DIGESTIVE ENDOSCOPY, Issue 2009
Kiyohito Tanaka
In the screening of early pancreatic cancer and bile duct cancer, the first issue was ,what are the types of abnormality in laboratory data and symptoms in case of early pancreatic cancer and bile duct cancer?' Early cancer in the pancreaticobiliary region has almost no symptoms, however epigastralgia without abnormality in the gastrointestinal (GI) tract is a sign of early stage pancreaticobiliary cancer. Sudden onset and aggravation of diabetes mellitus is an important change in the case of pancreatic cancer. Extracorporeal ultrasonography is a very useful procedure of checking up changes of pancreatic and biliary lesions. As the role of endoscopy in screening, endoscopic ultrasonography (EUS) is the most effective means of cancer detection of the pancreas, and endoscopic retrograde cholangiopancreatography (ERCP) is most useful of diagnosis tool for abnormalities of the common bile duct. Endoscopic retrograde cholangiopancreatography is an important modality as the procedure of sampling of diagnostic materials. Endoscopic ultrasonography-fine needle aspiration (EUS-FNA) has the role of histological diagnosis of pancreatic mass lesion also. Especially, in the case of pancreas cancer without evidence of cancer by pancreatic juice cytology and brushing cytology, EUS-FNA is essential. Intra ductal ultrasonography (IUDS) and perotral cholangioscopy (POCS) are useful for determination of mucosal extent in extrahepatic bile duct cancer. Further improvements of endoscopical technology, endoscopic procedures are expected to be more useful modalities in detection and diagnosis of early pancreatic and bile duct cancers. [source]

MULTIPLE CRITERIA SCREENING OF A LARGE WATER POLICY SUBSET SELECTION PROBLEM,

JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 3 2001
Siamak Rajabi
ABSTRACT: A new screening approach is applied to a large-scale multiple criteria water management problem to remove actions that cannot possibly be in the best subset. An inherent advantage of the approach is its ability to identify inferior actions by examining them individually, rather than within subsets. In a case study involving the selection of actions to address high water levels in the Great Lakes-St. Lawrence Basin, two statistical indicators, the mode and the mean, are used to aggregate the opinions of experts and representatives of interest groups on the impacts of actions according to various criteria. Application of the screening approach shows that some of the proposed actions can be removed as they can never be in the optimal subset, thereby reducing the size of the problem. [source]

BEWARE: SCREENING IS NOT ASSESSMENT WHEN IT COMES TO MALNUTRITION

NUTRITION & DIETETICS, Issue 2 2010
Cheryl Watterson BSc
No abstract is available for this article. [source]

Recurrence of kernicterus in term and near-term infants in Denmark

ACTA PAEDIATRICA, Issue 10 2000
F Ebbesen
Classical acute bilirubin encephalopathy (kernicterus) in term and near-term infants had not been seen in Denmark for at least 20 y until 1994. From 1994 to 1998, however, six cases were diagnosed. Aetiology of the hyperbilirubinaemia was known in two infants; spherocytosis and galactosaemia, most likely known in two infants; possible A-O blood type immunization, and unknown in two infants. However, one of these last-mentioned infants had a gestational age of only 36 wk. The maximum plasma total bilirubin concentrations were 531,745 ,mol/L. The increase in the number of cases of kernicterus was considered to have been caused by: (i) a decreased awareness of the pathological signs, (ii) a change in the assessment of the risk of bilirubin encephalopathy, (iii) early discharge of the infants from the maternity ward, (iv) so-called breastfeeding-associated jaundice, (v) demonstration of bilirubin being an antioxidant, and (vi) difficulty in estimating the degree of jaundice in certain groups of immigrants. Accordingly, for prevention: (a) Attempt to change the healthcare workers' understanding of the risk of bilirubin encephalopathy, (b) give further instructions, both orally and in writing, to mothers before discharge from the maternity ward, (c) be more liberal in giving infant formula supplements, (d) conduct home visits by the community nurse at an earlier stage, (e) follow authorized guidelines for phototherapy and exchange transfusion, (f) lower plasma bilirubin concentration limits as an indication for phototherapy and exchange transfusion, (g) screen all term and near-term infants, and (h) measure the skin's yellow colour with a device that corrects for the skin's melanin content. Conclusions: Audit of the six cases presented indicates that measures are necessary in both the primary and secondary healthcare sectors if the risk of kernicterus is to be avoided. Screening may be considered, but in order to identify the problems it would first be reasonable to perform a larger prospective study in which audit is performed on all newborn infants, born at term and near-term, who develop a plasma bilirubin concentration above the exchange transfusion limit. [source]

BNP Consensus Panel 2004: A Clinical Approach for the Diagnostic, Prognostic, Screening, Treatment Monitoring, and Therapeutic Roles of Natriuretic Peptides in Cardiovascular Diseases

CONGESTIVE HEART FAILURE, Issue 2004
Marc A. Silver MD
Among the most exciting developments in the field of heart failure in recent times has been the rediscovery of the natriuretic peptide system and its pleuripotent effects on cardiac structure and function. This is particularly true of its natriuretic and hemodynamic effects. There has been an explosion of the knowledge base seeking to understand the wide range of homeostatic, regulatory, and counter-regulatory functions in which the natriuretic peptide system participates. Additional interest has been stimulated by advances in technology such as point-of-care and core laboratory BNP assays and the use of the recombinant B-type natriuretic peptide nesiritide as a treatment option. Despite this recent interest, the available literature lacks a comprehensive expert review of the current science and roles of natriuretic peptides for diagnostic, prognostic, screening, treatment monitoring, and therapeutic purposes. More importantly, a summary updating and guiding the clinician on most of these advances was lacking. An expert Consensus Panel with basic, methodological, and clinical expertise was convened to summarize current knowledge in these areas and the findings and consensus statements are contained herein. [source]

Sesquiterpene lactone dermatitis in the young: is atopy a risk factor?

CONTACT DERMATITIS, Issue 1 2008
Evy Paulsen
Screening for Compositae contact allergy has documented fairly high prevalence in adults, and recent studies indicate that the allergy may be more common in children than previously believed. However, detailed information on sensitization in this age group is sparse. The objective of this study was to present another 2 cases in children and review the literature. Screening with sesquiterpene lactone (SL) mix has shown prevalence of 0.5% and 1.8% in 2 studies, while screening with 2 different Compositae mixes detected 4.2% and 2.6% positives among children and adolescents. All individual case reports describe sensitization in atopic children, and the largest screening study showed a prevalence of Compositae mix sensitization that was significantly higher in children with atopic dermatitis compared with non-atopics. Compositae sensitization should be considered in children with a family or personal history of atopy, summer-related, or -exacerbated dermatitis of any kind, and a history of plant exposure. Screening with SL mix is recommended but should be supplemented with plant extracts based on exposure history. Compositae weeds, especially dandelions, seem to be important sensitizers in children. [source]

European guidelines for quality assurance in cervical cancer screening: recommendations for cytology laboratories,

CYTOPATHOLOGY, Issue 2 2007
H. G. Wiener
The quality of a cervical cytology laboratory depends on adequate handling and staining of the samples, screening and interpretation of the slides and reporting of the results. These guidelines give an overview of procedures recommended in Europe to manage the balance between best patient care possible, laboratory quality assurance and cost effectiveness and will be published as a chapter 4 in the European Guidelines for Quality Assurance in Cervical Cancer Screening. The laboratory guidelines include protocols for personnel and organisation, material requirements, handling and analysing cervical samples, recording of results, quality management and communication. The section on quality management is comprehensive and includes protocols for all aspects of internal and external quality assurance. The guidelines are extensively referenced and as far as possible the recommendations are evidence-based. [source]

Screening for type 2 diabetes: an update of the evidence

DIABETES OBESITY & METABOLISM, Issue 10 2010
R. K. Simmons
A growing body of evidence on diabetes screening has been published during the last 10 years. Type 2 diabetes meets many but not all of the criteria for screening. Concerns about potential harms of screening have largely been resolved. Screening identifies a high-risk population with the potential to gain from widely available interventions. However, in spite of the findings of modelling studies, the size of the benefit of earlier initiation of treatment and the overall cost-effectiveness remains uncertain, in contrast to other screening programmes (such as for abdominal aortic aneurysms) that are yet to be fully implemented. There is also uncertainty about optimal specifications and implementation of a screening programme, and further work to complete concerning development and delivery of individual- and population-level preventive strategies. While there is growing evidence of the net benefit of earlier detection of individuals with prevalent but undiagnosed diabetes, there remains limited justification for a policy of universal population-based screening for type 2 diabetes at the present time. Data from ongoing studies should inform the key assumptions in existing modelling studies and further reduce uncertainty. [source]

Screening and diagnosis of prediabetes: where are we headed?

DIABETES OBESITY & METABOLISM, Issue 2007
K. G. M. M. Alberti
It is currently estimated that more than 300 million people have impaired glucose tolerance (IGT), putting them at increased risk for type 2 diabetes mellitus (T2DM) and its adverse consequences. In addition, many others are at risk on the basis of a family history of T2DM, obesity, dyslipidaemia and hypertension. Screening for risk should include both blood glucose testing in high-risk populations and prescreening (e.g. by questionnaire, waist circumference measurement) to identify high-risk individuals in overall low-risk populations; these individuals should then undergo glucose testing. Fasting plasma glucose measurement cannot diagnose IGT; the preferred definite test for diagnosis is oral glucose tolerance testing. [source]

Screening for diabetes in Indigenous populations using glycated haemoglobin: sensitivity, specificity, post-test likelihood and risk of disease

DIABETIC MEDICINE, Issue 7 2005
K. G. Rowley
Abstract Aims Screening for diabetes using glycated haemoglobin (HbA1c) offers potential advantages over fasting glucose or oral glucose tolerance testing. Current recommendations advise against the use of HbA1c for screening but test properties may vary systematically across populations, according to the diabetes prevalence and risk. We aimed to: (i) characterize the properties of test cut-offs of HbA1c for diagnosis of diabetes relative to a diagnosis based on a fasting plasma glucose concentration of 7.0 mmol/l for high-risk Indigenous populations; and (ii) examine test properties across a range of diabetes prevalence from 5 to 30%. Methods Data were collected from Aboriginal and Torres Strait Islander communities in Australia and a Canadian First Nations community (diabetes prevalence 12,22%) in the course of diabetes diagnostic and risk factor screening programmes (n = 431). Screening test properties were analyzed for the range of HbA1c observed (3,12.9%). Results In separate and pooled analyses, a HbA1c cut point of 7.0% proved the optimal limit for classifying diabetes, with summary analysis results of sensitivity = 73 (56,86)%, specificity = 98 (96,99)%, overall agreement (Youden's index) = 0.71, and positive predictive value (for an overall prevalence of 18%) = 88%. For diabetes prevalence from 5 to 30% the post-test likelihood of having diabetes given HbA1c = 7.0% (positive predictive value) ranged from 62.7 to 93.2%; for HbA1c < 7.0%, the post-test likelihood of having diabetes ranged from 4.5 to 27.7%. Conclusions The results converge with research on the likelihood of diabetes complications in supporting a HbA1c cut-off of 7.0% in screening for diabetes in epidemiological research. Glycated haemoglobin has potential utility in screening for diabetes in high-risk populations. [source]

Prospective screening for biopsy proven coeliac disease, autoimmunity and malabsorption markers in Belgian subjects with Type 1 diabetes

DIABETIC MEDICINE, Issue 7 2005
M. Buysschaert
Abstract Aims To determine prospectively the prevalence of biopsy proven coeliac disease (CD) in an adult Type 1 diabetic population from Belgium with regards to associated auto-immunity and malabsorption. Methods and results Determination in 400 Type 1 diabetic patients of serum anti-endomysial and/or anti-transglutaminase auto-antibodies. All subjects with abnormal serology underwent an intestinal biopsy. Ten patients (2.5%) had positive antibodies. Diagnosis of CD was confirmed by an intestinal biopsy. Eight patients were symptom-free, although laboratory findings suggesting malabsorption were prominent in the presence of CD [microcytic anaemia, iron and folate deficiencies, low levels of 25(OH)vitamin D3, calcium and cholesterol]. Other auto-immune conditions, especially vitiligo, were found in patients with CD. Conclusions Asymptomatic coeliac disease occurs frequently in adult Type 1 diabetic patients, and is often associated with subclinical malabsorption. Screening should be part of routine evaluation, to implement life-long dietary gluten avoidance. [source]

Preservation of sight in diabetes: developing a national risk reduction programme

DIABETIC MEDICINE, Issue 9 2000
L. Garvican
SUMMARY Background Early treatment for diabetic retinopathy is effective at saving sight, but dependent on pre-symptomatic detection. Although 60% of people with diabetes have their eyes examined annually, few UK health authorities have systematic programmes that meet the British Diabetic Association's standards for sensitivity (> 80%) and specificity (> 95%). Screening is generally performed by general practitioners and optometrists, with some camera-based schemes, operated by dedicated staff. The National Screening Committee commissioned a group to develop a model and cost estimates for a comprehensive national risk-reduction programme. Ophthalmoscopy Evidence indicates that direct ophthalmoscopy using a hand-held ophthalmoscope does not give adequate specificity and sensitivity, and should be abandoned as a systematic screening technique. Indirect ophthalmoscopy using a slit lamp is sensitive and specific enough to be viable, and widespread availability in high street optometrists is an advantage, but the method requires considerable skill. Photographic schemes The principal advantage of camera-based screening is the capturing of an image, for patient education, review of disease progression, and quality assurance. Digital cameras are becoming cheaper, and are now the preferred option. The image is satisfactory for screening and may be transmitted electronically. With appropriate training and equipment, different professional groups might participate in programme delivery, based on local decisions. Cost issues Considerable resources are already invested in ad hoc screening, with inevitable high referral rates incurring heavy outpatient costs. Treatment for advanced disease is expensive, but less likely to be effective. The costs of a new systematic screening and treatment programme appear similar to current expenditure, as a result of savings in treatment of late-presenting advanced retinopathy. Conclusion A systematic national programme based on digital photography is proposed. [source]

Assessment of specimen adequacy reproducibility: An Italian experience

DIAGNOSTIC CYTOPATHOLOGY, Issue 4 2003
Gioia Montanari M.D.
Abstract Interobserver disagreement on smear adequacy may influence the evaluation of the performance of samplers as well as Pap test sensitivity and follow-up. In 1998, the Italian Group for Cervical Cancer Screening (GISCi) promoted a study on the reproducibility of adequacy criteria using a modified version of the Bethesda system. A set of 200 smears was circulated among six Italian laboratories situated in different parts of the country. For each smear, participants were requested to provide a summary judgment on its adequacy and on the cause(s) of inadequacy, if any. Agreement was measured using kappa-type statistics. The agreement among laboratories was generally good. In comparisons, among five laboratories, kappa values ranged from 0.47 to 0.66. At the consensus meeting on 42 slides, on which at least 2 laboratories dissented from the majority, agreement was reached unanimously for 31 reviewed slides and among 5,6 centers for 11. In this article, some guidance is given in order to attribute to one of the two categories satisfactory/unsatisfactory those smears that have been traditionally considered as candidates for the category of "satisfactory but limited by ," (SBLB). New Italian guidelines on adequacy proposed the GISCi are presented and the recommendation is made to eliminate the SBLB category. Diagn. Cytopathol. 2003;28:224,226. © 2003 Wiley-Liss, Inc. [source]

Six-month outcomes associated with a brief alcohol intervention for adult in-patients with psychiatric disorders

DRUG AND ALCOHOL REVIEW, Issue 2 2002
GARY K. HULSE
Abstract The objective of this study was to evaluate the 6-month outcomes of a brief intervention to reduce alcohol consumption by psychiatric in-patients in the general hospital setting and following resolution of psychiatric morbidity. Patients from the psychiatric wards of three general hospitals were screened using the Alcohol Use Disorders Identification Test. Of 144 people approached who matched the study criteria, 120 (83%) people aged 18,64 years (mean 31.7) were recruited. Participants were randomized to either a brief motivational interview or an information package to reduce alcohol consumption. Alcohol consumption was assessed as total weekly consumption and categorized on Australian National Health and Medical Research Council (NH&MRC) criteria. We delivered 62 motivational interviews and 58 information packages. At the 6-month follow-up 83 (69%), participants were reassessed. Both groups had significantly reduced alcohol consumption. However, the motivation group had a significantly greater reduction in weekly consumption than the information group (F = 6.8, (1,65) p < 0.025) after controlling for age, sex, SCL-90-R GSI and alcohol dependence (and baseline alcohol consumption). A greater proportion of the motivation group compared to the information group also ,improved' in their classification on NH&MRC criteria (,2 = 7.3, df 1, p < 0.01). Brief interventions, especially motivational interviews, are effective in reducing alcohol use in persons with psychiatric disorders. They are effective across the mid-range of GSI severity scores for in-patients. Screening and brief interventions can and should be incorporated into the routine assessment and management in psychiatric units. [source]

The Effects of Screening and Monitoring on Credit Rationing of SMEs

ECONOMIC NOTES, Issue 2 2008
Mariarosaria Agostino
In this paper, we seek to empirically assess which determinants of the capability and incentives of banks to screen and monitor firms are significant in explaining credit rationing to Italian SMEs. After testing for the presence of non-random selection bias and the potential endogeneity of some determinants of interest, the probit model results we obtain suggest that the average banking size and the multiple banking relationship phenomenon are statistically significant factors affecting credit rationing, presumably through their impact on the aforementioned banks' capability and incentives. Other potential determinants of banks' incentives to monitor and screen, such as local banking competition and firm' capacity to collateralize, are never significant. However, when we split the sample according to the level of competition in credit markets, we find that the estimated marginal effects of all significant determinants of interest are larger in absolute value than those obtained when using the whole sample. [source]

Impedance Spectroscopy: A Powerful Tool for Rapid Biomolecular Screening and Cell Culture Monitoring

ELECTROANALYSIS, Issue 23 2005
Isaac
Abstract Dielectric spectroscopy or Electrochemical impedance spectroscopy (EIS) is traditionally used in corrosion monitoring, coatings evaluation, batteries, and electrodeposition and semiconductor characterization. However, in recent years, it is gaining widespread application in biotechnology, tissue engineering, and characterization of biological cells, disease diagnosis and cell culture monitoring. This article discusses the principles and implementation of dielectric spectroscopy in these bioanalytical applications. It provides examples of EIS as label-free, mediator-free strategies for rapid screening of biocompatible surfaces, monitoring pathogenic bacteria, as well as the analysis of heterogeneous systems, especially biological cells and tissues. Descriptions are given of the application of nanoparticles to improve the analytical sensitivities in EIS. Specific examples are given of the detection of base pair mismatches in the DNA sequence of Hepatitis B disease, TaySach's disease and Microcystis spp. Others include the EIS detection of viable pathogenic bacteria and the influence of nanomaterials in enhancing biosensor performance. Expanding applications in tissue engineering such as adsorption of proteins onto thiolated hexa(ethylene glycol)-terminated (EG6) self-assembled monolayer (SAM) are discussed. [source]

Development of a Rapid Single-Drop Analysis Biosensor for Screening of Phenanthrene in Water Samples

ELECTROANALYSIS, Issue 20 2004

Abstract Detection techniques for biosensors often require bulky instruments or cells that are not feasible for in-field analysis. Our single-drop cell design, optimized in this work, comprised a screen-printed three-electrode (SPE), strip in horizontal position onto which a volume of 100,,L of sample or substrate solution was placed to ensure electrical contact (complete circuit). Together with optimized linear sweep voltammetry (LSV), parameters for the detection of the enzyme alkaline phosphatase (AP), the system was applied to a biosensor for the analysis of polycyclic aromatic hydrocarbons (PAHs), in environmental samples. A limit of detection (LOD), of 0.15,ppb was achieved for a model system with an IC50 value of 0.885 ppb and a linear range (LR), of 0.2,10,ppb. Application of the single drop analysis (SDA), format to a PAH biosensor gave a LOD of 1.4,ppb for detection of phenanthrene with an IC50 value of 29.3,ppb and linear range of 2,100,ppb. Proof of concept is shown with spiked sample analysis of phenanthrene in matrices such as sea, river and tap water. [source]

Screening, Characterization and Application of Cyanide-resistant Nitrile Hydratases

ENGINEERING IN LIFE SCIENCES (ELECTRONIC), Issue 6 2004
T. Gerasimova
Abstract Two new bacterial strains, Pseudomonas marginales MA32 and Pseudomonas putida MA113, containing nitrile hydratases resistant to cyanide were isolated from soil samples by an enrichment procedure. In contrast to known nitrile hydratases, which rapidly lose activity at low to moderate cyanide concentrations, the enzymes described in this paper tolerate up to 50 mM cyanide. They show a broad substrate spectrum including not only small substrates like acrylonitrile but also nitriles with longer side chains and even nitriles with quarternary alpha-carbon atoms. Both characteristics are essential for the transformation of ketone cyanohydrins, which are much more instable and therefore releasing much higher amounts of prussic acid than cyanohydrins formed from aldehydes. P. marginales MA32 was used as a whole cell biocatalyst for the hydration of acetone cyanohydrin to ,-Hydroxyisobutyramide, which is a precursor of methacrylamide, an important pre-polymer. After optimization of the process conditions a maximum amide concentration of more than 1.6 M could be reached within 5 hours with 5,g/L biocatalyst referred to cell dry weight. [source]

Case Study: Chemical Screening at Eastman Kodak Company

ENVIRONMENTAL QUALITY MANAGEMENT, Issue 3 2001
Michele Ochsner
This case study is the final installment in a four-part series profiling environmental decision making at leading companies. © 2001 John Wiley & Sons, Inc. [source]

Competitive binding comparison of endocrine-disrupting compounds to recombinant androgen receptor from fathead minnow, rainbow trout, and human

ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 9 2007
Vickie S. Wilson
Abstract Typically, in vitro hazard assessments for the identification of endocrine-disrupting compounds (EDCs), including those outlined in the Endocrine Disruptor Screening and Testing Advisory Committee (EDSTAC) Tier 1 Screening protocols, utilize mammalian receptors. Evidence, however, exists that fish sex steroid hormone receptors differ from mammalian receptors both structurally and in their binding affinities for some steroids and environmental chemicals. Most of the binding studies to date have been conducted using cytosolic preparations from various tissues. In the present study, we compare competitive binding of a set of compounds to full-length recombinant rainbow trout androgen receptor , (rtAR), fathead minnow androgen receptor (fhAR), and human androgen receptor (hAR), each expressed in COS cells. Saturation binding and subsequent Scatchard analysis using [3H]R1881, a high-affinity synthetic androgen, revealed an equilibrium dissociation constant (Kd) of 0.11 nM for the rtAR, 1.8 nM for the fhAR, and 0.84 nM for the hAR. Compounds, including endogenous and synthetic steroids, known mammalian antiandrogens, and environmental compounds, were tested for competitive binding to each of the three receptors. Overall, agreement existed across receptors as to binding versus nonbinding for all compounds tested in this study. Minor differences, however, were found in the relative order of binding of the compounds to the individual receptors. Studies such as these will facilitate the identification of EDCs that may differentially affect specific species and aid in the development and support of future risk assessment protocols. [source]

A novel amphibian tier 2 testing protocol: A 30-week exposure of Xenopus tropicalis to the antiandrogen flutamide

ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 3 2007
Paul L. Knechtges
Abstract In 1996, the U.S. Congress mandated the development of a screening program for endocrine-disrupting chemicals (EDCs) using validated test systems. Subsequently, the Endocrine Disruptor Screening and Testing Advisory Committee recommended the development of a standardized amphibian assay for tier 2 testing of EDCs. For that reason, a tier 2 testing protocol using Xenopus (Silurana) tropicalis and a 30-week, flow-through exposure to the antiandrogen flutamide from stage 46 tadpoles through sexually mature adult frogs were developed and evaluated in this pilot study. The endpoints for this study included measurements of frog body lengths and weights, liver weights, ovary/egg mass weights, testicular and ovarian histopathology, plasma vitellogenin levels, and notes on any abnormalities observed at necropsy. Increasing exposure concentrations to flutamide caused significant increases in frogs with no recognizable gonadal tissue and increased body and liver weights in male frogs, whereas the body lengths and weights decreased significantly in female frogs. Important issues must be resolved before a tier 2 amphibian assay can be further developed and validated, including the establishment of baseline values in the controls for the parameters under study; the maintenance, measurement, and timing of exposure concentrations; and the development of additional biomolecular markers of effect. This study demonstrated the feasibility of conducting long-term EDC exposure studies using X. tropicalis. [source]

Screening of the European Union New Chemicals Database concerning an aquatic exposure threshold of no concern

ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 2 2007
Birgit Sokull-Klüttgen
No abstract is available for this article. [source]

Validation of a brief screening instrument for the ascertainment of epilepsy

EPILEPSIA, Issue 2 2010
Ruth Ottman
Summary Purpose:, To validate a brief screening instrument for identifying people with epilepsy in epidemiologic or genetic studies. Methods:, We designed a nine-question screening instrument for epilepsy and administered it by telephone to individuals with medical record,documented epilepsy (lifetime history of ,2 unprovoked seizures, n = 168) or isolated unprovoked seizure (n = 54), and individuals who were seizure-free on medical record review (n = 120), from a population-based study using Rochester Epidemiology Project resources. Interviewers were blinded to record-review findings. Results:, Sensitivity (the proportion of individuals who screened positive among affected individuals) was 96% for epilepsy and 87% for isolated unprovoked seizure. The false positive rate (FPR, the proportion who screened positive among seizure-free individuals) was 7%. The estimated positive predictive value (PPV) for epilepsy was 23%, assuming a lifetime prevalence of 2% in the population. Use of only a single question asking whether the subject had ever had epilepsy or a seizure disorder resulted in sensitivity 76%, FPR 0.8%, and estimated PPV 66%. Subjects with epilepsy were more likely to screen positive with this question if they were diagnosed after 1964 or continued to have seizures for at least 5 years after diagnosis. Discussion:, Given its high sensitivity, our instrument may be useful for the first stage of screening for epilepsy; however, the PPV of 23% suggests that only about one in four screen-positive individuals will be truly affected. Screening with a single question asking about epilepsy yields a higher PPV but lower sensitivity, and screen-positive subjects may be biased toward more severe epilepsy. [source]

Preventive Care in the Emergency Department: Should Emergency Departments Conduct Routine HIV Screening?

ACADEMIC EMERGENCY MEDICINE, Issue 3 2003
A Systematic Review
Abstract Objective: To perform a systematic review of the emergency medicine literature to assess the appropriateness of offering routine HIV screening to patients in the emergency department (ED). Methods: The systematic review was conducted with the aid of a structured template, a companion explanatory guide, and a grading and methodological scoring system based on published criteria for critical appraisal. Two reviewers conducted independent searches using OvidR, PubMed, MD Consult, and Grateful Med. Relevant abstracts were reviewed; those most pertinent to the stated objective were selected for complete evaluation using the structured template. Results: Fifty-two relevant abstracts were reviewed; of these, nine were selected for detailed evaluation. Seven ED-based prospective cross-sectional seroprevalence studies found HIV rates of 2,17%. Highest rates of infection were seen among patients with behavioral risks such as male homosexual activity and intravenous drug use. Two studies demonstrated feasibility of both standard and rapid HIV testing in the ED, with more than half of the patients approached consenting to testing by either method, consistent with voluntary testing acceptance rates described in other settings. Several cost,benefit analyses lend indirect support for HIV screening in the ED. Conclusions: Multiple ED-based studies meeting the Centers for Disease Control and Prevention Guideline threshold to recommend routine screening, in conjunction with limited feasibility trials and extrapolation from cost,benefit studies, provide evidence to recommend that EDs offer HIV screening to high-risk patients (i.e., those with identifiable risk factors) or high-risk populations (i.e., those where HIV seroprevelance is at least 1%). [source]

Ultrasonographic Screening of Clinically-suspected Necrotizing Fasciitis

ACADEMIC EMERGENCY MEDICINE, Issue 12 2002
Zui-Shen Yen MD
Objective: To determine the accuracy of ultrasonography for the diagnosis of necrotizing fasciitis. Methods: This study was a prospective observational review of patients with clinically-suspected necrotizing fasciitis presenting to the emergency department of an urban (Taipei) medical center between October 1996 and May 1998. All patients underwent ultrasonographic examination, with the ultrasonographic diagnosis of necrotizing fasciitis based on the criterion of a diffuse thickening of the subcutaneous tissue accompanied by a layer of fluid accumulation more than 4 millimeters in depth along the deep fascial layer, when compared with the contralateral position on the corresponding normal limb. The final diagnosis of necrotizing fasciitis was determined by pathological findings for patients who underwent fasciotomy or biopsy results for patients managed nonoperatively. Results: Data were collected for 62 patients, of whom 17 (27.4%) were considered to suffer from necrotizing fasciitis. Ultrasonography revealed a sensitivity of 88.2%, a specificity of 93.3%, a positive predictive value of 83.3%, a negative predictive value of 95.4%, and an accuracy of 91.9% as regards the diagnosis of necrotizing fasciitis. Conclusions: Ultrasonography can provide accurate information for emergency physicians for the diagnosis of necrotizing fasciitis. [source]

Screening for fetal alcohol syndrome: is it feasible and necessary?

ADDICTION BIOLOGY, Issue 2 2000
Larry Burd
The potential to utilize screening strategies to improve the identification and outcome of persons with fetal alcohol syndrome (FAS) is reviewed. FAS is a condition where screening and surveillance activities would be appropriate. Development of FAS screening and surveillance programs is encouraged because the disorder is expensive. People with FAS have poor outcomes as adults with less than 10% living independently. Several useful tools and models are available. Screening would improve ascertainment and prevalence estimates. Early identification could improve access to services and long term outcome, secondary disabilities and, by extension, excess disability in affected children could be decreased. Lastly, mothers who are at the highest risk to have additional children with FAS could be identified and offered treatment. While both screening and surveillance activities are discussed, the principle focus of this article is a review of the screening process. Two screening tools and several screening methodologies for FAS are available. Since no test will be appropriate in all settings, screening tests need to be selected depending on the setting and population of interest. Screening for FAS should be conducted in a variety of settings and in populations of both high and moderate risk. The results would also provide important data to influence public policy development and resource allocation. Appropriate evaluation of the efficacy, efficiency and effectiveness of FAS screening tools and methodologies would be important before utilization in screening programs. [source]

Screening of the Interactions Between Mg-PSZ and TRIP-Steel and Its Alloys During Sintering,

ADVANCED ENGINEERING MATERIALS, Issue 6 2010
Christian Weigelt
Ceramic,steel compound materials are used in a wide range of applications up to date. Major advantages are the mechanical properties due to the combination of brittle ceramic with tough steel. This study deals with effects of the sintering process on austenitic TRIP-steel/Mg-PSZ composite materials for mechanical load applications. Both, the FeCrNisteel and partially stabilized zirconia offer their special mechanical behavior only in a metastable state. The ability of phase transformation depends mainly on the chemical composition. Mutual interactions of the alloying metals (Cr, Ni, Mn, and Fe) and the ceramic stabilizer (MgO) during sintering may prevent the martensitic phase transformation. This may cause disadvantageous mechanical behavior on mechanical load in use. [source]

Synthesis of 3,-BODIPY-Labeled Active Esters of Nucleotides and a Chemical Primer Extension Assay on Beads

EUROPEAN JOURNAL OF ORGANIC CHEMISTRY, Issue 19 2010
Kerstin Gießler
Abstract A solution-phase synthesis of active esters of 3,-fluorophore-labeled deoxynucleoside 5,-monophosphates was developed for thymine and cytosine as nucleobases by using two different BODIPY dyes. Starting from the respective 2,-amino-2,,3,-dideoxynucleoside-5,-monophosphate, the fluorescent oxyazabenzotriazolides can be prepared in one-pot procedures involving labeling and activation. Screening of a range of supports led to a chemical primer extension assay on beads with in situ detection of nucleobases in target DNA through optical read-out. [source]

Alkyne Hydroarylations with Chelating Dicarbene Palladium(II) Complex Catalysts: Improved and Unexpected Reactivity Patterns Disclosed Upon Additive Screening,

EUROPEAN JOURNAL OF ORGANIC CHEMISTRY, Issue 19 2009
Andrea Biffis
Abstract Palladium(II) complexes with a ligand set made from a chelating N-heterocyclic dicarbene ligand and two weakly coordinating anions (generally introduced in situ upon addition of 2 equiv. of a suitable silver salt) were found to be very active and selective catalysts for the room-temperature hydroarylation of alkynes at low catalyst loading (0.1 mol-%). Moreover, the screening of various strong acids as reaction promoters revealed that both the strength of the acid and the coordinating ability of its conjugated base influence the catalytic performance. Most remarkably, the use of HBF4 together with a dicarbene Pd complex catalyst provides a dramatic change in the selectivity of the reaction, with the prevalent formation of a product stemming from the insertion of two molecules of alkyne into the aromatic C,H bond. The results presented herein highlight the fact that the dicarbene ligand, apart from stabilising the catalyst, is also able to enhance catalytic activity and, most notably, to steer the reaction selectivity towards novel products. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2009) [source]

Hydrophobically Directed Aldol Reactions: Polystyrene-Supported L -Proline as a Recyclable Catalyst for Direct Asymmetric Aldol Reactions in the Presence of Water,

EUROPEAN JOURNAL OF ORGANIC CHEMISTRY, Issue 28 2007
Michelangelo Gruttadauria
Abstract A simple synthetic methodology for the preparation of a polystyrene-supported L -proline material is reported, and this material has been used as catalyst in direct asymmetric aldol reactions between several ketones and arylaldehydes to furnish aldol products in high yields and stereoselectivities. Screening of solvents showed that these reactions take place only in the presence of water or methanol, at lower levels of conversion in the latter case. This solvent effect, coupled with the observed high stereoselectivities, has been explained in terms of the formation of a hydrophobic core in the inner surface of the resin, whereas the hydrophilic proline moiety lies at the resin/water interface. Such a microenvironment both promotes the aldol reaction and increases the stereoselectivity. Recycling investigations have shown that this material can be reused, without loss in levels of conversion and stereoselectivity, for at least five cycles. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2007) [source]