time. They also suggest that immature defenses are the best predictors of time-to-recovery. PMID:23223866

  12. A fracture criterion for nuclear graphite

    Science.gov (United States)

    Rose, A. P. G.; Tucker, M. O.

    1982-10-01

    Measurements of tensile and flexural strength of a nuclear graphite using small bar specimens are reported. A theoretical model of failure is described in which critical defects are assumed to be associated with cleaved large coke particles. It is further assumed that these subcritical cracks can only extend by the cleavage of small particles which surround them. The size of the critical flaws is defined on the basis of linear elastic fracture mechanics. The model predicts the observed variation in flexural strength in three- and four-point bending as the knife edge spacings are varied. It slightly overestimates the observed ratio of tensile-to-bend strength, and this is thought to be due to some of the simplifying assumptions made in the models formulation. The potential of the model for use in engineering applications is discussed.

  13. Assessment centers versus cognitive ability tests: Challenging the conventional wisdom on criterion-related validity.

    Science.gov (United States)

    Sackett, Paul R; Shewach, Oren R; Keiser, Heidi N

    2017-10-01

    Separate meta-analyses of the cognitive ability and assessment center (AC) literatures report higher criterion-related validity for cognitive ability tests in predicting job performance. We instead focus on 17 samples in which both AC and ability scores are obtained for the same examinees and used to predict the same criterion. Thus, we control for differences in job type and in criteria that may have affected prior conclusions. In contrast to Schmidt and Hunter's (1998) meta-analysis, reporting mean validity of .51 for ability and .37 for ACs, we found using random-effects models mean validity of .22 for ability and .44 for ACs using comparable corrections for range restriction and measurement error in the criterion. We posit that 2 factors contribute to the differences in findings: (a) ACs being used on populations already restricted on cognitive ability and (b) the use of less cognitively loaded criteria in AC validation research. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  14. Imaging patterns predict patient survival and molecular subtype in glioblastoma via machine learning techniques.

    Science.gov (United States)

    Macyszyn, Luke; Akbari, Hamed; Pisapia, Jared M; Da, Xiao; Attiah, Mark; Pigrish, Vadim; Bi, Yingtao; Pal, Sharmistha; Davuluri, Ramana V; Roccograndi, Laura; Dahmane, Nadia; Martinez-Lage, Maria; Biros, George; Wolf, Ronald L; Bilello, Michel; O'Rourke, Donald M; Davatzikos, Christos

    2016-03-01

    MRI characteristics of brain gliomas have been used to predict clinical outcome and molecular tumor characteristics. However, previously reported imaging biomarkers have not been sufficiently accurate or reproducible to enter routine clinical practice and often rely on relatively simple MRI measures. The current study leverages advanced image analysis and machine learning algorithms to identify complex and reproducible imaging patterns predictive of overall survival and molecular subtype in glioblastoma (GB). One hundred five patients with GB were first used to extract approximately 60 diverse features from preoperative multiparametric MRIs. These imaging features were used by a machine learning algorithm to derive imaging predictors of patient survival and molecular subtype. Cross-validation ensured generalizability of these predictors to new patients. Subsequently, the predictors were evaluated in a prospective cohort of 29 new patients. Survival curves yielded a hazard ratio of 10.64 for predicted long versus short survivors. The overall, 3-way (long/medium/short survival) accuracy in the prospective cohort approached 80%. Classification of patients into the 4 molecular subtypes of GB achieved 76% accuracy. By employing machine learning techniques, we were able to demonstrate that imaging patterns are highly predictive of patient survival. Additionally, we found that GB subtypes have distinctive imaging phenotypes. These results reveal that when imaging markers related to infiltration, cell density, microvascularity, and blood-brain barrier compromise are integrated via advanced pattern analysis methods, they form very accurate predictive biomarkers. These predictive markers used solely preoperative images, hence they can significantly augment diagnosis and treatment of GB patients. © The Author(s) 2015. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. Cerebral Oximetry for the Prediction of Neurological Dysfunction in Cardiosurgical Patients

    Directory of Open Access Journals (Sweden)

    A. N. Shepelyuk

    2011-01-01

    Full Text Available Objective: to study the efficiency of intraoperative transeosophageal echocardiography in the detection of indications for and contraindications to early activation in the operating room after myocardial revascularization under extracorporeal circulation. Subject and methods. One hundred and eighty-six patients aged 55.0±0.6 years were examined. A Sonos Agilent 5500 apparatus and a multipurpose Omni-2 transducer were used for ultrasound study. Left ventricular ejection fraction was determined in the four-chamber (Simpson and transgastric views (visualization of the left ventricle in cross-section at the level of the papillary muscles. To identify impaired myocardial contractility hindering immediate activation, the authors analyzed the data of examining 142 patients who might undergo tracheal extubation in the operating room. A decreased left ventricular ejection fraction of less than 50% in the transgastric view was considered to be a contraindication to activation. The sensitivity of echocardiography in the differential diagnosis of acute myocardial infarction _ was studied in 44 patients with echocardiographic signs of acute myocardial ischemic lesion. Results. A left ventricular ejection fraction of less than 50% (41.5±2.2% in the transgastric view was a refusal criterion for immediate patient activation. This group of patients, as compared with those having a left ventricular ejection fraction of 60.1±1.7%, had a longer duration of inotropic therapy (45.2±2.1 and 13±1.1 hrs; p<0.05 and a more prolonged length of postoperative intensive care unit stay (36.2±1.7 and 18.8±0.75 hrs; p<0.05. The correlation coefficient between the left ventricular ejection fraction at the end of surgery and the duration of inotropic therapy was 0.51 (p<0.0001 and that with an intensive care unit stay was 0.48 (p=0.00018. Among the patients with electrocardiographic signs of acute myocardial ischemic lesion, ultrasound study did not confirm the diagnosis

  16. Angiotensinogen and HLA class II predict bevacizumab response in recurrent glioblastoma patients

    DEFF Research Database (Denmark)

    Urup, Thomas; Michaelsen, Signe Regner; Olsen, Lars Rønn

    2016-01-01

    .0009) and high expression of a HLA class II gene (2-fold increase in HLA-DQA1; OR = 1.22; 95% CI: 1.01-1.47; P = 0.04). These two genes were included in a model that is able predict response to bevacizumab combination therapy in clinical practice. When stratified for a validated prognostic index, the predictive...... model for response was significantly associated with improved overall survival. Conclusion: Two genes (low angiotensinogen and high HLA-class II expression) were predictive for bevacizumab response and were included in a predictive model for response. This model can be used in clinical practice...... for bevacizumab response in recurrent glioblastoma patients. Methods: The study included a total of 82 recurrent glioblastoma patients treated with bevacizumab combination therapy whom were both response and biomarker evaluable. Gene expression of tumor tissue was analyzed by using a customized Nano...

  17. Femoral artery pressure measurement to predict the outcome of arterial surgery in patients with multilevel disease

    DEFF Research Database (Denmark)

    Faris, I; Tønnesen, K H; Agerskov, K

    1982-01-01

    Direct measurement of the femoral artery pressure before operation has been used to predict the postoperative change in ankle and toe pressure in 102 limbs (83 patients) that underwent aortoiliac surgery for the treatment of atherosclerotic occlusion or stenosis affecting both the aortoiliac...... 25 mm Hg was associated with a high probability that amputation would be required. The chances of an amputation were less than 3% if a toe pressure higher than 40 mm Hg was predicted. If the predicted ankle pressure index was lower than 0.56, there was a 90% chance that intermittent claudication...... would persist. Measurement of the femoral artery pressure allows prediction of the toe and ankle pressure response to surgery to be made with sufficient accuracy to permit a preoperative decision to be made between the need for a single-level or a two-level arterial reconstruction: no patients who had...

  18. Early prediction of long-term response to cabergoline in patients with macroprolactinomas.

    Science.gov (United States)

    Lee, Youngki; Ku, Cheol Ryong; Kim, Eui-Hyun; Hong, Jae Won; Lee, Eun Jig; Kim, Sun Ho

    2014-09-01

    Cabergoline is typically effective for treating prolactinomas; however, some patients display cabergoline resistance, and the early characteristics of these patients remain unclear. We analyzed early indicators predicting long-term response to cabergoline. We retrospectively reviewed the cases of 44 patients with macroprolactinomas who received cabergoline as first-line treatment; the patients were followed for a median of 16 months. The influence of various clinical parameters on outcomes was evaluated. Forty patients (90.9%) were treated medically and displayed tumor volume reduction (TVR) of 74.7%, a prolactin normalization (NP) rate of 81.8%, and a complete response (CR; TVR >50% with NP, without surgery) rate of 70.5%. Most patients (93.1%) with TVR ≥25% and NP at 3 months eventually achieved CR, whereas only 50% of patients with TVR ≥25% without NP and no patients with TVR cabergoline (β=-1.181 mg/week), and two of four patients who underwent surgery were able to discontinue cabergoline. Determining cabergoline response using TVR and NP 3 months after treatment is useful for predicting later outcomes. However, further cabergoline administration should be considered for patients with TVR >25% at 3 months without NP, particularly those with huge prolactinomas, because a delayed response may be achieved. As surgery can reduce the cabergoline dose necessary for successful disease control, it should be considered for cabergoline-resistant patients.

  19. Can Patient Variables Measured on Arrival to the Emergency Department Predict Disposition in Medium-acuity Patients?

    Science.gov (United States)

    Riordan, John P; Dell, Wayne L; Patrie, James T

    2017-05-01

    Emergency department crowding has led to innovative "front end" care models to safely and efficiently care for medium and lower acuity patients. In the United States, most treatment algorithms rely on the emergency severity index (ESI) triage tool to sort patients. However, there are no objective criteria used to differentiate ESI 3 patients. We seek to derive and validate a model capable of predicting patient discharge disposition (DD) using variables present on arrival to the emergency department for ESI 3 patients. Our retrospective cohort study included adult patients with an ESI triage designation 3 treated in an academic emergency department over the course of 2 successive years (2013-2015). The main outcome was DD. Two datasets were used in the modeling process. One dataset, the derivation dataset (n = 25,119), was used to develop the statistical model, while the second dataset, the validation dataset (n = 24,639), was used to evaluate the statistical model's prediction performance. All variables included in the derivation model were uniquely associated with DD status (p saturation (1.06 [95% CI 1.01-1.10]), temperature (1.10 [95% CI 1.06-1.15]), systolic blood pressure (1.18 [95% CI 1.12-1.25]), diastolic blood pressure (1.16 [95% CI 1.09-1.22]), respiratory rate (1.05 [95% CI 1.01-1.10]), and pain score (1.13 [95% CI 1.06-1.21]). The validation C-statistic was 0.73. We derived and validated a model and created a nomogram with acceptable discrimination of ESI 3 patients on arrival for purposes of predicting DD. Incorporating these variables into the care of these patients could improve patient flow by identifying patients who are likely to be discharged. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Deletion of Chromosome 4q Predicts Outcome in Stage II Colon Cancer Patients

    Directory of Open Access Journals (Sweden)

    R. P. M. Brosens

    2010-01-01

    Full Text Available Background: Around 30% of all stage II colon cancer patients will relapse and die of their disease. At present no objective parameters to identify high-risk stage II colon cancer patients, who will benefit from adjuvant chemotherapy, have been established. With traditional histopathological features definition of high-risk stage II colon cancer patients is inaccurate. Therefore more objective and robust markers for prediction of relapse are needed. DNA copy number aberrations have proven to be robust prognostic markers, but have not yet been investigated for this specific group of patients. The aim of the present study was to identify chromosomal aberrations that can predict relapse of tumor in patients with stage II colon cancer.

  1. Do Patient Characteristics Predict Outcome of Psychodynamic Psychotherapy for Social Anxiety Disorder?

    Science.gov (United States)

    Wiltink, Jörg; Hoyer, Jürgen; Beutel, Manfred E.; Ruckes, Christian; Herpertz, Stephan; Joraschky, Peter; Koranyi, Susan; Michal, Matthias; Nolting, Björn; Pöhlmann, Karin; Salzer, Simone; Strauss, Bernhard

    2016-01-01

    Objectives Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT). No study has addressed which patient variables predict outcome of PDT for social anxiety disorder. Research Design and Methods In the largest multicenter trial on psychotherapy of social anxiety (SA) to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatment. Treatment outcome was assessed based on diverse parameters such as endstate functioning, remission, response, and drop-out. The relationship between patient characteristics (demographic variables, mental co-morbidity, personality, interpersonal problems) and outcome was analysed using logistic and linear regressions. Results Pre-treatment SA predicted up to 39 percent of variance of outcome. Only few additional baseline characteristics predicted better treatment outcome (namely, lower comorbidity and interpersonal problems) with a limited proportion of incremental variance (5.5 to 10 percent), while, e.g., shame, self-esteem or harm avoidance did not. Conclusions We argue that the central importance of pre-treatment symptom severity for predicting outcomes should advocate alternative treatment strategies (e.g. longer treatments, combination of psychotherapy and medication) in those who are most disturbed. Given the relatively small amount of variance explained by the other patient characteristics, process variables and patient-therapist interaction should additionally be taken into account in future research. Trial Registration Controlled-trials.com/ISRCTN53517394 PMID:26785255

  2. Preoperative urodynamic assessment in patients with spinal cord lesions undergoing sphincterotomy: is success predictable?

    Science.gov (United States)

    Pannek, Juergen; Hilfiker, Roger; Goecking, Konrad; Bersch, Ulf

    2009-01-01

    Sphincterotomy is a well-established therapeutic option in male patients with neurogenic bladder dysfunction and detrusor-sphincter-dyssynergia due to spinal cord lesions. Indication and prediction of treatment outcome, however, are mainly based on clinical parameters. We analyzed the clinical usefulness of preoperative urodynamic evaluation for the prediction of success in patients undergoing external sphincterotomy. In a retrospective study, residual urine, retrograde perfusion pressure (RESP) and detrusor leak point pressure (DLPP) in 62 male patients with spinal cord injury were assessed before sphincterotomy. Data were compared to surgical success evaluated by postoperative DLPP and residual urine. Sphincterotomy was successful in 85.4% of our patients. In multivariate analysis, both preoperative DLPP and RESP were superior to measurement of residual urine concerning prediction of surgical success. However, these differences were not statistically significant. To our knowledge, this is the first study to evaluate preoperative predictors for surgical success in patients undergoing sphincterotomy. Although urodynamic evaluation is strongly advised prior to surgery in patients with spinal cord lesions, it improves prediction of success only marginally. Copyright 2009 S. Karger AG, Basel.

  3. Do Patient Characteristics Predict Outcome of Psychodynamic Psychotherapy for Social Anxiety Disorder?

    Directory of Open Access Journals (Sweden)

    Jörg Wiltink

    Full Text Available Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT. No study has addressed which patient variables predict outcome of PDT for social anxiety disorder.In the largest multicenter trial on psychotherapy of social anxiety (SA to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatment. Treatment outcome was assessed based on diverse parameters such as endstate functioning, remission, response, and drop-out. The relationship between patient characteristics (demographic variables, mental co-morbidity, personality, interpersonal problems and outcome was analysed using logistic and linear regressions.Pre-treatment SA predicted up to 39 percent of variance of outcome. Only few additional baseline characteristics predicted better treatment outcome (namely, lower comorbidity and interpersonal problems with a limited proportion of incremental variance (5.5 to 10 percent, while, e.g., shame, self-esteem or harm avoidance did not.We argue that the central importance of pre-treatment symptom severity for predicting outcomes should advocate alternative treatment strategies (e.g. longer treatments, combination of psychotherapy and medication in those who are most disturbed. Given the relatively small amount of variance explained by the other patient characteristics, process variables and patient-therapist interaction should additionally be taken into account in future research.Controlled-trials.com/ISRCTN53517394.

  4. Do Patient Characteristics Predict Outcome of Psychodynamic Psychotherapy for Social Anxiety Disorder?

    Science.gov (United States)

    Wiltink, Jörg; Hoyer, Jürgen; Beutel, Manfred E; Ruckes, Christian; Herpertz, Stephan; Joraschky, Peter; Koranyi, Susan; Michal, Matthias; Nolting, Björn; Pöhlmann, Karin; Salzer, Simone; Strauss, Bernhard; Leibing, Eric; Leichsenring, Falk

    2016-01-01

    Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT). No study has addressed which patient variables predict outcome of PDT for social anxiety disorder. In the largest multicenter trial on psychotherapy of social anxiety (SA) to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatment. Treatment outcome was assessed based on diverse parameters such as endstate functioning, remission, response, and drop-out. The relationship between patient characteristics (demographic variables, mental co-morbidity, personality, interpersonal problems) and outcome was analysed using logistic and linear regressions. Pre-treatment SA predicted up to 39 percent of variance of outcome. Only few additional baseline characteristics predicted better treatment outcome (namely, lower comorbidity and interpersonal problems) with a limited proportion of incremental variance (5.5 to 10 percent), while, e.g., shame, self-esteem or harm avoidance did not. We argue that the central importance of pre-treatment symptom severity for predicting outcomes should advocate alternative treatment strategies (e.g. longer treatments, combination of psychotherapy and medication) in those who are most disturbed. Given the relatively small amount of variance explained by the other patient characteristics, process variables and patient-therapist interaction should additionally be taken into account in future research. Controlled-trials.com/ISRCTN53517394.

  5. Symptoms predictive of postural tachycardia syndrome (POTS) in the adolescent headache patient.

    Science.gov (United States)

    Heyer, Geoffrey L; Fedak, Erin M; LeGros, Aggie L

    2013-06-01

    To identify symptoms that may predict postural tachycardia syndrome (POTS) among adolescent patients with headache and lightheadedness referred for tilt table testing. Individuals with POTS can have a variety of symptoms that impair quality of life. The specific symptoms that help to distinguish the POTS patient in an adolescent headache population have not been determined. A group of symptoms was compared among 70 adolescent patients with headache and lightheadedness referred to a pediatric headache clinic for tilt table testing. Every patient completed a symptom questionnaire prior to the tilt table test. The chi-square test was used to compare questionnaire responses between patients found to have POTS and those who did not have POTS. Thirteen symptoms were analyzed. Symptoms that differed statistically between groups were further assessed for sensitivity, specificity, and diagnostic predictive values. Thirty-seven (53%) patients met diagnostic criteria for POTS. Several symptoms differed between the patients found to have POTS and those without POTS. Headache type was not predictive. Vertigo and evening exacerbation of headaches had P values headache trigger, and orthostatic headaches had P values headache type reliably establishes the POTS diagnosis, several symptoms can help to distinguish the POTS patient in an adolescent headache population. © 2013 American Headache Society.

  6. Molecular Based Temperature and Strain Rate Dependent Yield Criterion for Anisotropic Elastomeric Thin Films

    Science.gov (United States)

    Bosi, F.; Pellegrino, S.

    2017-01-01

    A molecular formulation of the onset of plasticity is proposed to assess temperature and strain rate effects in anisotropic semi-crystalline rubbery films. The presented plane stress criterion is based on the strain rate-temperature superposition principle and the cooperative theory of yielding, where some parameters are assumed to be material constants, while others are considered to depend on specific modes of deformation. An orthotropic yield function is developed for a linear low density polyethylene thin film. Uniaxial and biaxial inflation experiments were carried out to determine the yield stress of the membrane via a strain recovery method. It is shown that the 3% offset method predicts the uniaxial elastoplastic transition with good accuracy. Both the tensile yield points along the two principal directions of the film and the biaxial yield stresses are found to obey the superposition principle. The proposed yield criterion is compared against experimental measurements, showing excellent agreement over a wide range of deformation rates and temperatures.

  7. Ethical leadership: meta-analytic evidence of criterion-related and incremental validity.

    Science.gov (United States)

    Ng, Thomas W H; Feldman, Daniel C

    2015-05-01

    This study examines the criterion-related and incremental validity of ethical leadership (EL) with meta-analytic data. Across 101 samples published over the last 15 years (N = 29,620), we observed that EL demonstrated acceptable criterion-related validity with variables that tap followers' job attitudes, job performance, and evaluations of their leaders. Further, followers' trust in the leader mediated the relationships of EL with job attitudes and performance. In terms of incremental validity, we found that EL significantly, albeit weakly in some cases, predicted task performance, citizenship behavior, and counterproductive work behavior-even after controlling for the effects of such variables as transformational leadership, use of contingent rewards, management by exception, interactional fairness, and destructive leadership. The article concludes with a discussion of ways to strengthen the incremental validity of EL. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  8. Wavelength selection in injection-driven Hele-Shaw flows: A maximum amplitude criterion

    Science.gov (United States)

    Dias, Eduardo; Miranda, Jose

    2013-11-01

    As in most interfacial flow problems, the standard theoretical procedure to establish wavelength selection in the viscous fingering instability is to maximize the linear growth rate. However, there are important discrepancies between previous theoretical predictions and existing experimental data. In this work we perform a linear stability analysis of the radial Hele-Shaw flow system that takes into account the combined action of viscous normal stresses and wetting effects. Most importantly, we introduce an alternative selection criterion for which the selected wavelength is determined by the maximum of the interfacial perturbation amplitude. The effectiveness of such a criterion is substantiated by the significantly improved agreement between theory and experiments. We thank CNPq (Brazilian Sponsor) for financial support.

  9. Can physicians accurately predict which patients will lose weight, improve nutrition and increase physical activity?

    Science.gov (United States)

    Pollak, Kathryn I; Coffman, Cynthia J; Alexander, Stewart C; Tulsky, James A; Lyna, Pauline; Dolor, Rowena J; Cox, Mary E; Brouwer, Rebecca J Namenek; Bodner, Michael E; Østbye, Truls

    2012-10-01

    Physician counselling may help patients increase physical activity, improve nutrition and lose weight. However, physicians have low outcome expectations that patients will change. The aims are to describe the accuracy of physicians' outcome expectations about whether patients will follow weight loss, nutrition and physical activity recommendations. The relationships between physician outcome expectations and patient motivation and confidence also are assessed. This was an observational study that audio recorded encounters between 40 primary care physicians and 461 of their overweight or obese patients. We surveyed physicians to assess outcome expectations that patients will lose weight, improve nutrition and increase physical activity after counselling. We assessed actual patient change in behaviours from baseline to 3 months after the encounter and changes in motivation and confidence from baseline to immediately post-encounter. Right after the visit, ~55% of the time physicians were optimistic that their individual patients would improve. Physicians were not very accurate about which patients actually would improve weight, nutrition and physical activity. More patients had higher confidence to lose weight when physicians thought that patients would be likely to follow their weight loss recommendations. Physicians are moderately optimistic that patients will follow their weight loss, nutrition and physical activity recommendations. Patients might perceive physicians' confidence in them and thus feel more confident themselves. Physicians, however, are not very accurate in predicting which patients will or will not change behaviours. Their optimism, although helpful for patient confidence, might make physicians less receptive to learning effective counselling techniques.

  10. Changes in Albuminuria Predict Mortality and Morbidity in Patients with Vascular Disease

    OpenAIRE

    Schmieder, Roland E.; Mann, Johannes F. E.; Schumacher, Helmut; Gao, Peggy; Mancia, Giuseppe; Weber, Michael A.; McQueen, Matthew; Koon, Teo; Yusuf, Salim

    2011-01-01

    The degree of albuminuria predicts cardiovascular and renal outcomes, but it is not known whether changes in albuminuria also predict similar outcomes. In two multicenter, multinational, prospective observational studies, a central laboratory measured albuminuria in 23,480 patients with vascular disease or high-risk diabetes. We quantified the association between a greater than or equal to twofold change in albuminuria in spot urine from baseline to 2 years and the incidence of cardiovascular...

  11. Mood color choice helps to predict response to hypnotherapy in patients with irritable bowel syndrome

    OpenAIRE

    Tarrier Nicholas; Morris Julie; Carruthers Helen R; Whorwell Peter J

    2010-01-01

    Abstract Background Approximately two thirds of patients with irritable bowel syndrome (IBS) respond well to hypnotherapy. However, it is time consuming as well as expensive to provide and therefore a way of predicting outcome would be extremely useful. The use of imagery and color form an integral part of the hypnotherapeutic process and we have hypothesised that investigating color and how it relates to mood might help to predict response to treatment. In order to undertake this study we ha...

  12. D-index: A New Scoring System in Febrile Neutropenic Patients for Predicting Invasive Fungal Infections

    Directory of Open Access Journals (Sweden)

    Gülden Yılmaz

    2016-05-01

    Full Text Available Objective: Neutropenia is a critical risk factor for invasive fungal infections (IFIs. We retrospectively performed this study to assess the performance of the D-index, a new test that combines both the duration and the severity of neutropenia, in predicting IFIs among patients with acute myelogenous leukemia. Materials and Methods: Fifteen patients with IFIs and 28 patients who did not develop IFIs were enrolled in the study. The D-index was defined as the area over the neutrophil curve, whereas the cumulativeD-index (c-D-index was the area over the neutrophil curve from the start of neutropenia until the first clinical manifestation of IFI. Results: The D-index and the c-D-index tended to be significantly higher in patients with IFIs, with medians of 10,150 (range: 4000- 22,000 and 5300 (range: 2300-22,200, respectively (p=0.037 and p=0.003, respectively. The receiver operating characteristic analyses showed that there was a cutoff point of 3875 for the D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values were 100%, 67.9%, 35.4%, and 100%, respectively. There was also a cutoff point of 4225 for the c-D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values for the c-D-index were 93.3%, 71.4%, 36.6%, and 98.4%. Conclusion: The D-index and especially the c-D-index could be useful tools with high negative predictive value to exclude as well as to predict IFIs in the management of neutropenic patients.

  13. FDG PET imaging for grading and prediction of outcome in chondrosarcoma patients

    Energy Technology Data Exchange (ETDEWEB)

    Brenner, Winfried; Eary, Janet F. [Division of Nuclear Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356113, WA 98195-6113, Seattle (United States); Conrad, Ernest U. [Department of Orthopaedics, University of Washington Medical Center, Seattle, WA (United States)

    2004-02-01

    The aims of this study were to assess the potential of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) for tumor grading in chondrosarcoma patients and to evaluate the role of standardized uptake value (SUV) as a parameter for prediction of patient outcome. FDG PET imaging was performed in 31 patients with chondrosarcoma prior to therapy. SUV was calculated for each tumor and correlated to tumor grade and size, and to patient outcome in terms of local relapse or metastatic disease with a mean follow-up period of 48 months. Chondrosarcomas were detectable in all patients. Tumor SUV was 3.38{+-}1.61 for grade I (n=15), 5.44{+-}3.06 for grade II (n=13), and 7.10{+-}2.61 for grade III (n=3). Significant differences were found between patients with and without disease progression: SUV was 6.42{+-}2.70 (n=10) in patients developing recurrent or metastatic disease compared with 3.74{+-}2.22 in patients without relapse (P=0.015). Using a cut-off of 4 for SUV, sensitivity, specificity, and positive and negative predictive values for a relapse were 90%, 76%, 64%, and 94%, respectively. Combining tumor grade and SUV, these parameters improved to 90%, 95%, 90%, and 95%, respectively. Pretherapeutic tumor SUV obtained by FDG PET imaging was a useful parameter for tumor grading and prediction of outcome in chondrosarcoma patients. The combination of SUV and histopathologic tumor grade further improved prediction of outcome substantially, allowing identification of patients at high risk for local relapse or metastatic disease. (orig.)

  14. Immediate postoperative Fibrosis-4 predicts postoperative liver failure for patients with hepatocellular carcinoma undergoing curative surgery.

    Science.gov (United States)

    Wang, Haiqing; Li, Lei; Bo, Wentao; Liu, Aixiang; Feng, Xielin; Hu, Yong; Tian, Lang; Zhang, Hui; Tang, Xiaoli; Zhang, Lixia; Zhang, Mingyi

    2018-01-01

    Postoperative liver failure remains the main complication and predominant cause of hepatectomy-related mortality for patients undergoing liver resection. Our aim is to investigate whether immediate postoperative Fibrosis-4 could predict postoperative liver failure. We retrospectively enrolled 1353 consecutive hepatocellular carcinoma patients undergoing radical resection. The characteristics and clinical outcomes were compared between patients with high and low immediate postoperative Fibrosis-4. Risk factors for hepatic failure were evaluated by univariate and multivariate analysis. Using a receiver operating characteristic curve, immediate postoperative Fibrosis-4 showed good prediction ability for postoperative liver failure (AUROC=0.647, Pfailure (13.9% vs 6.2%, Pfailure. Immediate postoperative Fibrosis-4 showed good prediction ability for postoperative liver failure, and required measure should be taken to prevent liver failure when high postoperative Fibrosis-4 appeared. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  15. Updating the Trainability Tests Literature on Black-White Subgroup Differences and Reconsidering Criterion-Related Validity

    Science.gov (United States)

    Roth, Philip L.; Buster, Maury A.; Bobko, Philip

    2011-01-01

    A number of applied psychologists have suggested that trainability test Black-White ethnic group differences are low or relatively low (e.g., Siegel & Bergman, 1975), though data are scarce. Likewise, there are relatively few estimates of criterion-related validity for trainability tests predicting job performance (cf. Robertson & Downs,…

  16. Development and Validation of Criterion-Referenced Clinically Relevant Fitness Standards for Maintaining Physical Independence in Later Years

    Science.gov (United States)

    Rikli, Roberta E.; Jones, C. Jessie

    2013-01-01

    Purpose: To develop and validate criterion-referenced fitness standards for older adults that predict the level of capacity needed for maintaining physical independence into later life. The proposed standards were developed for use with a previously validated test battery for older adults--the Senior Fitness Test (Rikli, R. E., & Jones, C. J.…

  17. A nomogram to predict Gleason sum upgrading of clinically diagnosed localized prostate cancer among Chinese patients

    Science.gov (United States)

    Wang, Jin-You; Zhu, Yao; Wang, Chao-Fu; Zhang, Shi-Lin; Dai, Bo; Ye, Ding-Wei

    2014-01-01

    Although several models have been developed to predict the probability of Gleason sum upgrading between biopsy and radical prostatectomy specimens, most of these models are restricted to prostate-specific antigen screening-detected prostate cancer. This study aimed to build a nomogram for the prediction of Gleason sum upgrading in clinically diagnosed prostate cancer. The study cohort comprised 269 Chinese prostate cancer patients who underwent prostate biopsy with a minimum of 10 cores and were subsequently treated with radical prostatectomy. Of all included patients, 220 (81.8%) were referred with clinical symptoms. The prostate-specific antigen level, primary and secondary biopsy Gleason scores, and clinical T category were used in a multivariate logistic regression model to predict the probability of Gleason sum upgrading. The developed nomogram was validated internally. Gleason sum upgrading was observed in 90 (33.5%) patients. Our nomogram showed a bootstrap-corrected concordance index of 0.789 and good calibration using 4 readily available variables. The nomogram also demonstrated satisfactory statistical performance for predicting significant upgrading. External validation of the nomogram published by Chun et al. in our cohort showed a marked discordance between the observed and predicted probabilities of Gleason sum upgrading. In summary, a new nomogram to predict Gleason sum upgrading in clinically diagnosed prostate cancer was developed, and it demonstrated good statistical performance upon internal validation. PMID:24559852

  18. Predicting dental attendance from dental hygienists' autonomy support and patients' autonomous motivation: A randomised clinical trial.

    Science.gov (United States)

    Halvari, Anne E Münster; Halvari, Hallgeir; Williams, Geoffrey C; Deci, Edward L

    2017-02-01

    To test the hypothesis that a Self-Determination Theory (SDT) intervention designed to promote oral health care competence in an autonomy-supportive way would predict change in caries competence relative to standard care. Further, to test the SDT process path-model hypotheses with: (1) the intervention and individual differences in relative autonomous locus of causality (RALOC) predicting increases in caries competence, which in turn would positively predict dental attendance; (2) RALOC negatively predicting dental anxiety, which would negatively predict dental attendance; (3) RALOC and caries disease referred to the dentist after an autonomy-supportive clinical exam directly positively predicting dental attendance; and (4) the intervention moderating the link between RALOC and dental attendance. A randomised two-group experiment was conducted at a dental clinic with 138 patients (Mage = 23.31 yr., SD = 3.5), with pre- and post-measures in a period of 5.5 months. The experimental model was supported. The SDT path model fit the data well and supported the hypotheses explaining 63% of the variance in dental attendance. Patients personality (RALOC) and hygienists promoting oral health care competence in an autonomy-supportive way, performance of autonomy-supportive clinical exams and reductions of anxiety for dental treatment have important practical implications for patients' dental attendance.

  19. An attempt at a molecular prediction of metastasis in patients with primary cutaneous melanoma.

    Science.gov (United States)

    Gschaider, Melanie; Neumann, Friederike; Peters, Bettina; Lenz, Florian; Cibena, Michael; Goiser, Malgorzata; Wolf, Ingrid; Wenzel, Jörg; Mauch, Cornelia; Schreiner, Wolfgang; Wagner, Stephan N

    2012-01-01

    Current prognostic clinical and morphological parameters are insufficient to accurately predict metastasis in individual melanoma patients. Several studies have described gene expression signatures to predict survival or metastasis of primary melanoma patients, however the reproducibility among these studies is disappointingly low. We followed extended REMARK/Gould Rothberg criteria to identify gene sets predictive for metastasis in patients with primary cutaneous melanoma. For class comparison, gene expression data from 116 patients with clinical stage I/II (no metastasis) and 72 with III/IV primary melanoma (with metastasis) at time of first diagnosis were used. Significance analysis of microarrays identified the top 50 differentially expressed genes. In an independent data set from a second cohort of 28 primary melanoma patients, these genes were analyzed by multivariate Cox regression analysis and leave-one-out cross validation for association with development of metastatic disease. In a multivariate Cox regression analysis, expression of the genes Ena/vasodilator-stimulated phosphoprotein-like (EVL) and CD24 antigen gave the best predictive value (p = 0.001; p = 0.017, respectively). A multivariate Cox proportional hazards model revealed these genes as a potential independent predictor, which may possibly add (both p = 0.01) to the predictive value of the most important morphological indicator, Breslow depth. Combination of molecular with morphological information may potentially enable an improved prediction of metastasis in primary melanoma patients. A strength of the gene expression set is the small number of genes, which should allow easy reevaluation in independent data sets and adequately designed clinical trials.

  20. Patient feature based dosimetric Pareto front prediction in esophageal cancer radiotherapy.

    Science.gov (United States)

    Wang, Jiazhou; Jin, Xiance; Zhao, Kuaike; Peng, Jiayuan; Xie, Jiang; Chen, Junchao; Zhang, Zhen; Studenski, Matthew; Hu, Weigang

    2015-02-01

    To investigate the feasibility of the dosimetric Pareto front (PF) prediction based on patient's anatomic and dosimetric parameters for esophageal cancer patients. Eighty esophagus patients in the authors' institution were enrolled in this study. A total of 2928 intensity-modulated radiotherapy plans were obtained and used to generate PF for each patient. On average, each patient had 36.6 plans. The anatomic and dosimetric features were extracted from these plans. The mean lung dose (MLD), mean heart dose (MHD), spinal cord max dose, and PTV homogeneity index were recorded for each plan. Principal component analysis was used to extract overlap volume histogram (OVH) features between PTV and other organs at risk. The full dataset was separated into two parts; a training dataset and a validation dataset. The prediction outcomes were the MHD and MLD. The spearman's rank correlation coefficient was used to evaluate the correlation between the anatomical features and dosimetric features. The stepwise multiple regression method was used to fit the PF. The cross validation method was used to evaluate the model. With 1000 repetitions, the mean prediction error of the MHD was 469 cGy. The most correlated factor was the first principal components of the OVH between heart and PTV and the overlap between heart and PTV in Z-axis. The mean prediction error of the MLD was 284 cGy. The most correlated factors were the first principal components of the OVH between heart and PTV and the overlap between lung and PTV in Z-axis. It is feasible to use patients' anatomic and dosimetric features to generate a predicted Pareto front. Additional samples and further studies are required improve the prediction model.

  1. Artificial neural networks to predict presence of significant pathology in patients presenting to routine colorectal clinics.

    Science.gov (United States)

    Maslekar, S; Gardiner, A B; Monson, J R T; Duthie, G S

    2010-12-01

    Artificial neural networks (ANNs) are computer programs used to identify complex relations within data. Routine predictions of presence of colorectal pathology based on population statistics have little meaning for individual patient. This results in large number of unnecessary lower gastrointestinal endoscopies (LGEs - colonoscopies and flexible sigmoidoscopies). We aimed to develop a neural network algorithm that can accurately predict presence of significant pathology in patients attending routine outpatient clinics for gastrointestinal symptoms. Ethics approval was obtained and the study was monitored according to International Committee on Harmonisation - Good Clinical Practice (ICH-GCP) standards. Three-hundred patients undergoing LGE prospectively completed a specifically developed questionnaire, which included 40 variables based on clinical symptoms, signs, past- and family history. Complete data sets of 100 patients were used to train the ANN; the remaining data was used for internal validation. The primary output used was positive finding on LGE, including polyps, cancer, diverticular disease or colitis. For external validation, the ANN was applied to data from 50 patients in primary care and also compared with the predictions of four clinicians. Clear correlation between actual data value and ANN predictions were found (r = 0.931; P = 0.0001). The predictive accuracy of ANN was 95% in training group and 90% (95% CI 84-96) in the internal validation set and this was significantly higher than the clinical accuracy (75%). ANN also showed high accuracy in the external validation group (89%). Artificial neural networks offer the possibility of personal prediction of outcome for individual patients presenting in clinics with colorectal symptoms, making it possible to make more appropriate requests for lower gastrointestinal endoscopy. © 2010 The Authors. Colorectal Disease © 2010 The Association of Coloproctology of Great Britain and Ireland.

  2. Maternal booking status as a criterion for admission for neonatal ...

    African Journals Online (AJOL)

    1994-08-08

    Aug 8, 1994 ... Chang RWS, Jacobs S. Lee B. Predicting outcome among intensive care unit patients using a computerised trend ... 32. Potgieter PO, Unton OM. The value of critical care in total health care. S Atr Med J. 1990 .... _. Qualifications. _. Connection with or interest in Critical Care Medicine. MEMBERSHIP FEES ...

  3. Liver Stiffness Assessed by Shear Wave Elastography Predicts Postoperative Liver Failure in Patients with Hepatocellular Carcinoma.

    Science.gov (United States)

    Shen, Yinghao; Zhou, Chenhao; Zhu, Guodong; Shi, Guoming; Zhu, Xiaodong; Huang, Cheng; Zhou, Jian; Fan, Jia; Ding, Hong; Ren, Ning; Sun, Hui-Chuan

    2017-09-01

    Cirrhosis increases a patient's risk of developing postoperative liver failure (PLF). Liver stiffness (LS), assessed by two-dimensional shear wave elastography (SWE), indicates liver fibrosis with high accuracy. Whether LS is superior to portal hypertension (PHT) in predicting PLF remains to be studied. The study enrolled 280 patients who underwent hepatectomy for hepatocellular carcinoma from July 2015 to July 2016. All patients received preoperative assessments for LS, PHT, and serum markers of liver fibrosis in addition to other clinicopathological tests. Risk factors for grade A and grade B (or greater) PLF were subjected to univariate and multivariate analysis and receiver operating characteristic curve analysis. Fifty-five patients (19.6%) experienced PLF. The cutoff value of LS for predicting cirrhosis was 10.1 kPa. Multivariate analysis identified LS, hyaluronic acid, IV collagen, and the presence of splenomegaly as independent predictors of PLF. The cutoff value of LS for predicting PLF and grade B (or greater) PLF was 11.75 and 11.9 kPa, respectively. LS was superior to PHT in predicting PLF or greater than grade B PLF (0.72 vs. 0.60, 0.76 vs. 0.59, P < 0.05). LS measured by SWE can predict risk of PLF with greater accuracy than PHT.

  4. Preoperative Electrocardiogram Score for Predicting New-Onset Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery.

    Science.gov (United States)

    Gu, Jiwei; Andreasen, Jan J; Melgaard, Jacob; Lundbye-Christensen, Søren; Hansen, John; Schmidt, Erik B; Thorsteinsson, Kristinn; Graff, Claus

    2017-02-01

    To investigate if electrocardiogram (ECG) markers from routine preoperative ECGs can be used in combination with clinical data to predict new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Retrospective observational case-control study. Single-center university hospital. One hundred consecutive adult patients (50 POAF, 50 without POAF) who underwent coronary artery bypass grafting, valve surgery, or combinations. Retrospective review of medical records and registration of POAF. Clinical data and demographics were retrieved from the Western Denmark Heart Registry and patient records. Paper tracings of preoperative ECGs were collected from patient records, and ECG measurements were read by two independent readers blinded to outcome. A subset of four clinical variables (age, gender, body mass index, and type of surgery) were selected to form a multivariate clinical prediction model for POAF and five ECG variables (QRS duration, PR interval, P-wave duration, left atrial enlargement, and left ventricular hypertrophy) were used in a multivariate ECG model. Adding ECG variables to the clinical prediction model significantly improved the area under the receiver operating characteristic curve from 0.54 to 0.67 (with cross-validation). The best predictive model for POAF was a combined clinical and ECG model with the following four variables: age, PR-interval, QRS duration, and left atrial enlargement. ECG markers obtained from a routine preoperative ECG may be helpful in predicting new-onset POAF in patients undergoing cardiac surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Auditory-evoked potentials during coma: do they improve our prediction of awakening in comatose patients?

    Science.gov (United States)

    Rodriguez, Rosendo A; Bussière, Miguel; Froeschl, Michael; Nathan, Howard J

    2014-02-01

    The mismatch negativity (MMN), an auditory event-related potential, has been identified as a good indicator of recovery of consciousness during coma. We explored the predictive value of the MMN and other auditory-evoked potentials including brainstem and middle-latency potentials for predicting awakening in comatose patients after cardiac arrest or cardiogenic shock. Auditory brainstem, middle-latency (Pa wave), and event-related potentials (N100 and MMN waves) were recorded in 17 comatose patients and 9 surgical patients matched by age and coronary artery disease. Comatose patients were followed up daily to determine recovery of consciousness and classified as awakened and nonawakened. Among the auditory-evoked potentials, the presence or absence of MMN best discriminated between patients who awakened or those who did not. Mismatch negativity was present during coma in all patients who awakened (7/7) and in 2 of those (2/10) who did not awaken. In patients who awakened and in whom MMN was detected, 3 of those awakened between 2 and 3 days and 4 between 9 and 21 days after evoked potential examination. All awakened patients had intact N100 waves and identifiable brainstem and middle-latency waves. In nonawakened patients, N100 and Pa waves were detected in 5 cases (50%) and brainstem waves in 9 (90%). The MMN is a good predictor of awakening in comatose patients after cardiac arrest and cardiogenic shock and can be measured days before awakening encouraging ongoing life support. © 2013.

  6. Geriatric Assessment Can Predict Outcomes of Endoscopic Surgery for Benign Prostatic Hyperplasia in Elderly Patients.

    Science.gov (United States)

    Pichon, Thomas; Lebdai, Souhil; Launay, Cyrille Patrice; Collet, Nadine; Chautard, Denis; Cerruti, Arnaud; Hoarau, Nicolas; Brassart, Eléna; Bigot, Pierre; Beauchet, Olivier; Azzouzi, Abdel-Rahmène; Culty, Thibaut

    2017-11-01

    Ojectives: Surgical management of benign prostatic hyperplasia (BPH) in elderly patients is associated with higher morbidity and mortality rate. This raises the question of benefice and risk balance. We conducted a prospective observational study to evaluate the results of endoscopic surgery for BPH in elderly patients, according to geriatric assessment. We included prospectively 60 patients older than 75 years, with an indwelling catheter for acute or chronic retention, who were candidates to endoscopic surgery for BPH. Patients underwent the brief geriatric assessment (BGA) and the comprehensive geriatric assessment (CGA) to classify them into three groups: "vigorous," "vulnerable," and "sick." Success was defined by the bladder catheter withdrawal after surgery. After geriatric assessment, 33 patients were classified in the "vigorous" group (55%), 25 in the "vulnerable" group (42%), and 2 in the "sick" group (3%). The success rate immediately after surgery was 85% and 41% in the "vigorous patient" group and the "vulnerable and sick" patient group, respectively (p Geriatric assessment can predict the outcome of endoscopic surgery for BPH for patients in retention older than 75 years. "Vulnerable and sick" patients had a higher risk to keep their indwelling catheter after the surgery compared with "vigorous" patients. The complication rate is also higher. The BGA can although predict a poor result of surgery when its score is equal or above 3/6.

  7. 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)....

  8. Predicting objective function weights from patient anatomy in prostate IMRT treatment planning.

    Science.gov (United States)

    Lee, Taewoo; Hammad, Muhannad; Chan, Timothy C Y; Craig, Tim; Sharpe, Michael B

    2013-12-01

    Intensity-modulated radiation therapy (IMRT) treatment planning typically combines multiple criteria into a single objective function by taking a weighted sum. The authors propose a statistical model that predicts objective function weights from patient anatomy for prostate IMRT treatment planning. This study provides a proof of concept for geometry-driven weight determination. A previously developed inverse optimization method (IOM) was used to generate optimal objective function weights for 24 patients using their historical treatment plans (i.e., dose distributions). These IOM weights were around 1% for each of the femoral heads, while bladder and rectum weights varied greatly between patients. A regression model was developed to predict a patient's rectum weight using the ratio of the overlap volume of the rectum and bladder with the planning target volume at a 1 cm expansion as the independent variable. The femoral head weights were fixed to 1% each and the bladder weight was calculated as one minus the rectum and femoral head weights. The model was validated using leave-one-out cross validation. Objective values and dose distributions generated through inverse planning using the predicted weights were compared to those generated using the original IOM weights, as well as an average of the IOM weights across all patients. The IOM weight vectors were on average six times closer to the predicted weight vectors than to the average weight vector, using l2 distance. Likewise, the bladder and rectum objective values achieved by the predicted weights were more similar to the objective values achieved by the IOM weights. The difference in objective value performance between the predicted and average weights was statistically significant according to a one-sided sign test. For all patients, the difference in rectum V54.3 Gy, rectum V70.0 Gy, bladder V54.3 Gy, and bladder V70.0 Gy values between the dose distributions generated by the predicted weights and IOM weights

  9. Predictive factors for gastroduodenal toxicity based on endoscopy following radiotherapy in patients with hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, H. [Sungkyunkwan Univ., Seoul (Korea, Republic of). Dept. of Health Sciences and Technology; Oh, D.; Park, H.C.; Han, Y.; Lim, D.H. [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of). Dept. of Radiation Oncology; Kang, S.W. [Korea Univ., Seoul (Korea, Republic of). Dept. of Radiologic Science; Paik, S.W. [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of). Dept. of Medicine

    2013-07-15

    Purpose: The aim of this work was to determine predictive factors for gastroduodenal (GD) toxicity in hepatocellular carcinoma (HCC) patients who were treated with radiotherapy (RT). Patients and methods: A total of 90 HCC patients who underwent esophagogastroduodenoscopy (EGD) before and after RT were enrolled. RT was delivered as 30-50 Gy (median 37.5 Gy) in 2-5 Gy (median 3.5 Gy) per fraction. All endoscopic findings were reviewed and GD toxicities related to RT were graded by the Common Toxicity Criteria for Adverse Events, version 3.0. The predictive factors for the {>=} grade 2 GD toxicity were investigated. Results: Endoscopic findings showed erosive gastritis in 14 patients (16 %), gastric ulcers in 8 patients (9 %), erosive duodenitis in 15 patients (17 %), and duodenal ulcers in 14 patients (16 %). Grade 2 toxicity developed in 19 patients (21 %) and grade 3 toxicity developed in 8 patients (9 %). V{sub 25} for stomach and V{sub 35} for duodenum (volume receiving a RT dose of more than x Gy) were the most predictive factors for {>=} grade 2 toxicity. The gastric toxicity rate at 6 months was 2.9 % for V{sub 25} {<=} 6.3 % and 57.1 % for V{sub 25} > 6.3 %. The duodenal toxicity rate at 6 months was 9.4 % for V{sub 35} > 5.4 % and 45.9 % for V{sub 35} > 5.4 %. By multivariate analysis including the clinical factors, V{sub 25} for stomach and V{sub 35} for duodenum were the significant factors. Conclusion: EGD revealed that GD toxicity is common following RT for HCC. V{sub 25} for the stomach and V{sub 35} for the duodenum were the significant factors to predict {>=} grade 2 GD toxicity. (orig.)

  10. Diastolic Heart Failure Predicted by Left Atrial Expansion Index in Patients with Severe Diastolic Dysfunction.

    Directory of Open Access Journals (Sweden)

    Shih-Hung Hsiao

    Full Text Available Left atrial (LA echocardiographic parameters are increasingly used to predict clinically relevant cardiovascular events. The study aims to evaluate the LA expansion index (LAEI for predicting diastolic heart failure (HF in patients with severe left ventricular (LV diastolic dysfunction.This prospective study enrolled 162 patients (65% male with preserved LV systolic function and severe diastolic dysfunction (132 grade 2 patients, 30 grade 3 patients. All patients had sinus rhythm at enrollment. The LAEI was calculated as (Volmax - Volmin x 100% / Volmin, where Volmax was defined as maximal LA volume and Volmin was defined as minimal volume. The endpoint was hospitalization for HF withp reserved LV ejection fraction (HFpEF.The median follow-up duration was 2.9 years. Fifty-four patients had cardiovascular events, including 41 diastolic and 8 systolic HF hospitalizations. In these 54 patients, 13 in-hospital deaths and 5 sudden out-of-hospital deaths occurred. Multivariate analyses revealed that HFpEF was associated with LAEI.and atrial fibrillation during follow-up. For predicting HFpEF, the LAEI had a hazard ratio of 1.197per 10% decrease. In patients who had HFpEF events, the LAEI significantly (P< 0.0001 decreased from 69±18% to 39±11% during hospitalization. Although the LAEI improved during follow-up (53±13%, it did not return to baseline.The LAEI predicts HFpEF in patients with severe diastolic dysfunction; it worsens during HFpEF events and partially recovers during followup.

  11. A validated rule for predicting patients who require prolonged ventilation post cardiac surgery.

    Science.gov (United States)

    Dunning, Joel; Au, John; Kalkat, Maninder; Levine, Adrian

    2003-08-01

    Prolonged ventilation post surgery causes logistic problems on cardiac surgical intensive care units (CSU). We thus sought to derive and validate a clinical decision rule to predict patients at high risk of prolonged ventilation, so that the timing of operations on high risk patients can be optimised in the context of the workload of the CSU. The North Staffordshire Royal Infirmary (NSRI) Open Heart Registry was analysed from April 1998 to May 2002. Prolonged ventilation was defined as that which was longer than 24 h. The Parsonnet score was assessed for its ability to predict these patients. Univariate analysis was first performed to identify predictive variables. Recursive partitioning and logistic regression was then performed to identify the optimal decision rule. This rule was then validated on the Blackpool Victoria Hospital (BVH) Open Heart Registry. A total of 3,070 patients were analysed of whom 201 were ventilated for more than 24 h. A Parsonnet score of 10 predicted 49% of high risk patients but 618 low risk patients are misclassified. Our rule that uses Parsonnet score over 7, ejection fraction, operation status, PA pressure and age, to identify high risk patients identifies 50% of those needing prolonged ventilation and only incorrectly identifies 282 of the 2869 patients with normal ventilation times giving a specificity of over 90%. Validation in the BVH database demonstrated similar findings. Our rule identifies 14% of all our patients as high risk and 50% of these required prolonged ventilation. Such a rule allows more efficient use of scarce CSU resources by appropriate surgical scheduling.

  12. Use of data mining techniques to determine and predict length of stay of cardiac patients.

    Science.gov (United States)

    Hachesu, Peyman Rezaei; Ahmadi, Maryam; Alizadeh, Somayyeh; Sadoughi, Farahnaz

    2013-06-01

    Predicting the length of stay (LOS) of patients in a hospital is important in providing them with better services and higher satisfaction, as well as helping the hospital management plan and managing hospital resources as meticulously as possible. We propose applying data mining techniques to extract useful knowledge and draw an accurate model to predict the LOS of heart patients. Data were collected from patients with coronary artery disease (CAD). The patient records of 4,948 patients who had suffered CAD were included in the analysis. The techniques used are classification with three algorithms, namely, decision tree, support vector machines (SVM), and artificial neural network (ANN). LOS is the target variable, and 36 input variables are used for prediction. A confusion matrix was obtained to calculate sensitivity, specificity, and accuracy. The overall accuracy of SVM was 96.4% in the training set. Most single patients (64.3%) had an LOS ≤5 days, whereas 41.2% of married patients had an LOS >10 days. Moreover, the study showed that comorbidity states, such as lung disorders and hemorrhage with drug consumption have an impact on long LOS. The presence of comorbidities, an ejection fraction <2, being a current smoker, and having social security type insurance in coronary artery patients led to longer LOS than other subjects. All three algorithms are able to predict LOS with various degrees of accuracy. The findings demonstrated that the SVM was the best fit. There was a significant tendency for LOS to be longer in patients with lung or respiratory disorders and high blood pressure.

  13. Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients.

    Science.gov (United States)

    Takahashi, Hiroshi; Ito, Yasuhiko; Ishii, Hideki; Aoyama, Toru; Kamoi, Daisuke; Kasuga, Hirotake; Yasuda, Kaoru; Maruyama, Shoichi; Matsuo, Seiichi; Murohara, Toyoaki; Yuzawa, Yukio

    2014-07-01

    Cardiovascular disease (CVD) is a leading cause of death in end-stage renal disease (ESRD) patients. Protein-energy wasting (PEW) or malnutrition is common in this population, and is associated with increasing risk of mortality. The geriatric nutritional risk index (GNRI) has been developed as a tool to assess the nutritional risk, and is associated with mortality not only in elderly patients but also in ESRD patients. However, whether the GNRI could predict the mortality due to CVD remains unclear in this population. We investigated the prognostic value of GNRI at initiation of hemodialysis (HD) therapy for CVD mortality in a large cohort of ESRD patients. Serum albumin, body weight, and height for calculating GNRI were measured in 1568 ESRD patients. Thereafter, the patients were divided into quartiles according to GNRI levels [quartile 1 (Q1): 97.3], and were followed up for up to 10 years. GNRI levels independently correlated with serum C-reactive-protein levels (β = -0.126, p index was also greater in an established CVD risk model with GNRI (0.749) compared to that with albumin (0.730), body mass index (0.732), and alone (0.710). Similar results were observed for all-cause mortality. GNRI at initiation of HD therapy could predict CVD mortality with incremental value of the predictability compared to serum albumin and body mass index in ESRD patients. Copyright © 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  14. The Prediction of Deterioration of Nutritional Status during Chemoradiation Therapy in Patients with Esophageal Cancer.

    Science.gov (United States)

    Rietveld, Sofia C M; Witvliet-van Nierop, Jill E; Ottens-Oussoren, Karen; van der Peet, Donald L; de van der Schueren, Marian A E

    2018-01-01

    Patients with esophageal cancer are at high risk of developing malnutrition during neoadjuvant chemoradiation therapy (CRT), which in turn is associated with postoperative morbidity. The aim of the study is to explore whether parameters of a complete pre-treatment nutritional status may predict deterioration of nutritional status during CRT in patients with esophageal cancer. In this prospective cohort study, 101 patients with esophageal cancer treated with CRT were included. Data of patient characteristics, tumor classification, performance score, %weight change, body mass index, fat (free) mass index, phase angle, handgrip strength, energy- and protein intake, and use of (additional) dietary supplements were collected. A prediction model was constructed to identify predictive parameters for deterioration in nutritional status (defined as weight loss of >5% and/or decline in fat free mass of ≥1.4 kg) during CRT. Nutritional status deteriorated in 49 patients (49%) during CRT. The only predictor for deterioration in nutritional status was fat free mass index (OR 1.21 (90% CI: 1.03 - 1.42)). Patients with a higher fat free mass index are at increased risk of deterioration in nutrition status during CRT. Results suggest that all patients should be carefully supervised during CRT, regardless of their nutritional status before start of CRT.

  15. A Predictive Model for Readmissions Among Medicare Patients in a California Hospital.

    Science.gov (United States)

    Duncan, Ian; Huynh, Nhan

    2017-11-17

    Predictive models for hospital readmission rates are in high demand because of the Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP). The LACE index is one of the most popular predictive tools among hospitals in the United States. The LACE index is a simple tool with 4 parameters: Length of stay, Acuity of admission, Comorbidity, and Emergency visits in the previous 6 months. The authors applied logistic regression to develop a predictive model for a medium-sized not-for-profit community hospital in California using patient-level data with more specific patient information (including 13 explanatory variables). Specifically, the logistic regression is applied to 2 populations: a general population including all patients and the specific group of patients targeted by the CMS penalty (characterized as ages 65 or older with select conditions). The 2 resulting logistic regression models have a higher sensitivity rate compared to the sensitivity of the LACE index. The C statistic values of the model applied to both populations demonstrate moderate levels of predictive power. The authors also build an economic model to demonstrate the potential financial impact of the use of the model for targeting high-risk patients in a sample hospital and demonstrate that, on balance, whether the hospital gains or loses from reducing readmissions depends on its margin and the extent of its readmission penalties.

  16. Predictive Factors of Postoperative Seizure for Pediatric Patients with Unruptured Arteriovenous Malformations.

    Science.gov (United States)

    Yang, Haibo; Deng, Zhenghai; Yang, Wuyang; Liu, Kai; Yao, Hongxin; Tong, Xianzeng; Wu, Jun; Zhao, Yuanli; Cao, Yong; Wang, Shuo

    2017-09-01

    Seizure is the second-most common presentation in patients with arteriovenous malformations (AVMs) and superimposes a significant burden on pediatric patients. Postoperative seizure risk in unruptured AVMs is underreported in the pediatric AVM literature. We aimed to characterize and identify predictive factors for postoperative seizures in this study. We performed a retrospective review of all surgically treated pediatric patients with unruptured AVM at our institution from 2001 to 2014. Patients younger than 18 years of age were included. Baseline variables was compared against our outcome of interest, which was defined as patients with or without follow-up seizures. Multivariable Cox regression was performed to identify potential predictive factors. The average age of all patients was 13.1 years, and 68.2% were male. Nine patients were asymptomatic (13.6%), and seizure presentation occurred in 57.6% (n = 38). During an average follow-up of 4.2 years, 12 (18.2%) patients experienced postoperative seizures, with 5 (17.9%) of 28 patients with seizures being de novo. In patients with seizure presentation, 81.6% were completely seizure-free throughout follow-up. In multivariable analysis, larger AVM size (hazard ratio [HR] 1.63, P = 0.023) and temporal location (HR 8.35, P = 0.007) were found to increase the risk of follow-up seizures. On the contrary, seizure presentation (HR 1.91, P = 0.369) and postoperative infection (HR 2.37, P = 0.265) were not associated. Surgery may eliminate most seizures with low risk of inducing de novo seizures in pediatric patients with unruptured AVM. Predictive factors for postoperative seizures included large AVM size and temporal location. For selected unruptured AVMs with small size and nontemporal location, consideration of surgery as primary treatment for persistent seizures is a reasonable option. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Decision tree-based learning to predict patient controlled analgesia consumption and readjustment

    Science.gov (United States)

    2012-01-01

    Background Appropriate postoperative pain management contributes to earlier mobilization, shorter hospitalization, and reduced cost. The under treatment of pain may impede short-term recovery and have a detrimental long-term effect on health. This study focuses on Patient Controlled Analgesia (PCA), which is a delivery system for pain medication. This study proposes and demonstrates how to use machine learning and data mining techniques to predict analgesic requirements and PCA readjustment. Methods The sample in this study included 1099 patients. Every patient was described by 280 attributes, including the class attribute. In addition to commonly studied demographic and physiological factors, this study emphasizes attributes related to PCA. We used decision tree-based learning algorithms to predict analgesic consumption and PCA control readjustment based on the first few hours of PCA medications. We also developed a nearest neighbor-based data cleaning method to alleviate the class-imbalance problem in PCA setting readjustment prediction. Results The prediction accuracies of total analgesic consumption (continuous dose and PCA dose) and PCA analgesic requirement (PCA dose only) by an ensemble of decision trees were 80.9% and 73.1%, respectively. Decision tree-based learning outperformed Artificial Neural Network, Support Vector Machine, Random Forest, Rotation Forest, and Naïve Bayesian classifiers in analgesic consumption prediction. The proposed data cleaning method improved the performance of every learning method in this study of PCA setting readjustment prediction. Comparative analysis identified the informative attributes from the data mining models and compared them with the correlates of analgesic requirement reported in previous works. Conclusion This study presents a real-world application of data mining to anesthesiology. Unlike previous research, this study considers a wider variety of predictive factors, including PCA demands over time. We analyzed

  18. Prospective prediction of resistance to neoadjuvant therapy in patients with locoregional esophageal adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Rosen DG

    2015-02-01

    Full Text Available Daniel G Rosen,1 Weiwei Shan,2 Natalie Lassen,2 Clare Johnson,2 Kristen Oelschlager,2 Yaeli Bierman-Harrar,1 Kenneth A Kesler,3 Derek Maetzold,2 Sunil Badve,3 Robert W Cook,2 Romil Saxena3 1Baylor College of Medicine, Houston TX, USA; 2Castle Biosciences, Incorporated, Friendswood, TX, USA; 3Indiana University, Indianapolis, IN, USA Background: To clinically validate a multianalyte algorithmic immunohistochemistry (IHC assay that has been previously shown to accurately identify patients with locoregional esophageal adenocarcinoma (EC who will exhibit extreme resistance to neoadjuvant chemoradiotherapy. Methods: Archived biopsy specimens of EC were subject to IHC examination of compartmentalized immunoreactivity of nuclear factor kappa B (NF-κB, Sonic Hedgehog (SHH, and GLI family zinc finger 1 (Gli-1, and a labeling index score was assigned to each biomarker. Test prediction was generated by logistic regression predictive modeling, using the labeling index scores for all three analytes from each sample, referring to a validated training set of 167 EC patients. Accuracy of the test was determined by comparing the predicted outcomes with pathologically determined College of American Pathologists tumor response grade. Analytical validity of the test was measured by comparing validation set prediction results obtained in two independent Clinical Laboratory Improvement Amendment-certified laboratories, and by measuring concordance between two trained labeling index readers. Results: Specimens from 64 patients that met specific criteria were collected. No technical failure was encountered during the IHC labeling procedures. The logistic regression algorithm generated an area under the curve of 0.96 and 0.85 for the 64 sample cohort in two independent clinical laboratories, respectively, comparing predictive results with the established training set. Positive predictive values of 88% and 82% were also achieved in each laboratory, respectively. A

  19. A predictive model of inflammatory markers and patient-reported symptoms for cachexia in newly diagnosed pancreatic cancer patients.

    Science.gov (United States)

    Fogelman, David R; Morris, J; Xiao, L; Hassan, M; Vadhan, S; Overman, M; Javle, S; Shroff, R; Varadhachary, G; Wolff, R; Vence, L; Maitra, A; Cleeland, C; Wang, X S

    2017-06-01

    Cachexia is a frequent manifestation of pancreatic cancer, can limit a patient's ability to take chemotherapy, and is associated with shortened survival. We developed a model to predict the early onset of cachexia in advanced pancreatic cancer patients. Patients with newly diagnosed, untreated metastatic or locally advanced pancreatic cancer were included. Serum cytokines were drawn prior to therapy. Patient symptoms were recorded using the M.D. Anderson Symptom Inventory (MDASI). Our primary endpoint was either 10% weight loss or death within 60 days of the start of therapy. Twenty-seven of 89 patients met the primary endpoint (either having lost 10% of body weight or having died within 60 days of the start of treatment). In a univariate analysis, smoking, history symptoms of pain and difficulty swallowing, high levels of MK, CXCL-16, IL-6, TNF-a, and low IL-1b all correlated with this endpoint. We used recursive partition to fit a regression tree model, selecting four of 26 variables (CXCL-16, IL-1b, pain, swallowing difficulty) as important in predicting cachexia. From these, a model of two cytokines (CXCL-16 > 5.135 ng/ml and IL-1b Cachexia is frequent in pancreatic cancer; one in three patients met our endpoint of 10% weight loss or death within 60 days. Inflammatory cytokines are better than conventional tumor markers at predicting this outcome. Recursive partitioning analysis suggests that a model of CXCL-16 and IL-1B may offer a better ability than individual cytokines to predict this outcome.

  20. Prediction

    CERN Document Server

    Sornette, Didier

    2010-01-01

    This chapter first presents a rather personal view of some different aspects of predictability, going in crescendo from simple linear systems to high-dimensional nonlinear systems with stochastic forcing, which exhibit emergent properties such as phase transitions and regime shifts. Then, a detailed correspondence between the phenomenology of earthquakes, financial crashes and epileptic seizures is offered. The presented statistical evidence provides the substance of a general phase diagram for understanding the many facets of the spatio-temporal organization of these systems. A key insight is to organize the evidence and mechanisms in terms of two summarizing measures: (i) amplitude of disorder or heterogeneity in the system and (ii) level of coupling or interaction strength among the system's components. On the basis of the recently identified remarkable correspondence between earthquakes and seizures, we present detailed information on a class of stochastic point processes that has been found to be particu...

  1. Decreased phenotypic susceptibility to etravirine in patients with predicted genotypic sensitivity.

    Directory of Open Access Journals (Sweden)

    Eva Agneskog

    Full Text Available BACKGROUND: A sensitive, phenotypic reverse transcriptase (RT-based drug susceptibility assay for the detection of etravirine (ETR resistance in patient isolates was developed and compared with the results from direct sequencing and ultra-deep pyrosequencing (UDPS. METHODS: Samples were obtained from 15 patients with antiretroviral therapy (ART failure and from five non-nucleoside reverse transcriptase inhibitor (NNRTI-naïve patients of whom four were infected by an NNRTI-resistant strain (transmitted drug resistance, TDR. In five patients, two consecutive samples (a and b were taken for follow up of the virological response. HIV-1 RT was purified and drug susceptibility (IC50 to ETR was estimated. Direct sequencing was performed in all samples and UDPS in samples from nine patients. RESULTS: Increased IC50 to ETR was found in samples from 13 patients where direct sequencing predicted resistance in only four. UDPS identified additional (N = 11 NNRTI resistance associated mutations (RAMs in six of nine tested patients. During early failure, IC50 increases were observed in three of six patients without any ETR-RAMs detected by direct sequencing. In further two patients, who stopped NNRTI before sampling, increased IC50 values were found shortly after, despite absence of ETR-RAMs. In two patients who had stopped NNRTI for >1 year, a concordance between phenotype and genotypes was found. Two patients with TDR had increased IC50 despite no ETR-RAMs were detected by direct sequencing. UDPS revealed additional ETR-RAMs in four patients with a discrepancy between phenotype and direct sequencing. CONCLUSIONS: The RT-based phenotypic assay showed decreased ETR susceptibility in patients where direct sequencing predicted ETR-sensitive virus. This increased phenotypic sensitivity was to a large extent supported by UDPS and treatment history. Our method could be valuable for further studies on the phenotypic kinetics of NNRTI resistance. The clinical

  2. Current psychiatric disorders in patients with epilepsy are predicted by maltreatment experiences during childhood.

    Science.gov (United States)

    Labudda, Kirsten; Illies, Dominik; Herzig, Cornelia; Schröder, Katharina; Bien, Christian G; Neuner, Frank

    2017-09-01

    Childhood maltreatment has been shown to be a risk factor for the development of psychiatric disorders. Although the prevalence of psychiatric disorders is high in epilepsy patients, it is unknown if childhood maltreatment experiences are elevated compared to the normal population and if early maltreatment is a risk factor for current psychiatric comorbidities in epilepsy patients. This is the main purpose of this study. Structured interviews were used to assess current Axis I diagnoses in 120 epilepsy patients from a tertiary Epilepsy Center (34 TLE patients, 86 non-TLE patients). Childhood maltreatment in the family and peer victimization were assessed with validated questionnaires. Patients' maltreatment scores were compared with those of a representative matched control group. Logistic regression analysis was conducted to assess the potential impact of childhood maltreatment on current psychiatric comorbidity in epilepsy patients. Compared to a matched control group, epilepsy patients had higher emotional and sexual maltreatment scores. Patients with a current psychiatric diagnosis reported more family and peer maltreatment than patients without a psychiatric disorder. Family maltreatment scores predicted the likelihood of a current psychiatric disorder. TLE patients did not differ from non-TLE patients according to maltreatment experiences and rates of current psychiatric disorders. Our findings suggest that in epilepsy patients emotional and sexual childhood maltreatment is experienced more often than in the normal population and that early maltreatment is a general risk factor for psychiatric comorbidities in this group. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Spectroscopic analysis of embryo culture media for predicting reproductive potential in patients undergoing in vitro fertilization.

    Science.gov (United States)

    Baştu, Ercan; Parlatan, Uğur; Başar, Günay; Yumru, Harika; Bavili, Nima; Sağ, Fatih; Bulgurcuoğlu, Sibel; Buyru, Faruk

    2017-09-01

    To predict the reproductive potential of embryos via Raman spectroscopy evaluation of the spent culture media as well as with a conventional morphologic evaluation. Women of reproductive age (n=31) who were treated for unexplained infertility and scheduled for single embryo transfer were invited to participate in this prospective study. After the embryos were removed from the culture, the spent culture media were stored at -80 °C after snap-freezing in liquid nitrogen. Fifteen patients were clinically pregnant, and 16 patients were clinically non-pregnant. Clinical pregnancy was predicted using Raman spectroscopy in 93% (14/15) of clinically pregnant patients, and in 62.5% (10 out of 16) of clinically non-pregnant patients. The sensitivity of the Raman spectroscopic analysis was 93% and the specificity was 62.5%. Metabolomic evaluation of spent embryo culture media is an emerging technique with promising objective results. However, there is clearly room for improvement.

  4. Voxel-Based Dose Prediction with Multi-Patient Atlas Selection for Automated Radiotherapy Treatment Planning

    CERN Document Server

    McIntosh, Chris

    2016-01-01

    Automating the radiotherapy treatment planning process is a technically challenging problem. The majority of automated approaches have focused on customizing and inferring dose volume objectives to used in plan optimization. In this work we outline a multi-patient atlas-based dose prediction approach that learns to predict the dose-per-voxel for a novel patient directly from the computed tomography (CT) planning scan without the requirement of specifying any objectives. Our method learns to automatically select the most effective atlases for a novel patient, and then map the dose from those atlases onto the novel patient. We extend our previous work to include a conditional random field for the optimization of a joint distribution prior that matches the complementary goals of an accurately spatially distributed dose distribution while still adhering to the desired dose volume histograms. The resulting distribution can then be used for inverse-planning with a new spatial dose objective, or to create typical do...

  5. Mortality Prediction Model of Septic Shock Patients Based on Routinely Recorded Data

    Directory of Open Access Journals (Sweden)

    Marta Carrara

    2015-01-01

    Full Text Available We studied the problem of mortality prediction in two datasets, the first composed of 23 septic shock patients and the second composed of 73 septic subjects selected from the public database MIMIC-II. For each patient we derived hemodynamic variables, laboratory results, and clinical information of the first 48 hours after shock onset and we performed univariate and multivariate analyses to predict mortality in the following 7 days. The results show interesting features that individually identify significant differences between survivors and nonsurvivors and features which gain importance only when considered together with the others in a multivariate regression model. This preliminary study on two small septic shock populations represents a novel contribution towards new personalized models for an integration of multiparameter patient information to improve critical care management of shock patients.

  6. Predictive value of NGAL for use of renal replacement therapy in patients with severe sepsis

    DEFF Research Database (Denmark)

    Hjortrup, P B; Haase, N; Treschow, F

    2015-01-01

    BACKGROUND: The predictive value of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) for use of renal replacement therapy (RRT) and acute kidney injury (AKI) is not established in patients with severe sepsis. METHODS: This was a prospective observational study in three general...... intensive care units (ICUs) in adult ICU patients with severe sepsis needing fluid resuscitation and a sub-study of the 6S trial. Plasma and urine were sampled at baseline and NGAL was measured using particle-enhanced turbidimetric immunoassay (The NGAL Test). Outcome measures were use of RRT in ICU......%) had RRT in the ICU, 91 patients had AKI at enrollment; of the remaining 131 patients 24% developed AKI during the first 48 h, and 55% had died at 90 days. Areas under receiver-operating characteristics curve (AuROC) for predicting use of RRT in ICU were 0.70 (95% confidence interval 0.61-0.78) and 0...

  7. Fear of cancer recurrence and its predictive factors among Iranian cancer patients

    Directory of Open Access Journals (Sweden)

    Alireza Mohajjel Aghdam

    2014-01-01

    Full Text Available Context: Fear of cancer recurrence (FOCR is one of the most important psychological problems among cancer patients. In extensive review of related literature there were no articles on FOCR among Iranian cancer patients. Aim: The aim of present study was to investigation FOCR and its predictive factors among Iranian cancer patients. Materials and Methods: In this descriptive-correlational study 129 cancer patients participated. For data collection, the demographic checklist and short form of fear of progression questionnaire was used. Logistic regression was used to determine predictive factors of FOCR. Result: Mean score of FOCR among participants was 44.8 and about 50% of them had high level of FOCR. The most important worries of participants were about their family and the future of their children and their lesser worries were about the physical symptoms and fear of physical damage because of cancer treatments. Also, women, breast cancer patient, and patients with lower level of education have more FOCR. Discussion: There is immediate need for supportive care program designed for Iranian cancer patients aimed at decreasing their FOCR. Especially, breast cancer patients and the patient with low educational level need more attention.

  8. [Prevalence and prediction of significant coronary artery lesions in patients with valvular heart diseases requiring surgery].

    Science.gov (United States)

    Radu, Rodica; Lucaci, L; Arsenescu-Georgescu, Cătălina

    2010-01-01

    First to estimate the prevalence of significant coronary artery narrowings in patients suffering from valvular heart diseases requiring surgery and second to assess the parameters able to predict significant coronary stenoses in those patients. Retrospective study of a group consisting of 92 patients (29 female, 63 male, mean age 61 +/- 7.15 years) with coronary angiography carried out before surgical valve correction. Patients having ischemia-related mitral regurgitation were excluded from the study. Significant coronary artery stenosis was defined as a luminal narrowing of an epicardial artery of at least 50%. Anginal pain and cardiovascular risk factors were ascertained therewith. Significant coronary artery stenoses were found in 24% of all patient enrolled in the study, their prevalence in the subgroup with aortic valve disease (alone or associated with mitral valve disease) and in the subgroup with isolated mitral valve disease being similar (31.8% vs. 21.4%, p = 0.2). The anginal chest pain, increased waist circumference and a host of at least 3 conventional cardiovascular risk factors were the elements best correlated with the presence of significant coronary narrowings. Both Romanian patients and patients from industrialized countries afflicted with valvular heart diseases have similar prevalence of coronary heart disease. The prevalence tends to increase in patients with abdominal obesity and in those with many risk factors, diabetes mellitus being the most frequently encountered traditional risk factor. Renal function impairment might represent a predictive marker for coronary heart disease in valvular patients.

  9. Baseline hepatitis B surface antigen quantitation can predict virologic response in entecavir-treated chronic hepatitis B patients

    Directory of Open Access Journals (Sweden)

    Chia-Chi Wang

    2014-11-01

    Conclusion: The baseline serum qHBsAg level can predict virologic response in entecavir-treated CHB patients. However, a significant decline in the qHBsAg level cannot predict serologic or virologic response of entecavir treatment.

  10. Preoperative PROMIS Scores Predict Postoperative Success in Foot and Ankle Patients.

    Science.gov (United States)

    Ho, Bryant; Houck, Jeff R; Flemister, Adolph S; Ketz, John; Oh, Irvin; DiGiovanni, Benedict F; Baumhauer, Judith F

    2016-09-01

    The use of patient-reported outcomes continues to expand beyond the scope of clinical research to involve standard of care assessments across orthopedic practices. It is currently unclear how to interpret and apply this information in the daily care of patients in a foot and ankle clinic. We prospectively examined the relationship between preoperative patient-reported outcomes (PROMIS Physical Function, Pain Interference and Depression scores), determined minimal clinical important differences for these values, and assessed if these preoperative values were predictors of improvement after operative intervention. Prospective collection of all consecutive patient visits to a multisurgeon tertiary foot and ankle clinic was obtained between February 2015 and April 2016. This consisted of 16 023 unique visits across 7996 patients, with 3611 new patients. Patients undergoing elective operative intervention were identified by ICD-9 and CPT code. PROMIS physical function, pain interference, and depression scores were assessed at initial and follow-up visits. Minimum clinically important differences (MCIDs) were calculated using a distribution-based method. Receiver operating characteristic (ROC) curves were calculated to determine whether preoperative PROMIS scores were predictive of achieving MCID. Cutoff values for PROMIS scores that would predict achieving MCID and not achieving MCID with 95% specificity were determined. Prognostic pre- and posttest probabilities based off these cutoffs were calculated. Patients with a minimum of 7-month follow-up (mean 9.9) who completed all PROMIS domains were included, resulting in 61 patients. ROC curves demonstrated that preoperative physical function scores were predictive of postoperative improvement in physical function (area under the curve [AUC] 0.83). Similarly, preoperative pain interference scores were predictive of postoperative pain improvement (AUC 0.73) and preoperative depression scores were also predictive of

  11. Predictive Factors for Hospitalization of Patients with Heat Illness in Yamaguchi, Japan

    OpenAIRE

    Takahiro Yamamoto; Masaki Todani; Yasutaka Oda; Tadashi Kaneko; Kotaro Kaneda; Motoki Fujita; Takashi Miyauchi; Ryosuke Tsuruta

    2015-01-01

    The objective of the study was to investigate the predictive factors for the hospitalization of patients who presented with mild to moderate heat illness at an emergency department. We conducted a retrospective survey of hospitals with an emergency department in Yamaguchi Prefecture, Japan. The survey questionnaire entries included patient age, sex, use of an ambulance, vital signs, blood examination conducted at the emergency department, the length of hospitalization, and outcome. We analyz...

  12. Oxygen Uptake Efficiency Slope Predicts Poor Outcome in Patients With Idiopathic Pulmonary Arterial Hypertension.

    Science.gov (United States)

    Tang, Yi; Luo, Qin; Liu, Zhihong; Ma, Xiuping; Zhao, Zhihui; Huang, Zhiwei; Gao, Liu; Jin, Qi; Xiong, Changming; Ni, Xinhai

    2017-06-30

    Few published studies have evaluated the power of the oxygen uptake efficiency slope (OUES) to predict outcomes in patients with idiopathic pulmonary arterial hypertension (IPAH), who typically die of right-sided heart failure. Our study sought to evaluate the power of OUES to predict clinical worsening and mortality in patients with IPAH. Patients with newly diagnosed IPAH who underwent symptom-limited cardiopulmonary exercise testing from November 11, 2010, to June 25, 2015, in our hospital were prospectively enrolled and followed for up to 66 months. Clinical worsening and mortality were recorded. A total of 210 patients with IPAH (159 women; mean age, 32±10 years) were studied with a median follow-up of 41 months. Thirty-one patients died, 1 patient underwent lung transplantation, and 85 patients presented with clinical worsening. The univariate analysis revealed that OUES, OUESI (OUESI=OUES/body surface area), peak oxygen uptake (V˙O2), peak V˙O2/kg, ventilation (V˙E)/carbon dioxide output (V˙CO2) slope, peak systolic blood pressure, heart rate recovery, pulmonary vascular resistance, cardiac index, N-terminal prohormone brain natriuretic peptide, and World Health Organization functional class were all predictive of clinical worsening and mortality (all P0.52 m-2 (41.9% versus 89.8%, P<0.0001). The OUES, a submaximal parameter obtained from cardiopulmonary exercise testing, provides prognostic information for predicting clinical worsening and mortality in patients with IPAH. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  13. Can available mathematical models predict serum digoxin levels in Thai patients?

    Science.gov (United States)

    Jiratham-Opas, J; Kanjanavanit, R; Wongcharoen, W; Punyawudho, B; Arunmanakul, P; Amaritakomol, A; Topaiboon, P; Gunaparn, S; Phrommintikul, A

    2018-01-24

    Digoxin is commonly prescribed for heart failure patients with reduced ejection fraction (HFrEF) and patients with atrial fibrillation (AF). Due to digoxin's narrow therapeutic range, monitoring the serum digoxin concentration (SDC) is important. However, the SDC measurement is not widely available. Equations using clinical parameters can be employed to estimate the SDC but have never been studied in the Thai population. Therefore, we conducted this study to evaluate the correlation between the measured SDC and predicted digoxin level using 2 commonly used equations: the Konishi equation and the Koup and Jusko equation. This report describes prospective, cross-sectional study conducted at Chiang Mai University. One hundred and fourteen patients were recruited in the study. All of the patients were diagnosed as having HFrEF, AF or both and had been receiving digoxin for at least 4 weeks. The SDC of each patient was measured at steady state and assigned to one of 3 groups according to the classifications of the Digitalis Investigation Group (DIG) trial: in the therapeutic range, over the therapeutic range and in the suboptimal range. There were significant correlations between the measured and predicted SDCs using both the Konishi equation and the Koup and Jusko equation, which had correlation coefficients (R) of 0.69 and 0.31 (P SDC that was over the therapeutic range. None of the readmitted patients had ventricular arrhythmia. The Konishi equation yielded better predictions of the SDC, especially in the subgroup of HFrEF patients. Furthermore, the prediction of SDCs in the over the therapeutic range using this equation was superior to that of the Koup and Jusko equation. With further validation in a larger population, this equation should facilitate the detection of patients who are over the therapeutic range in clinical practice. © 2018 John Wiley & Sons Ltd.

  14. Black Hole Sign Predicts Poor Outcome in Patients with Intracerebral Hemorrhage.

    Science.gov (United States)

    Li, Qi; Yang, Wen-Song; Chen, Sheng-Li; Lv, Fu-Rong; Lv, Fa-Jin; Hu, Xi; Zhu, Dan; Cao, Du; Wang, Xing-Chen; Li, Rui; Yuan, Liang; Qin, Xin-Yue; Xie, Peng

    2018-01-10

    In spontaneous intracerebral hemorrhage (ICH), black hole sign has been proposed as a promising imaging marker that predicts hematoma expansion in patients with ICH. The aim of our study was to investigate whether admission CT black hole sign predicts hematoma growth in patients with ICH. From July 2011 till February 2016, patients with spontaneous ICH who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan were recruited into the study. The presence of black hole sign on admission non-enhanced CT was independently assessed by 2 readers. The functional outcome was assessed using the modified Rankin Scale (mRS) at 90 days. Univariate and multivariable logistic regression analyses were performed to assess the association between the presence of the black hole sign and functional outcome. A total of 225 patients (67.6% male, mean age 60.3 years) were included in our study. Black hole sign was identified in 32 of 225 (14.2%) patients on admission CT scan. The multivariate logistic regression analysis demonstrated that age, intraventricular hemorrhage, baseline ICH volume, admission Glasgow Coma Scale score, and presence of black hole sign on baseline CT independently predict poor functional outcome at 90 days. There are significantly more patients with a poor functional outcome (defined as mRS ≥4) among patients with black hole sign than those without (84.4 vs. 32.1%, p black hole sign independently predicts poor outcome in patients with ICH. Early identification of black hole sign is useful in prognostic stratification and may serve as a potential therapeutic target for anti-expansion clinical trials. © 2018 S. Karger AG, Basel.

  15. The prediction of difficult intubation in obese patients using mirror indirect laryngoscopy: A prospective pilot study

    Directory of Open Access Journals (Sweden)

    Arne O Budde

    2013-01-01

    Full Text Available Background: The incidence of difficult laryngoscopy and intubation in obese patients is higher than in the general population. Classical predictors of difficult laryngoscopy and intubation have been shown to be unreliable. We prospectively evaluated indirect mirror laryngoscopy as a predictor of difficult laryngoscopy in obese patients. Materials and Methods: 60 patients with a body mass index (BMI greater than 30, scheduled to undergo general anesthesia, were enrolled. Indirect mirror laryngoscopy was performed and was graded 1-4 according to Cormack and Lehane. A view of grade 3-4 was classified as predicting difficult laryngoscopy. Additional assessments for comparison were the Samsoon and Young modification of the Mallampati airway classification, Wilson Risk Sum Score, neck circumference, and BMI. The view obtained upon direct laryngoscopy after induction of general anesthesia was classified according to Cormack and Lehane as grade 1-4. Results: Sixty patients met the inclusion criteria; however, 8 (13.3% patients had an excessive gag reflex, and examination of the larynx was not possible. 15.4% of patients who underwent direct laryngoscopy had a Cormack and Lehane grade 3 or 4 view and were classified as difficult. Mirror laryngoscopy had a tendency toward statistical significance in predicting difficult laryngoscopy in these patients. Conclusions: This study is consistent with previous studies, which have demonstrated that no one individual traditional test has proven to be adequate in predicting difficult airways in the obese population. However, the new application of an old test - indirect mirror laryngoscopy - could be a useful additional test to predict difficult laryngoscopy in obese patients.

  16. Predictive score of uncomplicated falciparum malaria patients turning to severe malaria

    OpenAIRE

    Tangpukdee, Noppadon; Krudsood, Srivicha; Thanachartwet, Vipa; Duangdee, Chatnapa; Paksala, Siriphan; Chonsawat, Putza; Srivilairit, Siripan; Looareesuwan, Sornchai; Wilairatana, Polrat

    2007-01-01

    In acute uncomplicated falciparum malaria, there is a continuum from mild to severe malaria. However, no mathematical system is available to predict uncomplicated falciparum malaria patients turning to severe malaria. This study aimed to devise a simple and reliable model of Malaria Severity Prognostic Score (MSPS). The study was performed in adult patients with acute uncomplicated falciparum malaria admitted to the Bangkok Hospital for Tropical Diseases between 2000 and 2005. Total 38 initia...

  17. Dubious decision evidence and criterion flexibility in recognition memory

    Directory of Open Access Journals (Sweden)

    Justin eKantner

    2015-09-01

    Full Text Available When old-new recognition judgments must be based on ambiguous memory evidence, a proper criterion for responding old can substantially improve accuracy, but participants are typically suboptimal in their placement of decision criteria. Various accounts of suboptimal criterion placement have been proposed. The most parsimonious, however, is that subjects simply over-rely on memory evidence – however faulty – as a basis for decisions. We tested this account with a novel recognition paradigm in which old-new discrimination was minimal and critical errors were avoided by adopting highly liberal or conservative biases. In Experiment 1, criterion shifts were necessary to adapt to changing target probabilities or, in a security patrol scenario, to avoid either letting dangerous people go free (misses or harming innocent people (false alarms. Experiment 2 added a condition in which financial incentives drove criterion shifts. Critical errors were frequent, similar across sources of motivation, and only moderately reduced by feedback. In Experiment 3, critical errors were only modestly reduced in a version of the security patrol with no study phase. These findings indicate that participants use even transparently non-probative information as an alternative to heavy reliance on a decision rule, a strategy that precludes optimal criterion placement.

  18. Contribution of temporal data to predictive performance in 30-day readmission of morbidly obese patients

    Directory of Open Access Journals (Sweden)

    Petra Povalej Brzan

    2017-04-01

    Full Text Available Background Reduction of readmissions after discharge represents an important challenge for many hospitals and has attracted the interest of many researchers in the past few years. Most of the studies in this field focus on building cross-sectional predictive models that aim to predict the occurrence of readmission within 30-days based on information from the current hospitalization. The aim of this study is demonstration of predictive performance gain obtained by inclusion of information from historical hospitalization records among morbidly obese patients. Methods The California Statewide inpatient database was used to build regularized logistic regression models for prediction of readmission in morbidly obese patients (n = 18,881. Temporal features were extracted from historical patient hospitalization records in a one-year timeframe. Five different datasets of patients were prepared based on the number of available hospitalizations per patient. Sample size of the five datasets ranged from 4,787 patients with more than five hospitalizations to 20,521 patients with at least two hospitalization records in one year. A 10-fold cross validation was repeted 100 times to assess the variability of the results. Additionally, random forest and extreme gradient boosting were used to confirm the results. Results Area under the ROC curve increased significantly when including information from up to three historical records on all datasets. The inclusion of more than three historical records was not efficient. Similar results can be observed for Brier score and PPV value. The number of selected predictors corresponded to the complexity of the dataset ranging from an average of 29.50 selected features on the smallest dataset to 184.96 on the largest dataset based on 100 repetitions of 10-fold cross-validation. Discussion The results show positive influence of adding information from historical hospitalization records on predictive performance using all

  19. LUPUS ANTICOAGULANT, BUT NOT ANTICARDIOLIPIN ANTIBODY, PREDICTS ADVERSE PREGNANCY OUTCOME IN PATIENTS WITH ANTIPHOSPHOLIPID ANTIBODIES

    Science.gov (United States)

    Lockshin, Michael D.; Kim, Mimi; Laskin, Carl A.; Guerra, Marta; Branch, D. Ware; Merrill, Joan; Petri, Michelle; Porter, Flint; Sammaritano, Lisa; Stephenson, Mary D.; Buyon, Jill; Salmon, Jane E.

    2012-01-01

    BACKGROUND Which serologic and clinical findings predict adverse pregnancy outcome (APO) in patients with antiphospholipid antibody (aPL) is controversial. METHODS PROMISSE is a multicenter, prospective observational study of risk factors for APO in patients with aPL (lupus anticoagulant [LAC], anticardiolipin antibody [aCL] and/or antibody to β2 glycoprotein I [anti-β2-GP-I]). We tested the hypothesis that a pattern of clinical and serological variables can identify women at highest risk for APO. RESULTS Between 2003 and 2011 we enrolled 144 pregnant patients, of whom 28 had APO. Thirty-nine percent of patients with LAC had APO, compared to 3% who did not have LAC (p aCL ≥40 u/mL but not LAC suffered APO, compared to 43% of those with LAC (p = 0.002). IgM aCL or IgG or IgM anti-β2-GP-I did not predict APO. In bivariate analysis, APO occurred in 52% of patients with and 13% of patients without prior thrombosis (p = 0.00005), and in 23% with SLE compared to 17% without SLE (not significant); SLE was a predictor in multivariate analysis. Prior pregnancy loss did not predict APO, nor did maternal race. Simultaneous aCL, anti-β2-GP-I, and LAC did not predict APO better than did LAC alone. CONCLUSIONS LAC is the primary predictor of APO after 12 weeks gestation in aPL-associated pregnancies. ACL and anti-β2-GP-I, if LAC is not also present, do not predict APO. PMID:22275304

  20. Clinical Decision Support Model to Predict Occlusal Force in Bruxism Patients.

    Science.gov (United States)

    Thanathornwong, Bhornsawan; Suebnukarn, Siriwan

    2017-10-01

    The aim of this study was to develop a decision support model for the prediction of occlusal force from the size and color of articulating paper markings in bruxism patients. We used the information from the datasets of 30 bruxism patients in which digital measurements of the size and color of articulating paper markings (12-µm Hanel; Coltene/Whaledent GmbH, Langenau, Germany) on canine protected hard stabilization splints were measured in pixels (P) and in red (R), green (G), and blue (B) values using Adobe Photoshop software (Adobe Systems, San Jose, CA, USA). The occlusal force (F) was measured using T-Scan III (Tekscan Inc., South Boston, MA, USA). The multiple regression equation was applied to predict F from the P and RGB. Model evaluation was performed using the datasets from 10 new patients. The patient's occlusal force measured by T-Scan III was used as a 'gold standard' to compare with the occlusal force predicted by the multiple regression model. The results demonstrate that the correlation between the occlusal force and the pixels and RGB of the articulating paper markings was positive (F = 1.62×P + 0.07×R -0.08×G + 0.08×B + 4.74; R 2 = 0.34). There was a high degree of agreement between the occlusal force of the patient measured using T-Scan III and the occlusal force predicted by the model (kappa value = 0.82). The results obtained demonstrate that the multiple regression model can predict the occlusal force using the digital values for the size and color of the articulating paper markings in bruxism patients.

  1. Predicting Mortality of Patients With Sepsis: A Comparison of APACHE II and APACHE III Scoring Systems.

    Science.gov (United States)

    Sadaka, Farid; EthmaneAbouElMaali, Cheikh; Cytron, Margaret A; Fowler, Kimberly; Javaux, Victoria M; O'Brien, Jacklyn

    2017-11-01

    Acute Physiology, Age and Chronic Health Evaluation (APACHE) II and III scores were developed in 1985 and 1991, respectively, and are used mainly for critically ill patients of all disease categories admitted to the intensive care unit (ICU). They differ in how chronic health status is assessed, in the number of physiologic variables included (12 vs. 17), and in the total score. These two scoring systems have not been compared in predicting hospital mortality in patients with sepsis. We retrospectively identified all septic patients admitted to our 54-bed medical-surgical ICU between June 2009 and February 2014 using the APACHE outcomes database. We calculated correlation coefficients for APACHE II and APACHE III scores in predicting hospital mortality. Receiver-operating characteristic (ROC) curves were also used to assess the mortality predictions. We identified a total of 2,054 septic patients. Average APACHE II score was 19 ± 7, and average APACHE III score was 68 ± 28. ICU mortality was 11.8% and hospital mortality was 18.3%. Both APACHE II (r = 0.41) and APACHE III scores (r = 0.44) had good correlations with hospital mortality. There was no statistically significant difference between the two correlations (P = 0.1). ROC area under the curve (AUC) was 0.80 (95% confidence interval (CI): 0.78 - 0.82) for APACHE II, and 0.83 (95% CI: 0.81 - 0.85) for APACHE III, suggesting that both scores have very good discriminative powers for predicting hospital mortality. This study shows that both APACHE II and APACHE III scores in septic patients were very strong predictors of hospital mortality. APACHE II was as good as APACHE III in predicting hospital mortality in septic patients.

  2. Prediction of potential for organ donation after circulatory death in neurocritical patients.

    Science.gov (United States)

    Xu, Guixing; Guo, Zhiyong; Liang, Wenhua; Xin, Erye; Liu, Bin; Xu, Ye; Luan, Zhongqin; Schroder, Paul Michael; Manyalich, Martí; Ko, Dicken Shiu-Chung; He, Xiaoshun

    2018-03-01

    The success or failure of donation after circulatory death depends largely on the functional warm ischemia time, which is closely related to the duration between withdrawal of life-sustaining treatment and circulatory arrest. However, a reliable predictive model for the duration is absent. We aimed to compare the performance of the Chinese Donation after Circulatory Death Nomogram (C-DCD-Nomogram) and 3 other tools in a cohort of potential donors. In this prospective, multicenter, observational study, data were obtained from 219 consecutive neurocritical patients in China. The patients were followed until circulatory death after withdrawal of life-sustaining treatment. The C-DCD-Nomogram performed well in predicting patient death within 30, 60, 120 and 240 minutes after withdrawal of life-sustaining treatment with c-statistics of 0.87, 0.88, 0.86 and 0.95, respectively. The DCD-N score was a poor predictor of death within 30, 60 and 240 minutes, with c-statistics of 0.63, 0.69 and 0.59, respectively, although it was able to predict patient death within 120 minutes, with a c-statistic of 0.73. Neither the University of Wisconsin DCD evaluation tool (UWDCD) nor the United Network for Organ Sharing (UNOS) criteria was able to predict patient death within 30, 60, 120 and 240 minutes after withdrawal of life-sustaining treatment (UWDCD tool: 0.48, 0.45, 0.49 and 0.57; UNOS criteria: 0.50, 0.53, 0.51 and 0.63). The C-DCD-Nomogram is superior to the other 3 tools for predicting death within a limited duration after withdrawal of life-sustaining treatment in Chinese neurocritical patients. Thus, it appears to be a reliable tool identifying potential donors after circulatory death. Copyright © 2018. Published by Elsevier Inc.

  3. Can Mathematical Models Predict the Outcomes of Prostate Cancer Patients Undergoing Intermittent Androgen Deprivation Therapy?

    Science.gov (United States)

    Everett, R. A.; Packer, A. M.; Kuang, Y.

    Androgen deprivation therapy is a common treatment for advanced or metastatic prostate cancer. Like the normal prostate, most tumors depend on androgens for proliferation and survival but often develop treatment resistance. Hormonal treatment causes many undesirable side effects which significantly decrease the quality of life for patients. Intermittently applying androgen deprivation in cycles reduces the total duration with these negative effects and may reduce selective pressure for resistance. We extend an existing model which used measurements of patient testosterone levels to accurately fit measured serum prostate specific antigen (PSA) levels. We test the model's predictive accuracy, using only a subset of the data to find parameter values. The results are compared with those of an existing piecewise linear model which does not use testosterone as an input. Since actual treatment protocol is to re-apply therapy when PSA levels recover beyond some threshold value, we develop a second method for predicting the PSA levels. Based on a small set of data from seven patients, our results showed that the piecewise linear model produced slightly more accurate results while the two predictive methods are comparable. This suggests that a simpler model may be more beneficial for a predictive use compared to a more biologically insightful model, although further research is needed in this field prior to implementing mathematical models as a predictive method in a clinical setting. Nevertheless, both models are an important step in this direction.

  4. Cardiac sympathetic nerve abnormality predicts ventricular tachyarrhythmic events in patients without conventional risk of sudden death

    Energy Technology Data Exchange (ETDEWEB)

    Akutsu, Yasushi; Kaneko, Kyouichi; Kodama, Yusuke; Li, Hui-Ling; Kawamura, Mitsuharu; Asano, Taku; Tanno, Kaoru; Kobayashi, Youichi [Showa University School of Medicine, Division of Cardiology, Department of Medicine, Tokyo (Japan); Shinozuka, Akira; Gokan, Takehiko [Showa University School of Medicine, Department of Radiology, Tokyo (Japan)

    2008-11-15

    Patients with structural heart disease, severe left ventricular dysfunction, or history of cardiac arrest are at increased risk of sudden cardiac death. However, a useful marker for predicting sudden cardiac death is not clarified in low-risk patients without those conventional risks. We hypothesized that cardiac sympathetic nerve system (SNS) abnormality would be associated with ventricular tachyarrhythmic events in low-risk patients with ventricular tachycardia (VT). Iodine-123 metaiodobenzylguanidine ({sup 123}I-MIBG) scintigraphy was performed in 50 patients (mean{+-}standard deviation, age 54 {+-} 16 years, 52% males) with VT who did not have structural heart disease, severe left ventricular dysfunction, or history of cardiac arrest, and SNS activity was assessed from heart/mediastinal (H/M) ratio on delayed images. Over 11 years of follow-up, three patients had sudden deaths (6%) and nine patients had sustained ventricular tachyarrhythmic events (18%). SNS abnormality, defined as H/M ratio <2.8, was predictive of sudden death or ventricular tachyarrhythmic events (45% in nine of 20 patients with SNS abnormality vs 16.7% in three of 30 patients without SNS abnormality, p = 0.005). After adjustment for potential confounding variables including slight left ventricular dysfunction, SNS abnormality remained independently predictive of ventricular tachyarrhythmic events with a hazard ratio of 5.3 (95% confidence interval = 1.4 to 20.8, p = 0.016). SNS abnormality is a readily available and powerful predictor of recurrent ventricular tachyarrhythmic events in patients with VT who did not have conventional risk of sudden cardiac death. {sup 123}I-MIBG scintigraphy can provide prognostic information of VT patients without conventional risk. (orig.)

  5. Predictive Score Card in Lumbar Disc Herniation: Is It Reflective of Patient Surgical Success after Discectomy?

    Directory of Open Access Journals (Sweden)

    Parisa Azimi

    Full Text Available Does the Finneson-Cooper score reflect the true value of predicting surgical success before discectomy? The aim of this study was to identify reliable predictors for surgical success two year after surgery for patients with LDH. Prospective analysis of 154 patients with LDH who underwent single-level lumbar discectomy was performed. Pre- and post-surgical success was assessed by the Oswestry Disability Index (ODI over a 2-year period. The Finneson-Cooper score also was used for evaluation of the clinical results. Using the ODI, surgical success was defined as a 30% (or more improvement on the ODI score from the baseline. The ODI was considered the gold standard in this study. Finally, the sensitivity, specificity, and positive and negative predictive power of the Finneson-Cooper score in predicting surgical success were calculated. The mean age of the patients was 49.6 (SD = 9.3 years and 47.4% were male. Significant improvement from the pre- to post-operative ODI scores was observed (P < 0.001. Post-surgical success was 76.0% (n = 117. The patients' rating on surgical success assessments by the ODI discriminated well between sub-groups of patients who differed with respect to the Finneson-Cooper score. Regarding patients' surgical success, the sensitivity, specificity, and accuracy of the Finneson-Cooper ratings correlated with success rate. The findings indicated that the Finneson-Cooper score was reflective of surgical success before discectomy.

  6. Prediction of Clinical Outcome Using Gene Expression Profiling and Artificial Neural Networks for Patients with Neuroblastoma

    Science.gov (United States)

    Wei, Jun S.; Greer, Braden T.; Westermann, Frank; Steinberg, Seth M.; Son, Chang-Gue; Chen, Qing-Rong; Whiteford, Craig C.; Bilke, Sven; Krasnoselsky, Alexei L.; Cenacchi, Nicola; Catchpoole, Daniel; Berthold, Frank; Schwab, Manfred; Khan, Javed

    2005-01-01

    Currently, patients with neuroblastoma are classified into risk groups (e.g., according to the Children’s Oncology Group risk-stratification) to guide physicians in the choice of the most appropriate therapy. Despite this careful stratification, the survival rate for patients with high-risk neuroblastoma remains artificial neural networks to develop an accurate predictor of survival for each individual patient with neuroblastoma. Using principal component analysis we found that neuroblastoma tumors exhibited inherent prognostic specific gene expression profiles. Subsequent artificial neural network-based prognosis prediction using expression levels of all 37,920 good-quality clones achieved 88% accuracy. Moreover, using an artificial neural network-based gene minimization strategy in a separate analysis we identified 19 genes, including 2 prognostic markers reported previously, MYCN and CD44, which correctly predicted outcome for 98% of these patients. In addition, these 19 predictor genes were able to additionally partition Children’s Oncology Group-stratified high-risk patients into two subgroups according to their survival status (P = 0.0005). Our findings provide evidence of a gene expression signature that can predict prognosis independent of currently known risk factors and could assist physicians in the individual management of patients with high-risk neuroblastoma. PMID:15466177

  7. Application of a prediction model for the progression of rheumatoid arthritis in patients with undifferentiated arthritis.

    Science.gov (United States)

    Arana-Guajardo, Ana; Pérez-Barbosa, Lorena; Vega-Morales, David; Riega-Torres, Janett; Esquivel-Valerio, Jorge; Garza-Elizondo, Mario

    2014-01-01

    Different prediction rules have been applied to patients with undifferentiated arthritis (UA) to identify those that progress to rheumatoid arthritis (RA). The Leiden Prediction Rule (LPR) has proven useful in different UA cohorts. To apply the LPR to a cohort of patients with UA of northeastern Mexico. We included 47 patients with UA, LPR was applied at baseline. They were evaluated and then classified after one year of follow-up into two groups: those who progressed to RA (according to ACR 1987) and those who did not. 43% of the AI patients developed RA. In the RA group, 56% of patients obtained a score ≤ 6 and only 15% ≥ 8. 70% who did not progress to RA had a score between 6 and ≤ 8. There was no difference in median score of LPR between groups, p=0.940. Most patients who progressed to RA scored less than 6 points in the LPR. Unlike what was observed in other cohorts, the model in our population did not allow us to predict the progression of the disease. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  8. Value of CT pulmonary angiography to predict short-term outcome in patient with pulmonary embolism.

    Science.gov (United States)

    Osman, Ahmed M; Abdeldayem, Emad H

    2018-01-18

    To evaluate the role of CT pulmonary angiography (CTPA) in the assessment of pulmonary embolism (PE) severity and the related CT cardiac changes, reflecting the clinical status of the patients and predicting the outcome. A prospective study of 184 patients presented with suspicious acute PE. All patients underwent CTPA followed by ECHO. Pulmonary artery obstructive index (PAOI) using Qanadli Score was calculated and cardiac changes recorded. The patients' outcome was followed up for 30 days. Only 150 patients completed the study; 26.7% needed ICU admission while 13.3% died during follow-up. There was a significant relationship between the PAOI and the risk classification, right ventricular dysfunction (RVD) diagnosed by ECHO and the patients' short outcome. We found PAOI cut off value 45% for mortality and 35% for ICU admission and 27.5% for RVD with 60, 75 and 90% sensitivity and 80, 73.3 and 68.6% specificity respectively. CT RV/LV ratio was the most sensitive parameter to predict RV dysfunction followed by pulmonary artery diameter. CTPA is not only used for diagnosis but also to assess the severity of PE, the effect on the right ventricular function and subsequently the need for ICU admission and prediction of the outcome.

  9. Predicting utility of exercise tests based on history/holter in patients with premature ventricular contractions.

    Science.gov (United States)

    Robinson, Brad; Xie, Li; Temple, Joel; Octavio, Jenna; Srayyih, Maytham; Thacker, Deepika; Kharouf, Rami; Davies, Ryan; Gidding, Samuel S

    2015-01-01

    Premature ventricular contractions (PVCs) are considered benign in patients with structurally normal hearts, particularly if they suppress with exercise. Catecholaminergic polymorphic ventricular tachycardia (CPVT) requires exercise testing to unmask the malignant phenotype. We studied risk factors and Holter monitor variables to help predict the necessity of exercise testing in patients with PVCs. We retrospectively reviewed 81 patients with PVCs that suppressed at peak exercise and structurally normal hearts referred to the exercise laboratory in 2011. We reviewed 11 patients from 2003 to 2012 whose PVCs were augmented at peak exercise (mean age 13 ± 4 years; 52 % male, 180 exercise studies). We recorded clinical risk factors and comorbidities (family history of arrhythmia or sudden unexpected death [SUD], presence of syncope) and Holter testing parameters. Family history of VT or SUD (P = 0.011) and presence of VT on Holter (P = 0.011) were significant in predicting failure of PVCs to suppress at peak heart rate on exercise testing. Syncope was not statistically significant in predicting suppression (P = 0.18); however, CPVT was diagnosed in four patients with syncope during exercise. Quantity of PVCs, Lown grade, couplets on Holter, monomorphism, and PVC elimination at peak heart rate on Holter were not predictors of PVC suppression on exercise testing. Patients with syncope during exercise, family history of arrhythmia or SUD, or a Holter monitor showing VT warrant exercise testing to assess for CPVT.

  10. The HOMR-Now! Model Accurately Predicts 1-Year Death Risk for Hospitalized Patients on Admission.

    Science.gov (United States)

    van Walraven, Carl; Forster, Alan J

    2017-08-01

    The Hospital-patient One-year Mortality Risk (HOMR) score is an externally validated index using health administrative data to accurately predict the risk of death within 1 year of admission to the hospital. This study derived and internally validated a HOMR modification using data that are available when the patient is admitted to the hospital. From all adult hospitalizations at our tertiary-care teaching hospital between 2004 and 2015, we randomly selected one per patient. We added to all HOMR variables that could be determined from our hospital's data systems on admission other factors that might prognosticate. Vital statistics registries determined vital status at 1 year from admission. Of 2,06,396 patients, 32,112 (15.6%) died within 1 year of admission to the hospital. The HOMR-now! model included patient (sex, comorbidities, living and cancer clinic status, and 1-year death risk from population-based life tables) and hospitalization factors (admission year, urgency, service and laboratory-based acuity score). The model explained that more than half of the total variability (Regenkirke's R(2) value of 0.53) was very discriminative (C-statistic 0.92), and accurately predicted death risk (calibration slope 0.98). One-year risk of death can be accurately predicted using routinely collected data available when patients are admitted to the hospital. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Functional network architecture predicts psychologically mediated analgesia related to treatment in chronic knee pain patients.

    Science.gov (United States)

    Hashmi, Javeria Ali; Kong, Jian; Spaeth, Rosa; Khan, Sheraz; Kaptchuk, Ted J; Gollub, Randy L

    2014-03-12

    Placebo analgesia is an indicator of how efficiently the brain translates psychological signals conveyed by a treatment procedure into pain relief. It has been demonstrated that functional connectivity between distributed brain regions predicts placebo analgesia in chronic back pain patients. Greater network efficiency in baseline brain networks may allow better information transfer and facilitate adaptive physiological responses to psychological aspects of treatment. Here, we theorized that topological network alignments in resting state scans predict psychologically conditioned analgesic responses to acupuncture treatment in chronic knee osteoarthritis pain patients (n = 45). Analgesia was induced by building positive expectations toward acupuncture treatment with verbal suggestion and heat pain conditioning on a test site of the arm. This procedure induced significantly more analgesia after sham or real acupuncture on the test site than in a control site. The psychologically conditioned analgesia was invariant to sham versus real treatment. Efficiency of information transfer within local networks calculated with graph-theoretic measures (local efficiency and clustering coefficients) significantly predicted conditioned analgesia. Clustering coefficients in regions associated with memory, motivation, and pain modulation were closely involved in predicting analgesia. Moreover, women showed higher clustering coefficients and marginally greater pain reduction than men. Overall, analgesic response to placebo cues can be predicted from a priori resting state data by observing local network topology. Such low-cost synchronizations may represent preparatory resources that facilitate subsequent performance of brain circuits in responding to adaptive environmental cues. This suggests a potential utility of network measures in predicting placebo response for clinical use.

  12. Electricity Consumption Forecasting Scheme via Improved LSSVM with Maximum Correntropy Criterion

    Directory of Open Access Journals (Sweden)

    Jiandong Duan

    2018-02-01

    Full Text Available In recent years, with the deepening of China’s electricity sales side reform and electricity market opening up gradually, the forecasting of electricity consumption (FoEC becomes an extremely important technique for the electricity market. At present, how to forecast the electricity accurately and make an evaluation of results scientifically are still key research topics. In this paper, we propose a novel prediction scheme based on the least-square support vector machine (LSSVM model with a maximum correntropy criterion (MCC to forecast the electricity consumption (EC. Firstly, the electricity characteristics of various industries are analyzed to determine the factors that mainly affect the changes in electricity, such as the gross domestic product (GDP, temperature, and so on. Secondly, according to the statistics of the status quo of the small sample data, the LSSVM model is employed as the prediction model. In order to optimize the parameters of the LSSVM model, we further use the local similarity function MCC as the evaluation criterion. Thirdly, we employ the K-fold cross-validation and grid searching methods to improve the learning ability. In the experiments, we have used the EC data of Shaanxi Province in China to evaluate the proposed prediction scheme, and the results show that the proposed prediction scheme outperforms the method based on the traditional LSSVM model.

  13. Predictability of survival models for waiting list and transplant patients: calculating LYFT.

    Science.gov (United States)

    Wolfe, R A; McCullough, K P; Leichtman, A B

    2009-07-01

    'Life years from transplant' (LYFT) is the extra years of life that a candidate can expect to achieve with a kidney transplant as compared to never receiving a kidney transplant at all. The LYFT component survival models (patient lifetimes with and without transplant, and graft lifetime) are comparable to or better predictors of long-term survival than are other predictive equations currently in use for organ allocation. Furthermore, these models are progressively more successful at predicting which of two patients will live longer as their medical characteristics (and thus predicted lifetimes) diverge. The C-statistics and the correlations for the three LYFT component equations have been validated using independent, nonoverlapping split-half random samples. Allocation policies based on these survival models could lead to substantial increases in the number of life years gained from the current donor pool.

  14. Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis

    NARCIS (Netherlands)

    Arts, E.E.A.; Popa, C.; Broeder, A.A. den; Semb, A.G.; Toms, T.; Kitas, G.D.; Riel, P.L.C.M. van; Fransen, J.

    2015-01-01

    OBJECTIVE: This study was undertaken to assess the predictive ability of 4 established cardiovascular (CV) risk models for the 10-year risk of fatal and non-fatal CV diseases in European patients with rheumatoid arthritis. METHODS: Prospectively collected data from the Nijmegen early rheumatoid

  15. Soluble Urokinase Plasminogen Activator Receptor for Risk Prediction in Patients Admitted with Acute Chest Pain

    DEFF Research Database (Denmark)

    Lyngbæk, Stig; Andersson, Charlotte; Marott, Jacob L

    2013-01-01

    Plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) predict mortality in several clinical settings, but the long-term prognostic importance of suPAR in chest pain patients admitted on suspicion of non-ST-segment elevation acute coronary syndrome (NSTEACS) is uncertain....

  16. Can We Predict Vesicovaginal or Rectovaginal Fistula Formation in Patients With Stage IVA Cervical Cancer?

    NARCIS (Netherlands)

    Biewenga, Petra; Mutsaerts, Meike A. Q.; Stalpers, Lukas J.; Buist, Marrije R.; Schilthuis, Marten S.; van der Velden, Jacobus

    2010-01-01

    Introduction: Patients with cervical carcinoma that invade the bladder or rectum ( International Federation of Obstetrics and Gynecology stage IVA) have a high risk to develop vesicovaginal and/or rectovaginal fistulae. If we could identify pretreatment factors that predict fistula formation, these

  17. Predictive value of different scoring systems for critically ill patients with hospital acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Tarek Hussein Al-Badawy

    2016-10-01

    Conclusions: SMART – cop score is the most sensitive score in predicting 28-day mortality in the studied patient followed by SMART – co and PSI score. SMART-cop score is the most specific one (Specificity = 93% in followed by Modified ATS score (Specificity = 90%.

  18. Prediction of complicated lower respiratory tract infections in older patients with diabetes

    NARCIS (Netherlands)

    Venmans, Leonie M A J; Bont, Jettie; Gorter, Kees J; Verheij, Theo J M; Rutten, Guy E H M; Hak, Eelko

    BACKGROUND: Patients with diabetes have an elevated risk of developing complicated lower respiratory tract infections (LRTIs). However, up until now, GPs have not had the tools to assess individual risks. AIM: To assess the applicability of an existing prediction rule for complicated LRTI among

  19. Predictive monitoring for early detection of sepsis in neonatal ICU patients.

    Science.gov (United States)

    Fairchild, Karen D

    2013-04-01

    Predictive monitoring is an exciting new field involving analysis of physiologic data to detect abnormal patterns associated with critical illness. The first example of predictive monitoring being taken from inception (proof of concept) to reality (demonstration of improved outcomes) is the use of heart rate characteristics (HRC) monitoring to detect sepsis in infants in the neonatal ICU. The commercially available 'HeRO' monitor analyzes electrocardiogram data from existing bedside monitors for decreased HR variability and transient decelerations associated with sepsis, and converts these changes into a score (the HRC index or HeRO score). This score is the fold increase in probability that a patient will have a clinical deterioration from sepsis within 24 h. This review focuses on HRC monitoring and discusses future directions in predictive monitoring of ICU patients. In a randomized trial of 3003 very low birthweight infants, display of the HeRO score reduced mortality more than 20%. Ongoing research aims to combine respiratory and HR analysis to optimize care of ICU patients. Predictive monitoring has recently been shown to save lives. Harnessing and analyzing the vast amounts of physiologic data constantly displayed in ICU patients will lead to improved algorithms for early detection, prognosis, and therapy of critical illnesses.

  20. Serum YKL-40 predicts long-term mortality in patients with stable coronary disease

    DEFF Research Database (Denmark)

    Harutyunyan, Marina; Gøtze, Jens P; Winkel, Per

    2013-01-01

    We investigated whether the inflammatory biomarker YKL-40 could improve the long-term prediction of death made by common risk factors plus high-sensitivity C-reactive protein (hs-CRP) and N-terminal-pro-B natriuretic peptide (NT-proBNP) in patients with stable coronary artery disease (CAD)....

  1. The impact of delirium on the prediction of in-hospital mortality in intensive care patients.

    NARCIS (Netherlands)

    Boogaard, M.H.W.A. van den; Peters, S.A.; Hoeven, J.G. van der; Dagnelie, P.C.; Leffers, P.; Pickkers, P.; Schoonhoven, L.J.

    2010-01-01

    INTRODUCTION: Predictive models, such as acute physiology and chronic health evaluation II (APACHE-II), are widely used in intensive care units (ICUs) to estimate mortality. Although the presence of delirium is associated with a higher mortality in ICU patients, delirium is not part of the APACHE-II

  2. The impact of delirium in the prediction of In-Hospital Mortality in Intensive Care patients

    NARCIS (Netherlands)

    Johannes van der Hoeven; Mark van den Boogaard; Sanne Peters; Pieter Leffers; Peter Pickkers; Pieter Dagnelie; Lisette Schoonhoven

    2010-01-01

    Predictive models, such as acute physiology and chronic health evaluation II (APACHE-II), are widely used in intensive care units (ICUs) to estimate mortality. Although the presence of delirium is associated with a higher mortality in ICU patients, delirium is not part of the APACHE-II model. The

  3. Nomograms for predicting survival and recurrence in patients with adenoid cystic carcinoma. An international collaborative study

    DEFF Research Database (Denmark)

    Ganly, Ian; Amit, Moran; Kou, Lei

    2015-01-01

    BACKGROUND: Due to the rarity of adenoid cystic carcinoma (ACC), information on outcome is based upon small retrospective case series. The aim of our study was to create a large multiinstitutional international dataset of patients with ACC in order to design predictive nomograms for outcome...

  4. External Validation of Prediction Models for Pneumonia in Primary Care Patients with Lower Respiratory Tract Infection

    DEFF Research Database (Denmark)

    Schierenberg, Alwin; Minnaard, Margaretha C; Hopstaken, Rogier M

    2016-01-01

    for prediction of pneumonia in primary care were externally validated in the individual patient data (IPD) of previously performed diagnostic studies. METHODS AND FINDINGS: S&S models for diagnosing pneumonia in adults presenting to primary care with lower respiratory tract infection and IPD for validation were...

  5. Prediction of treatment outcomes to exercise in patients with nonremitted major depressive disorder.

    Science.gov (United States)

    Rethorst, Chad D; South, Charles C; Rush, A John; Greer, Tracy L; Trivedi, Madhukar H

    2017-12-01

    Only one-third of patients with major depressive disorder (MDD) achieve remission with initial treatment. Consequently, current clinical practice relies on a "trial-and-error" approach to identify an effective treatment for each patient. The purpose of this report was to determine whether we could identify a set of clinical and biological parameters with potential clinical utility for prescription of exercise for treatment of MDD in a secondary analysis of the Treatment with Exercise Augmentation in Depression (TREAD) trial. Participants with nonremitted MDD were randomized to one of two exercise doses for 12 weeks. Participants were categorized as "remitters" (≤12 on the IDS-C), nonresponders (depressive symptom severity, and higher postexercise positive affect. Predictors of treatment nonresponse were low cardiorespiratory fitness, lower levels of IL-6 and BDNF, and lower postexercise positive affect. Models including these predictors resulted in predictive values greater than 70% (true predicted remitters/all predicted remitters) with specificities greater than 25% (true predicted remitters/all remitters). Results indicate feasibility in identifying patients who will either remit or not respond to exercise as a treatment for MDD utilizing a clinical decision model that incorporates multiple patient characteristics. © 2017 Wiley Periodicals, Inc.

  6. Inflammation biomarkers and mortality prediction in patients with type 2 diabetes (ZODIAC-27)

    NARCIS (Netherlands)

    Landman, Gijs W. D.; Kleefstra, Nanne; Groenier, Klaas H.; Bakker, Stephan J. L.; Groeneveld, Geert H.; Bilo, Henk J. G.; van Hateren, Kornelis J. J.

    Background: C-reactive protein (CRP), procalcitonin (PCT) and pro-adrenomedullin (MR-proADM) are inflammation markers associated with long-term mortality risk. We compared the associations and predictive capacities of CRP, PCT and MR-proADM with cardiovascular and all-cause mortality in patients

  7. The need for ICU admission in intoxicated patients : a prediction model

    NARCIS (Netherlands)

    Brandenburg, Raya; Brinkman, Sylvia; de Keizer, Nicolette F; Kesecioglu, Jozef; Meulenbelt, Jan; de Lange, Dylan W

    CONTEXT: Intoxicated patients are frequently admitted from the emergency room to the ICU for observational reasons. The question is whether these admissions are indeed necessary. OBJECTIVE: The aim of this study was to develop a model that predicts the need of ICU treatment (receiving mechanical

  8. Predictive value of the smell identification test for nigrostriatal dopaminergic depletion in Korean tremor patients.

    Science.gov (United States)

    Hong, Jin Yong; Chung, Seok Jong; Lee, Ji E; Sunwoo, Mun Kyung; Lee, Phil Hyu; Sohn, Young H

    2013-11-01

    The predictive value of Cross-Cultural Smell Identification Test for nigrostriatal dopaminergic depletion in Korean tremor patients has yet to be assessed. Three hundred nineteen drug-naive patients who visited our clinic for the diagnosis of their tremor, and took both Cross-Cultural Smell Identification Test and dopamine transporter PET were included in the data analysis. Visual grading of each PET image was performed by two independent neurologists. Smell test scores were significantly correlated to the striatal dopaminergic activity (Kendall's τb = -0.291, p smell test score alone appeared to have relatively weak power for predicting dopaminergic depletion (area under the curve = 0.693). Multivariate logistic regression model with inclusion of the patient's age and symptom duration as independent variables enhanced predictive power for dopaminergic depletion (area under the curve = 0.812). These results demonstrated that Cross-Cultural Smell Identification Test measurements alone may be insufficient to predict striatal dopaminergic depletion in Korean tremor patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Surgical outcome prediction in patients with advanced ovarian cancer using computed tomography scans and intraoperative findings

    Directory of Open Access Journals (Sweden)

    Ha-Jeong Kim

    2014-09-01

    Conclusion: The combination of omental extension to the stomach or spleen and involvement of inguinal or pelvic lymph nodes in preoperative CT scans is considered predictive of suboptimal cytoreduction. These patients may be more appropriately treated with neoadjuvant chemotherapy followed by surgical cytoreduction.

  10. Predictive factors of cessation of ambulation in patients with Duchenne muscular dystrophy

    NARCIS (Netherlands)

    Bakker, Jan P. J.; de Groot, Imelda J. M.; Beelen, Anita; Lankhorst, Gustaaf J.

    2002-01-01

    To identify baseline patient and treatment characteristics that can predict wheelchair dependency within 2 yr. This prospective cohort study included 44 subjects who met study inclusion criteria. The same investigator examined them at 6-mo intervals. Ambulatory status, anthropometric data, muscle

  11. Presence of albuminuria predicts left ventricular mass in patients with chronic systemic arterial hypertension

    NARCIS (Netherlands)

    de Beus, Esther; Meijs, Matthijs F L; Bots, Michiel L.; Visseren, Frank L J; Blankestijn, Peter J.

    2015-01-01

    Background: Increased left ventricular mass (LVM) is known to predict cardiovascular morbidity and mortality. LVM is high in patients with advanced kidney disease. Our aim was to study the relationship between renal parameters and LVM in hypertensive subjects at high risk of cardiovascular disease.

  12. Predictive value of ambulatory blood pressure shortly after withdrawal of antihypertensive drugs in primary care patients

    NARCIS (Netherlands)

    Beltman, FW; Heesen, WF; Smit, AJ; May, JF; deGraeff, PA; Havinga, TK; Schuurman, FH; vanderVeur, E; Lie, KI; MeyboomdeJong, B

    1996-01-01

    Objective-To determine whether ambulatory blood pressure eight weeks after withdrawal of antihypertensive medication is a more sensitive measure than seated blood pressure to predict blood pressure in the long term. Design-Patients with previously untreated diastolic hypertension were treated with

  13. Predictive factors of unfavorable prostate cancer in patients who underwent prostatectomy but eligible for active surveillance

    Directory of Open Access Journals (Sweden)

    Seol Ho Choo

    2014-06-01

    Conclusions: A significant proportion of patients who were candidates for active surveillance had unfavorable prostate cancer. Age, PSA density, and two positive cores were independent significant predictive factors for unfavorable prostate cancer. These factors should be considered when performing active surveillance.

  14. Predicting complex acute wound healing in patients from a wound expertise centre registry : a prognostic study

    NARCIS (Netherlands)

    Ubbink, Dirk T; Lindeboom, Robert; Eskes, Anne M; Brull, Huub; Legemate, Dink A; Vermeulen, Hester

    2015-01-01

    It is important for caregivers and patients to know which wounds are at risk of prolonged wound healing to enable timely communication and treatment. Available prognostic models predict wound healing in chronic ulcers, but not in acute wounds, that is, originating after trauma or surgery. We

  15. Predicting complex acute wound healing in patients from a wound expertise centre registry: a prognostic study

    NARCIS (Netherlands)

    Ubbink, Dirk T.; Lindeboom, Robert; Eskes, Anne M.; Brull, Huub; Legemate, Dink A.; Vermeulen, Hester

    2015-01-01

    It is important for caregivers and patients to know which wounds are at risk of prolonged wound healing to enable timely communication and treatment. Available prognostic models predict wound healing in chronic ulcers, but not in acute wounds, that is, originating after trauma or surgery. We

  16. What are Predictive Factors for Developing of Barrett's Esophagus in Patients with Gerd-our Experience.

    Science.gov (United States)

    Gashi, Zaim; Ivkovski, Ljube; Shabani, Ragip; Haziri, Adem; Juniku-Shkololli, Argjira

    2011-09-01

    Barrett's esophagus (BE) is a condition in which the normal squamous epithelium of the esophagus is replaced with metaplastic intestinal-type epithelium. This epithelium can progress sequentially from metaplasia to low-grade dysplasia, then to high-grade dysplasia and finally to invasive adenocarcinoma. Many factors that appear to be risk factors for the presence of BE include obesity, the presence of hiatal hernia, and interestingly, the absence of Helicobacter pylori infection. The aim of this study was to determine the predictive factors for progression of gastroesophageal reflux disease (GERD) to BE. 42 patients with endoscopically diagnosed and histopathologically verified BE were included in this prospective study. We analysed predictive factors such as: age, sex, obesity, alcohol consumption and smoking, reflux symptom duration in this patients, prevalence of short and long segment of BE, and the presence of hiatal hernia. After endoscopic examination of these patients, the presence of BE was verified with histopathological examination and finally, infection with H. pylori was determined. Among 42 subjects, 25 (59%) were males and 17 (41%) were females, with mean age of 52.8±3.28 years. Obesity was present in 24 of 42 patients (57%). 27 of 42 patients (64%) were smokers. Symptom duration in this patients was approximately 9.4 years. From total number of patients, 52% were with SSBE and 48% patients were with LSBE. Hiatal hernia was present in 64% of patients, of which 66% were with LSBE and 34% with SSBE. In these patients, prevalence of infection with H. pylori was present in 12% of cases, 9.5% in patients with SSBE and 2.5% in patients with LSBE. The important risk factors for appearance of BE in GERD patients were male sex, middle age, smooking and alcohol consumption. Obesity is an important factor for development of BE. Most of patients with BE also had hiatal hernia, in majority of cases these were patients with LSBE. The prevalence of infection with

  17. Subjective global assessment: a reliable nutritional assessment tool to predict outcomes in critically ill patients.

    Science.gov (United States)

    Fontes, Daniel; Generoso, Simone de Vasconcelos; Toulson Davisson Correia, Maria Isabel

    2014-04-01

    Nutritional assessment of critically ill patients has created controversy. However, it is well established that malnourished patients who are severely ill have worse outcomes than well-nourished patients. Therefore, assessing patients' nutritional status may be useful in predicting which patients may experience increased morbidity and mortality. One hundred eighty-five consecutively admitted patients were followed until discharge or death, and their nutritional status was evaluated using Subjective Global Assessment (SGA) as well as anthropometric and laboratory methods. Agreement between the methods was measured using the Kappa coefficient. Malnutrition was highly prevalent (54%), according to SGA. Malnourished patients had significantly higher rates of readmission to the intensive care unit (ICU) (OR 2.27; CI 1.08-4.80) and mortality (OR 8.12; CI 2.94-22.42). The comparison of SGA with other tests used to assess nutritional status showed that the correlation between the methods ranged from poor to superficial. SGA, an inexpensive and quick nutritional assessment method conducted at the bedside, is a reliable tool for predicting outcomes in critically ill patients. Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  18. Serum alpha 2-HS glycoprotein predicts survival in patients with glioblastoma.

    Science.gov (United States)

    Petrik, Vladimir; Saadoun, Samira; Loosemore, Alison; Hobbs, Josie; Opstad, Kirstie S; Sheldon, Joanna; Tarelli, Edward; Howe, Franklyn A; Bell, B Anthony; Papadopoulos, Marios C

    2008-04-01

    Glioblastoma, the most common primary brain tumor, has variable prognosis. We aimed to identify serum biomarkers that predict survival of patients with glioblastoma. In phase 1 (biomarker discovery), SELDI-TOF mass spectra were studied in 200 serum samples from 58 control subjects and 36 patients with grade II astrocytoma, 15 with anaplastic astrocytoma, and 91 with glioblastoma. To identify potential biomarkers, we searched for peptide peaks that changed progressively in size with increasing malignancy. One peak, identified as the B-chain of alpha 2-Heremans-Schmid glycoprotein (AHSG), was less prominent with increasing tumor grade. We therefore investigated AHSG as a survival predictor in glioblastoma. We measured serum AHSG by turbidimetry and determined indices of malignancy, including tumor proliferation (Ki67 immunolabel) and necrosis (tumor lipids on magnetic resonance spectroscopy). In phase 2 (biomarker validation), the prognostic power of AHSG was validated in an independent group of 72 glioblastoma patients. Median survival was longer (51 vs 29 weeks) in glioblastoma patients with normal vs low serum AHSG concentrations (hazard ratio 2.7, 95% CI 1.5-5.0, P AHSG inversely correlated with Ki-67 immunolabeling and tumor lipids. A prognostic index combining serum AHSG with patient age and Karnofsky score separated glioblastoma patients with short (2 years) median survival. The prognostic value of serum AHSG was validated in a different cohort of glioblastoma patients. We conclude that serum AHSG concentration, measured before starting treatment, predicts survival in patients with glioblastoma.

  19. Preoperative Nutritional Risk Index to predict postoperative survival time in primary liver cancer patients.

    Science.gov (United States)

    Bo, Yacong; Yao, Mingjie; Zhang, Ling; Bekalo, Wolde; Lu, Weiquan; Lu, Quanjun

    2015-01-01

    We designed this study to determine the predictive value of Nutritional Risk Index (NRI) for postoperative survival time of patients who had undergone hepatectomy for primary liver cancer. The 620 patients who underwent hepatectomy for primary liver cancer (PLC) in the Department of Hepatobiliary Surgery, Cancer Hospital of Henan Province, Zhengzhou, China from December 1, 2008 to December 1, 2012 were followed up. A nutritional risk index (NRI) was used to screen the patients with malnutrition (NRI100) patients had longer postoperative survival time compared with malnourished patients. NRI values>100 was sig-nificantly associated with longer postoperative survival time. Cox proportional hazards model showed that NRI was an independent predictor of postoperative survival time and that NRI varied inversely with the risk of death. The patients with NRI values>100 survived longer than those with NRI values

  20. Persistent enhancement after treatment for cerebral toxoplasmosis in patients with AIDS: predictive value for subsequent recurrence.

    Science.gov (United States)

    Laissy, J P; Soyer, P; Parlier, C; Lariven, S; Benmelha, Z; Servois, V; Casalino, E; Bouvet, E; Sibert, A; Vachon, F

    1994-10-01

    To determine the predictive imaging (CT and/or MR) features of brain toxoplasmosis recurrences in acquired immunodeficiency syndrome. The imaging studies of patients with brain toxoplasmosis were retrospectively reviewed. Forty-three patients with significant decrease or disappearance of brain lesions under specific treatment on follow-up imaging examinations were included. MR examinations were performed using T2- and T1-weighted sequences, before and after intravenous administration of gadolinium-DOTA. A recurrence occurred in 11 (26%) of 43 cases. Ten (91%) of these 11 patients with recurrence showed focal persistent enhancement after the initial treatment of toxoplasmosis abscess. One of the 11 patients with recurrence showed no persistent enhancement; 3 patients showed persistent enhancement but had no recurrence. Recurrences of brain toxoplasmosis in our series correlated with persistent contrast enhancement. We hypothesize that demonstration of persistent areas of contrast enhancement after treatment for initial toxoplasmosis may be a valuable sign for identifying patients at risk for recurrence.

  1. The "ick" Factor Matters: Disgust Prospectively Predicts Avoidance in Chemotherapy Patients.

    Science.gov (United States)

    Reynolds, Lisa M; Bissett, Ian P; Porter, David; Consedine, Nathan S

    2016-12-01

    Chemotherapy can be physically and psychologically demanding. Avoidance and withdrawal are common among patients coping with these demands. This report compares established emotional predictors of avoidance during chemotherapy (embarrassment; distress) with an emotion (disgust) that has been unstudied in this context. This report outlines secondary analyses of an RCT where 68 cancer patients undergoing chemotherapy were randomized to mindfulness or relaxation interventions. Self-reported baseline disgust (DS-R), embarrassment (SES-SF), and distress (Distress Thermometer) were used to prospectively predict multiple classes of avoidance post-intervention and at 3 months follow-up. Measures assessed social avoidance, cognitive and emotional avoidance (IES Avoidance), as well as information seeking and treatment adherence (General Adherence Scale). Repeated-measures ANOVAs evaluated possible longitudinal changes in disgust and forward entry regression models contrasted the ability of the affective variables to predict avoidance. Although disgust did not change over time or vary between groups, greater disgust predicted greater social, cognitive, and emotional avoidance, as well as greater information seeking. Social avoidance was predicted by trait embarrassment and distress predicted non-adherence. This report represents the first investigation of disgust's ability to prospectively predict avoidance in people undergoing chemotherapy. Compared to embarrassment and distress, disgust was a more consistent predictor across avoidance domains and its predictive ability was evident across a longer period of time. Findings highlight disgust's role as an indicator of likely avoidance in this health context. Early identification of cancer patients at risk of deleterious avoidance may enable timely interventions and has important clinical implications (ACTRN12613000238774).

  2. Stability criterion and its calculation for sail-assisted ship

    Directory of Open Access Journals (Sweden)

    Yihuai Hu

    2015-01-01

    Full Text Available Stability criterion and its calculation are the crucial issue in the application of sail-assisted ship. How- ever, there is at present no specific criterion and computational methods for the stability of sail-assisted ship. Based on the stability requirements for seagoing ships, the stability criterion of the sail-assisted ships is suggested in this paper. Furthermore, how to calculate the parameters and determine some specific coefficients for the ship stability calculation, as well as how to redraw stability curve are also discussed in this paper. Finally, to give an illustration, the proposed method is applied on a sail assisted-ship model with comments and recommendations for improvement.

  3. Stability criterion and its calculation for sail-assisted ship

    Directory of Open Access Journals (Sweden)

    Hu Yihuai

    2015-01-01

    Full Text Available Stability criterion and its calculation are the crucial issue in the application of sail-assisted ship. How- ever, there is at present no specific criterion and computational methods for the stability of sail-assisted ship. Based on the stability; requirements for seagoing ships, the stability criterion of the sail-assisted ships is suggested in this paper. Furthermore, how to calculate the parameters and determine some specific coefficients for the ship stability; calculation, as well as how to redraw stability! curve are also discussed in this paper. Finally, to give an illustration, the proposed method is applied on a sail assisted-ship model with comments and recommendations for improvement.

  4. A Joint Optimization Criterion for Blind DS-CDMA Detection

    Directory of Open Access Journals (Sweden)

    Sergio A. Cruces-Alvarez

    2007-01-01

    Full Text Available This paper addresses the problem of the blind detection of a desired user in an asynchronous DS-CDMA communications system with multipath propagation channels. Starting from the inverse filter criterion introduced by Tugnait and Li in 2001, we propose to tackle the problem in the context of the blind signal extraction methods for ICA. In order to improve the performance of the detector, we present a criterion based on the joint optimization of several higher-order statistics of the outputs. An algorithm that optimizes the proposed criterion is described, and its improved performance and robustness with respect to the near-far problem are corroborated through simulations. Additionally, a simulation using measurements on a real software-radio platform at 5 GHz has also been performed.

  5. SOCIO-PSYCHOLOGICAL CRITERIONS OF FAMILY LIFESTYLE TYPOLOGY

    Directory of Open Access Journals (Sweden)

    Yekaterina Anatolievna Yumkina

    2015-02-01

    Full Text Available The purpose of this article is to present socio-psychological criterions of family lifestyle typology, which were found during theoretical modelling and empirical research work. It is important in fundamental and practical aspects. St-Petersburg students (n = 116, from 19 to 21 years old were examined by special questionnaire «Family relationship and home» (Kunitsi-na V.N., Yumkina Ye.A., 2012 which measures different aspects of family lifestyle. We also used complex of methods that gave us information about personal values, self-rating and parent-child relationships. Dates were divided into six groups according to three main criterions of family lifestyle typology: social environment of family life, family activity, and family interpersonal relationships. There were found statistically significant differences between pairs of group from every criterions. The results can be useful in spheres dealing with family crisis, family development, family traditions etc.

  6. Patient feature based dosimetric Pareto front prediction in esophageal cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Jiazhou; Zhao, Kuaike; Peng, Jiayuan; Xie, Jiang; Chen, Junchao; Zhang, Zhen; Hu, Weigang, E-mail: jackhuwg@gmail.com [Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032 (China); Jin, Xiance [The 1st Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325000 (China); Studenski, Matthew [Department of Radiation Oncology, University of Miami-Miller School of Medicine, Miami, Florida 33136 (United States)

    2015-02-15

    Purpose: To investigate the feasibility of the dosimetric Pareto front (PF) prediction based on patient’s anatomic and dosimetric parameters for esophageal cancer patients. Methods: Eighty esophagus patients in the authors’ institution were enrolled in this study. A total of 2928 intensity-modulated radiotherapy plans were obtained and used to generate PF for each patient. On average, each patient had 36.6 plans. The anatomic and dosimetric features were extracted from these plans. The mean lung dose (MLD), mean heart dose (MHD), spinal cord max dose, and PTV homogeneity index were recorded for each plan. Principal component analysis was used to extract overlap volume histogram (OVH) features between PTV and other organs at risk. The full dataset was separated into two parts; a training dataset and a validation dataset. The prediction outcomes were the MHD and MLD. The spearman’s rank correlation coefficient was used to evaluate the correlation between the anatomical features and dosimetric features. The stepwise multiple regression method was used to fit the PF. The cross validation method was used to evaluate the model. Results: With 1000 repetitions, the mean prediction error of the MHD was 469 cGy. The most correlated factor was the first principal components of the OVH between heart and PTV and the overlap between heart and PTV in Z-axis. The mean prediction error of the MLD was 284 cGy. The most correlated factors were the first principal components of the OVH between heart and PTV and the overlap between lung and PTV in Z-axis. Conclusions: It is feasible to use patients’ anatomic and dosimetric features to generate a predicted Pareto front. Additional samples and further studies are required improve the prediction model.

  7. A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae.

    Science.gov (United States)

    Gutiérrez-Gutiérrez, Belén; Salamanca, Elena; de Cueto, Marina; Hsueh, Po-Ren; Viale, Pierluigi; Paño-Pardo, José Ramón; Venditti, Mario; Tumbarello, Mario; Daikos, George; Pintado, Vicente; Doi, Yohei; Tuon, Felipe Francisco; Karaiskos, Ilias; Machuca, Isabel; Schwaber, Mitchell J; Azap, Özlem Kurt; Souli, Maria; Roilides, Emmanuel; Pournaras, Spyros; Akova, Murat; Pérez, Federico; Bermejo, Joaquín; Oliver, Antonio; Almela, Manel; Lowman, Warren; Almirante, Benito; Bonomo, Robert A; Carmeli, Yehuda; Paterson, David L; Pascual, Alvaro; Rodríguez-Baño, Jesús

    2016-10-01

    To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE). A multinational retrospective cohort study (INCREMENT project) was performed from January 1, 2004, through December 31, 2013. Patients with clinically relevant monomicrobial BSIs due to CPE were included and randomly assigned to either a derivation cohort (DC) or a validation cohort (VC). The variables were assessed on the day the susceptibility results were available, and the predictive score was developed using hierarchical logistic regression. The main outcome variable was 14-day all-cause mortality. The predictive ability of the model and scores were measured by calculating the area under the receiver operating characteristic curve. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. The DC and VC included 314 and 154 patients, respectively. The final logistic regression model of the DC included the following variables: severe sepsis or shock at presentation (5 points); Pitt score of 6 or more (4 points); Charlson comorbidity index of 2 or more (3 points); source of BSI other than urinary or biliary tract (3 points); inappropriate empirical therapy and inappropriate early targeted therapy (2 points). The score exhibited an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.74-0.85) in the DC and 0.80 (95% CI, 0.73-0.88) in the VC. The results for 30-day all-cause mortality were similar. A validated score predictive of early mortality in patients with BSIs due to CPE was developed. clinicaltrials.gov Identifier: NCT01 764490. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  8. Accuracy of circulating histones in predicting persistent organ failure and mortality in patients with acute pancreatitis.

    Science.gov (United States)

    Liu, T; Huang, W; Szatmary, P; Abrams, S T; Alhamdi, Y; Lin, Z; Greenhalf, W; Wang, G; Sutton, R; Toh, C H

    2017-08-01

    Early prediction of acute pancreatitis severity remains a challenge. Circulating levels of histones are raised early in mouse models and correlate with disease severity. It was hypothesized that circulating histones predict persistent organ failure in patients with acute pancreatitis. Consecutive patients with acute pancreatitis fulfilling inclusion criteria admitted to Royal Liverpool University Hospital were enrolled prospectively between June 2010 and March 2014. Blood samples were obtained within 48 h of abdominal pain onset and relevant clinical data during the hospital stay were collected. Healthy volunteers were enrolled as controls. The primary endpoint was occurrence of persistent organ failure. The predictive values of circulating histones, clinical scores and other biomarkers were determined. Among 236 patients with acute pancreatitis, there were 156 (66·1 per cent), 57 (24·2 per cent) and 23 (9·7 per cent) with mild, moderate and severe disease respectively, according to the revised Atlanta classification. Forty-seven healthy volunteers were included. The area under the receiver operating characteristic (ROC) curve (AUC) for circulating histones in predicting persistent organ failure and mortality was 0·92 (95 per cent c.i. 0·85 to 0·99) and 0·96 (0·92 to 1·00) respectively; histones were at least as accurate as clinical scores or biochemical markers. For infected pancreatic necrosis and/or sepsis, the AUC was 0·78 (0·62 to 0·94). Histones did not predict or correlate with local pancreatic complications, but correlated negatively with leucocyte cell viability (r = -0·511, P = 0·001). Quantitative assessment of circulating histones in plasma within 48 h of abdominal pain onset can predict persistent organ failure and mortality in patients with acute pancreatitis. Early death of immune cells may contribute to raised circulating histone levels in acute pancreatitis. © 2017 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS

  9. Ventilator-associated pneumonia in trauma patients with open tracheotomy: Predictive factors and prognosis impact

    Science.gov (United States)

    Chaari, Anis; Kssibi, Hichem; Zribi, Wassim; Medhioub, Fatma; Chelly, Hedi; Algia, Najla B.; Hamida, Chokri B.; Bahloul, Mabrouk; Bouaziz, Mounir

    2013-01-01

    Objective: To assess the predictive factors of ventilator associated pneumonia (VAP) occurrence following open tracheotomy in trauma patients. Materials and Methods: We conducted an observational, prospective study over 15 months, between 01/08/2010 and 30/11/2011. All trauma patients (except those with cervical spine trauma), older than 15 years, undergoing open tracheotomy during their ICU stay were included. All episode of VAP following tracheotomy were recorded. Predictive factor of VAP onset were studied. Results: We included 106 patients. Mean age was 37.9 ± 15.5 years. Mean Glasgow coma Scale (GCS) was 8.5 ± 3.7 and mean Injury Severity Score (ISS) was 53.1 ± 23.8. Tracheotomy was performed for 53 patients (50%) because of prolonged ventilation whereas 83 patients (78.3%) had tracheotomy because of projected long mechanical ventilation. Tracheotomy was performed within 8.6 ± 5.3 days. Immediate complications were bleeding events (22.6%) and barotrauma (0.9%). Late complications were stomal infection (28.3%) and VAP (52.8%). In multivariate analysis, independent factors predicting VAP onset were delayed