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Moderate Sensitivity (moderate + sensitivity)
Selected AbstractsScoring Total Inflammation Is Superior to the Current Banff Inflammation Score in Predicting Outcome and the Degree of Molecular Disturbance in Renal AllograftsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2009M. Mengel Emerging molecular analysis can be used as an objective and independent assessment of histopathological scoring systems. We compared the existing Banff i-score to the total inflammation (total i-) score for assessing the molecular phenotype in 129 renal allograft biopsies for cause. The total i-score showed stronger correlations with microarray-based gene sets representing major biological processes during allograft rejection. Receiver operating characteristic curves showed that total-i was superior (areas under the curves 0.85 vs. 0.73 for Banff i-score, p = 0.012) at assessing an abnormal cytotoxic T-cell burden, because it identified molecular disturbances in biopsies with advanced scarring. The total-i score was also a better predictor of graft survival than the Banff i-score and essentially all current diagnostic Banff categories. The exception was antibody-mediated rejection which is able to predict graft loss with greater specificity (96%) but at low sensitivity (38%) due to the fact that it only applies to cases with this diagnosis. The total i-score is able to achieve moderate sensitivities (60,80%) with losses in specificity (60,80%) across the whole population. Thus, the total i-score is superior to the current Banff i-score and most diagnostic Banff categories in predicting outcome and assessing the molecular phenotype of renal allografts. [source] Comparison of the Medical Priority Dispatch System to an Out-of-hospital Patient Acuity ScoreACADEMIC EMERGENCY MEDICINE, Issue 9 2006Michael J. Feldman MD Abstract Background: Although the Medical Priority Dispatch System (MPDS) is widely used by emergency medical services (EMS) dispatchers to determine dispatch priority, there is little evidence that it reflects patient acuity. The Canadian Triage and Acuity Scale (CTAS) is a standard patient acuity scale widely used by Canadian emergency departments and EMS systems to prioritize patient care requirements. Objectives: To determine the relationship between MPDS dispatch priority and out-of-hospital CTAS. Methods: All emergency calls on a large urban EMS communications database for a one-year period were obtained. Duplicate calls, nonemergency transfers, and canceled calls were excluded. Sensitivity and specificity to detect high-acuity illness, as well as positive predictive value (PPV) and negative predictive value (NPV), were calculated for all protocols. Results: Of 197,882 calls, 102,582 met inclusion criteria. The overall sensitivity of MPDS was 68.2% (95% confidence interval [CI] = 67.8% to 68.5%), with a specificity of 66.2% (95% CI = 65.7% to 66.7%). The most sensitive protocol for detecting high acuity of illness was the breathing-problem protocol, with a sensitivity of 100.0% (95% CI = 99.9% to 100.0%), whereas the most specific protocol was the one for psychiatric problems, with a specificity of 98.1% (95% CI = 97.5% to 98.7%). The cardiac-arrest protocol had the highest PPV (92.6%, 95% CI = 90.3% to 94.3%), whereas the convulsions protocol had the highest NPV (85.9%, 95% CI = 84.5% to 87.2%). The best-performing protocol overall was the cardiac-arrest protocol, and the protocol with the overall poorest performance was the one for unknown problems. Sixteen of the 32 protocols performed no better than chance alone at identifying high-acuity patients. Conclusions: The Medical Priority Dispatch System exhibits at least moderate sensitivity and specificity for detecting high acuity of illness or injury. This performance analysis may be used to identify target protocols for future improvements. [source] The Brøset violence checklist (BVC)ACTA PSYCHIATRICA SCANDINAVICA, Issue 2002Phil Woods Objective:, The Brøset violence checklist (BVC) is a short-term violence prediction instrument assessing confusion, irritability, boisterousness, verbal threats, physical threats and attacks on objects as either present or absent. The aim of this paper is to describe the evolution and usefulness of the BVC. Method:, This paper reviews studies on the BVC and discusses implications for further research. Results:, Empirical research has shown that it has moderate sensitivity and high specificity with an adequate inter-rater reliability. Conclusion:, The BVC is a useful instrument for predicting inpatient violence within the next 24-h period. The psychometric properties of the instrument are satisfactory. Results from ongoing studies will give important information on cultural differences, the validity of the BVC in less well staffed wards, the clinical use of the checklist and its ability to predict violence throughout all the hospital stay. [source] Role of cytology in the diagnosis of Barrett's esophagus and associated neoplasiaDIAGNOSTIC CYTOPATHOLOGY, Issue 3 2003Reda S. Saad M.D. Abstract We studied 327 consecutive paired esophageal biopsies and brushing specimens obtained during the same endoscopic session to evaluate the role of cytology for the diagnosis of Barrett's esophagus (BE) and/or surveillance for associated dysplasia. A diagnosis of BE was based on the cytologic presence of goblet cells. Cases were reviewed and categorized into: 1) benign esophageal lesions (125 cases), with 48 cases of Candida (32 cases diagnosed by both techniques and 16 diagnosed only by cytology), 3 cases of herpes simplex with only 1 case diagnosed by cytology, and 74 cases of inflammation and/or repair; 2) benign BE (141 cases), with 74 cases (52%) diagnosed by both techniques, 11 cases by cytology only (8%), and 56 cases (40%) by histology only; 3) low-grade dysplasia (LGD, 30 cases), with 5 cases (17%) diagnosed with both specimens, one case (3%) by cytology only, and 24 cases (80%) by histology only; 4) high-grade dysplasia (HGD, 10 cases), with 8 cases (80%) diagnosed with both specimens, 1 case (10%) by cytology, and 1 case (10%) by histology; and 5) carcinomas (23 cases), with 20 cases (87%) diagnosed with both specimens, 2 cases (9%) by cytology only, and 1 case (4%) by histology only. Our results support the high degree of diagnostic accuracy of cytology for the diagnosis of Barrett's-associated HGD and/or carcinoma, and moderate sensitivity for BE. Diagn. Cytopathol. 2003;29:130,135. © 2003 Wiley-Liss, Inc. [source] Report of an EFNS task force on management of sleep disorders in neurologic disease (degenerative neurologic disorders and stroke)EUROPEAN JOURNAL OF NEUROLOGY, Issue 11 2007P. Jennum A task force to develop guidelines for diagnostic evaluation and treatment of sleep disorders in degenerative neurologic disorders and stroke was initiated by the European Federation of Neurological Societies (EFNS). The aims were to provide evidence-based recommendations in the management of sleep disorders associated with degenerative neurologic disorders and stroke. Neurological patients often have significant sleep disorders like sleep-related breathing disorders (SBD), insomnia, sleep-related motor and rapid eye movement behavioral disorders affecting nocturnal sleep and daytime function. A polysomnography (PSG) is usually a diagnostic minimum for the diagnoses of the most commonly reported sleep disorders in patients with neurologic diseases. A full video-PSG/video-EEG-PSG should be considered in patients with nocturnal motor and/behavior manifestations. Respiratory polygraphy has a moderate sensitivity and specificity in the diagnosis of SBD without neurologic diseases, but its value in patients with neurologic diseases has not been evaluated. Oximetry has a poor sensitivity-specificity for the identification of SDB. Continuous and bi-level positive airway pressure devices are the most effective treatment of SDB in patients with neurologic diseases. There is a need for further studies focusing on the diagnostic procedures and treatment modalities in patients with sleep disorders and degenerative neurologic diseases and stroke. [source] The diagnostic utility of MOC31, BerEP4, RCC marker and CD10 in the classification of renal cell carcinoma and renal oncocytoma: an immunohistochemical analysis of 328 casesHISTOPATHOLOGY, Issue 5 2004C-C Pan Aims:, To demonstrate the diagnostic utility of MOC31, BerEP4, renal cell carcinoma marker (RCC Ma) and CD10 in the classification of RCC and renal oncocytoma, based upon a comprehensive immunohistochemical analysis. Methods and results:, Immunohistochemistry was performed on 328 samples consisting of 256 clear cell/conventional, 27 papillary, 28 chromophobe, five collecting duct, five unclassified RCCs and seven renal oncocytomas using antibodies MOC31, BerEP4 and antibodies against cytokeratins (KL-1, CAM5.2, 34,E12, cytokeratin 7), RCC Ma, epithelial membrane antigen, E-cadherin, CD10, CD15 and vimentin. Multivariate analysis showed that MOC31, BerEP4, RCC Ma and CD10 have discriminatory value. MOC31 and BerEP4 chiefly labelled distal tubules of normal kidney while RCC Ma and CD10 labelled the proximal tubules. Twenty-three chromophobe RCCs (82%) were reactive for MOC31, while only four clear cell RCCs and three papillary RCCs were positive for this marker. Clear cell RCCs were characterized by a high positive rate for CD10 (82%) and a low positive rate for BerEP4 (27%). Papillary RCCs frequently coexpressed RCC Ma and BerEP4 (51%). All renal oncocytomas were negative for MOC31 and CD10. Conclusions:, MOC31 has diagnostic merit in discerning chromophobe RCC. The CD10+/BerEP4, profile and RCC Ma+/BerEP4+ profile achieve moderate sensitivity and good specificity for clear cell RCC and papillary RCC, respectively. The non-reactivity for both MOC31 and CD10 is helpful in distinguishing renal oncocytoma from RCC. When properly selected, antibodies have immunohistochemical diagnostic utility for the classification of renal cortical epithelial tumours. [source] Diagnostic utility of light transmission platelet aggregometry: results from a prospective study of individuals referred for bleeding disorder assessmentsJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 4 2009C. P. M. HAYWARD Summary.,Background: Light transmission aggregometry (LTA) is commonly performed to assess individuals for bleeding disorders. Objectives: The goal was to evaluate the incidence and spectrum of platelet function abnormalities in a prospective cohort of individuals referred for bleeding disorder assessments after exclusion of thrombocytopenia and von Willebrand disease. Patients/methods: Subjects were healthy controls and patients from a prospective cohort of individuals referred for bleeding disorder assessments after exclusion of thrombocytopenia and von Willebrand disease. LTA was performed by standardized methods using platelet-rich plasma adjusted to 250 × 109 platelets L,1. Maximal aggregation data were analyzed to determine the likelihood of detecting a platelet function disorder by LTA, and the sensitivity and specificity of LTA for platelet disorders. Results: The incidence of false positive LTA among subjects excluded of having bleeding disorders was similar to healthy controls. Abnormal LTA was more common in subjects with bleeding disorders and the likelihood of a bleeding disorder was significantly increased (odds ratio 32) when maximal aggregation was reduced with two or more agonists. Receiver operator curve analyses indicated that LTA had high specificity and moderate sensitivity for detecting inherited defects in platelet function and that the LTA agonists 1.25 ,g mL,1 collagen, 6 ,M epinephrine, 1.6 mM arachidonic acid and 1.0 ,M thromboxane analogue U44619 detected most inherited disorders with abnormal LTA. Conclusions: LTA is valuable for detecting platelet function abnormalities among individuals referred for bleeding problems, particularly when the test indicates abnormal responses to multiple agonists. [source] Alkali-Dinitramide Salts Part 2: Oxidizers for Special Pyrotechnic ApplicationsPROPELLANTS, EXPLOSIVES, PYROTECHNICS, Issue 4 2006Abstract Ammonium dinitramide is planned to be a substitute for commonly used oxidizers in rocket motor compositions. Different teams worldwide have already synthesized alkali salts of dinitramide and several times it was used as an oxidizer for pyrotechnic compositions containing boron as a reducing agent. In this paper the results of a systematic investigation to characterize the pyrotechnic redox systems titanium/potassium dinitramide and titanium/cesium dinitramide are presented and the data are compared. The heats of reaction as well as the burning rates of the redox system titanium/potassium dinitramide are higher than those of the redox system titanium/cesium dinitramide. Both systems show a moderate sensitivity to friction and electrostatic discharges. However the sensitivity of mixtures of both redox systems shows a very high sensitivity to impact. These sensitivities are in the range of pure HMX or pentaerythritol tetranitrate. [source] Monitoring of sympathetic tone to assess postoperative pain: skin conductance vs surgical stress indexANAESTHESIA, Issue 7 2009T. Ledowski Summary The number of fluctuations in skin conductance per second has been described as a potential tool for monitoring postoperative pain. More recently, the surgical stress index has shown promising correlations with intra-operative painful stimuli. We compared both methods for their ability to assess postoperative pain, in 100 postoperative patients who were also asked to quantify their level of pain at different time points in the recovery room. The number of fluctuations per second and surgical stress index were significantly different between pain scoring , 5/10 and > 5/10 on a numeric rating scale (mean (SE) number of fluctuations per second 0.12 (0.02) vs 0.21 (0.03), respectively; p = 0.017, and surgical stress index 57 (1.4) vs 64 (1.9) points, respectively; p = 0.001). Both number of fluctuations in skin conductance per second and surgical stress index identified timepoints with moderate to severe pain with only moderate sensitivity and specificity. [source] Salinity-induced changes in essential oil, pigments and salts accumulation in sweet basil (Ocimum basilicum) in relation to alterations of morphological developmentANNALS OF APPLIED BIOLOGY, Issue 2 2010N. Bernstein The objective of the project was to study salinity-induced effects on essential oil, pigments and salts accumulation in sweet basil (Ocimum basilicum, the cultivar Perrie) in relation to the alteration of plant morphological development and yield production. Hydroponically grown plants were exposed to one of six NaCl concentrations (1, 25, 50, 75, 100 and 130 mM NaCl). Inhibitory effects of salinity on biomass production of the shoot and the root, and area of individual leaves were apparent already under cultivation with 25 mM NaCl. Elevation of salinity from 1 to 100 mM NaCl induced 63% and 61% reductions in fresh and dry herb biomass production, respectively. The stress-induced reduction of foliage biomass sourced mainly from inhibition of leaf area development rather than reduction of internode and leaf number. Cl and Na concentrations in the leaves, stems and roots increased with elevation of NaCl concentration in the cultivation solution. While the extent of Cl accumulation was leaves>stems>roots, Na was largely excluded from the leaves and was preferentially accumulated in roots and the stems, potentially accounting for the moderate sensitivity of the leaf tissue to salinity. Salt stress increased the contents of essential oil and carotenoids in the leaves that may further account for the moderate sensitivity of sweet basil to salinity and suggest a potential for agro-industrial production. A twofold increase in both carotenoid concentration and the percent of essential oil in the fresh tissue was observed by elevation of the salinity from 1 to 130 mM NaCl. Overall, the stress induced increase of the percent of essential oil in the tissue in the salinity range 1,75 mM NaCl was about 50%, and thereby compensated for the similar reduction of biomass production in this salinity range, so that oil production on per plant basis was not reduced by salinity. [source] Use of Quantitative Broad-based Polymerase Chain Reaction for Detection and Identification of Common Bacterial Pathogens in Cerebrospinal FluidACADEMIC EMERGENCY MEDICINE, Issue 7 2010Richard Rothman MD ACADEMIC EMERGENCY MEDICINE 2010; 17:741,747 © 2010 by the Society for Academic Emergency Medicine Abstract Background:, Conventional laboratory diagnosis of bacterial meningitis based on microscopy followed by culture is time-consuming and has only moderate sensitivity. Objectives:, The objective was to define the limit of detection (LOD), analytic specificity, and performance characteristics of a broad-based quantitative multiprobe polymerase chain reaction (PCR) assay for rapid bacterial detection and simultaneous pathogen-specific identification in patients with suspected meningitis. Methods:, A PCR algorithm consisting of initial broad-based detection of Eubacteriales by a universal probe, followed by pathogen identification using either pathogen-specific probes or Gram-typing probes, was employed to detect pathogens. The 16S rRNA gene, which contains both conserved and variable regions, was chosen as the target. Pathogen-specific probes were designed for Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, and Listeria monocytogenes. Gram-positive and -negative typing probes were designed based on conserved regions across all eubacteria. The LOD and time to detection were assessed by dilutional mocked-up samples. A total of 108 convenience cerebrospinal fluid (CSF) clinical samples obtained from the Johns Hopkins Hospital (JHH) microbiology laboratory were tested, and results were compared with hospital microbiologic culture reports. Results:, The LOD of the assay ranged from 101 to 102 colony-forming units (CFU)/mL. Pathogen-specific probes showed no cross-reactivity with other organisms. Time to detection was 3 hours. In clinical specimens, the universal probe correctly detected 16 of 22 culture-positive clinical specimens (sensitivity = 72.7%; 95% confidence interval [CI] = 49.8% to 89.3%), which were all correctly characterized by either pathogen-specific or Gram-typing probes. Adjusted sensitivity after removing probable microbiologic laboratory contaminants was 88.9% (95% CI = 65.3% to 98.6%). The universal probe was negative for 86 of 86 culture-negative specimens. Conclusions:, A broad-based multiprobe PCR assay demonstrated strong analytic performance characteristics. Findings from a pilot clinical study showed promise in translation to human subjects, supporting potential utility of the assay as an adjunct to traditional diagnostics for early identification of bacterial meningitis. [source] | ||||||||||