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Receiver Operating Characteristic (receiver + operating_characteristic)
Terms modified by Receiver Operating Characteristic Selected AbstractsJuvenile sex offenders and institutional misconduct: the role of thought psychopathologyCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 5 2008Matt Delisi Background,Little is known about the institutional behaviour of incarcerated sex offenders. Aim,To study the relationships between juvenile sex offending, thought psychopathology and institutional misconduct. Method,We applied negative binomial regression and Area Under Curve Receiver Operating Characteristic (AUC-ROC) analyses to self-report and records data from institutionalised delinquents (N = 813) committed to the California Youth Authority to explore the links between sex offending and institutional misconduct, controlling for offender demographics, institution, index offence, and self-reported and official criminal history. Results,Juvenile sex offending was associated with six forms of institutional misconduct (sexual, general and total misconduct as reviewed by parole board) over 12 and 24 months prior to rating. Two measures of thought psychopathology, which were related to psychosis-like thought, were significantly associated with juvenile sex offender status. These constructs did not, however, mediate the independent predictive effects of adolescent sex offending on institutional misconduct. Conclusion,Interventions to help incarcerated young offenders are likely to be particularly important for those with a sex offending history as they are otherwise likely to persist with antisocial behaviours of all kinds within and beyond the institution. Attention to their thought processes may be particularly useful. Copyright © 2008 John Wiley & Sons, Ltd. [source] Depression in dementia: a comparative and validation study of four brief scales in the elderly ChineseINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2004Chee Kum Lam Abstract Aim The study aimed to determine: (i) the diagnostic accuracy of four brief depression scales, the Geriatric Depression Scale (GDS), Even Briefer Assessment Scale for Depression (EBAS DEP), Single Question and Cornell Scale for Depression in Dementia (Cornell) in an elderly Chinese population with varying dementia severity; and (ii) which scale had the best diagnostic performance. Method All four scales were administered to 88 elderly outpatients with dementia: 66 without and 22 with depression. Receiver Operating Characteristic (ROC) analysis was used to establish the optimal cut-off scores of the GDS, EBAS DEP and Cornell scales. The patients' dementia-severity was dichotomously categorized into mild and moderate-severe dementia, and the above analysis was repeated in both these groups to look at changes in the scales' diagnostic performance as dementia advances. Results The best diagnostic scale for detecting depression in dementia was the Cornell scale. Its optimal cut-off score was 6/7 (sensitivity 91.7%, specificity 80.0%) in the mild dementia group and 12/13 (sensitivity 70.0%, specificity 87.0%) in the more advanced dementia group. The optimal cut-off scores of the GDS and EBAS DEP also shifted to higher values when moving from the mild to the more advanced dementia groups, indicating the increasing difficulty on all these scales to detect depression with worsening cognitive impairment. The Single Question, however, was more robust with much less changes in its diagnostic parameters in both dementia cohorts: sensitivity 58.3%, specificity 90.0% for mild dementia, and 60.0 and 84.8%, respectively, for more advanced dementia. Conclusion An efficient strategy to diagnose depression in dementia amongst elderly Chinese patients is to administer the Single Question followed by, when necessary, the Cornell scale. Copyright © 2004 John Wiley & Sons, Ltd. [source] Lymphocyte volume and conductivity indices of the haematology analyser Coulter® GEN.STM in lymphoproliferative disorders and viral diseasesINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 1 2006M. SILVA Summary The haematology analyser Coulter® GEN.STM gives a set of data ,,positional parameters', defining white blood cell (WBC) populations by mean of index values (mean and standard deviation of volume, conductivity and scatter, used to identify the WBC populations). The volume and conductivity parameters related to the lymphocytes were analysed at diagnosis in patients suffering from chronic B-lymphocytic leukaemia (B-CLL), other non-CLL lymphoproliferative disorders (OLPD) and viral diseases. The standard deviation of volume index (SDVI) is significantly higher in the three groups, whereas the mean volume index (MVI) is significantly lower in B-CLL, and increased in OLPD and viral diseases. These two groups could be distinguished by their mean conductivity index (MCI), which is significantly lower in viral disease group. Cut-offs were calculated for each parameter by the mean of Receiver Operating Characteristic (ROC) analysis. The study of the detection performances showed that the combination of lymphocyte count with SDVI, MVI and MCI could be used with a good sensitivity and specificity to discriminate between the most frequent lymphocyte pathologies, even in patients with normal lymphocyte count. [source] Detecting Alcohol-Related Problems in Developing Countries: A Comparison of 2 Screening Measures in IndiaALCOHOLISM, Issue 12 2009Madhabika B. Nayak Background:, There is inadequate recognition of alcohol misuse as a public health issue in India. Information on screening measures is critical for prevention and early intervention efforts. This study critically evaluated the full and shorter versions of the AUDIT and RAPS4-QF as screening measures for alcohol use disorders (AUDs) in a community sample of male drinkers in Goa, India. Methods:, Data from male drinking respondents in a population study on alcohol use patterns and sexual risk behaviors in randomly selected rural and urban areas of North Goa are reported. Overall, 39% (n = 743) of the 1899 screened men, age 18 to 49, reported consuming alcohol in the last 12 months. These current drinkers were administered the screening measures as part of detailed interviews on drinking patterns and AUD symptoms. Receiver Operating Characteristic (ROC) analysis was conducted for each combination of screening measure and criterion (alcohol dependence or any AUD). Reliability and correlations among the 4 measures were also examined. Results:, All 4 measures performed well with area under the curves of at least 0.79. The full screeners that included both drinking patterns and problem items (the AUDIT and the RAP4-QF) performed better than their shorter versions (the AUDIT-C and the RAPS4) in detecting AUDs. Performance of the AUDIT and RAPS4-QF improved with lowered and raised thresholds, respectively, and alternate cut-off scores are suggested. Scores on the full measures were significantly correlated (0.80). Reliability estimates for the AUDIT measures were higher than those for the RAPS4 measures. Conclusions:, All measures were efficient at detecting AUDs. When screening for alcohol-related problems among males in the general population in India, cut-off scores for screeners may need to be adjusted. Selecting an appropriate screening measure and cut-off score necessitates careful consideration of the screening context and resources available to confirm alcohol-related diagnoses. [source] A general class of hierarchical ordinal regression models with applications to correlated roc analysisTHE CANADIAN JOURNAL OF STATISTICS, Issue 4 2000Hemant Ishwaran Abstract The authors discuss a general class of hierarchical ordinal regression models that includes both location and scale parameters, allows link functions to be selected adaptively as finite mixtures of normal cumulative distribution functions, and incorporates flexible correlation structures for the latent scale variables. Exploiting the well-known correspondence between ordinal regression models and parametric ROC (Receiver Operating Characteristic) curves makes it possible to use a hierarchical ROC (HROC) analysis to study multilevel clustered data in diagnostic imaging studies. The authors present a Bayesian approach to model fitting using Markov chain Monte Carlo methods and discuss HROC applications to the analysis of data from two diagnostic radiology studies involving multiple interpreters. RÉSUMÉ Les auteurs s'intéressent à une classe assez vaste de modèles de régression ordinale avec paramètres de localisation et d'échelle, laquelle permet la sélection adaptative de fonctions de lien s'exprimant comme mélanges finis de fonctions de répartition normales et fournit des structures de correlation flexibles pour les variables d'échelle latentes. En exploitant la correspondance bien connue entre les modèles de régression ordinale et les courbes d'efficacité paramétriques (CEP) des tests diagnostiques, il est possible d'analyser des données d'imagerie médicate diagnostique regroupées à plusieurs niveaux au moyen d'une CEP hiéiarchique. Les auteurs décrivent une approche bayésienne pour l'ajustement de tels modèles au moyen des méthodes de Monte Carlo à cha,ne de Markov et présentent deux applications concrètes concernant l'interprétation de clichés radiologiques [source] Using the Optimal Robust Receiver Operating Characteristic (ROC) Curve for Predictive Genetic TestsBIOMETRICS, Issue 2 2010Qing Lu Summary Current ongoing genome-wide association (GWA) studies represent a powerful approach to uncover common unknown genetic variants causing common complex diseases. The discovery of these genetic variants offers an important opportunity for early disease prediction, prevention, and individualized treatment. We describe here a method of combining multiple genetic variants for early disease prediction, based on the optimality theory of the likelihood ratio (LR). Such theory simply shows that the receiver operating characteristic (ROC) curve based on the LR has maximum performance at each cutoff point and that the area under the ROC curve so obtained is highest among that of all approaches. Through simulations and a real data application, we compared it with the commonly used logistic regression and classification tree approaches. The three approaches show similar performance if we know the underlying disease model. However, for most common diseases we have little prior knowledge of the disease model and in this situation the new method has an advantage over logistic regression and classification tree approaches. We applied the new method to the type 1 diabetes GWA data from the Wellcome Trust Case Control Consortium. Based on five single nucleotide polymorphisms, the test reaches medium level classification accuracy. With more genetic findings to be discovered in the future, we believe a predictive genetic test for type 1 diabetes can be successfully constructed and eventually implemented for clinical use. [source] Identifying Combinations of Cancer Markers for Further Study as Triggers of Early InterventionBIOMETRICS, Issue 4 2000Stuart G. Baker Summary. In many long-term clinical trials or cohort studies, investigators repeatedly collect and store tissue or serum specimens and later test specimens from cancer cases and a random sample of controls for potential markers for cancer. An important question is what combination, if any, of the molecular markers should be studied in a future trial as a trigger for early intervention. To answer this question, we summarized the performance of various combinations using Receiver Operating Characteristic (ROC) curves, which plot true versus false positive rates. To construct the ROC curves, we proposed a new class of nonparametric algorithms which extends the ROC paradigm to multiple tests. We fit various combinations of markers to a training sample and evaluated the performance in a test sample using a target region based on a utility function. We applied the methodology to the following markers for prostate cancer, the last value of total prostate-specific antigen (PSA), the last ratio of total to free PSA, the last slope of total PSA, and the last slope of the ratio. In the test sample, the ROC curve for last total PSA was slightly closer to the target region than the ROC curve for a combination of four markers. In a separate validation sample, the ROC curve for last total PSA intersected the target region in 77% of bootstrap replications, indicating some promise for further study. We also discussed sample size calculations. [source] INFORMATION POINT: Receiver Operating Characteristics (ROC) curves (see pg.JOURNAL OF CLINICAL NURSING, Issue 1 2002[source] Effect of Normal Saline Infusion on the Diagnostic Utility of Base Deficit in Identifying Major Injury in Trauma PatientsACADEMIC EMERGENCY MEDICINE, Issue 12 2006Richard Sinert DO Abstract Background Base deficit (BD) is a reliable marker of metabolic acidosis and is useful in gauging hemorrhage after trauma. Resuscitation with chloride-rich solutions such as normal saline (NS) can cause a dilutional acidosis, possibly confounding the interpretation of BD. Objectives To test the diagnostic utility of BD in distinguishing minor from major injury after administration of NS. Methods This was a prospective observational study at a Level 1 trauma center. The authors enrolled patients with significant mechanism of injury and measured BD at triage (BD-0) and at four hours after triage (BD-4). Major injury was defined by any of the following: injury severity score of ,15, drop in hematocrit of ,10 points, or the patient requiring a blood transfusion. Patients were divided into a low-volume (NS < 2L) and a high-volume (NS , 2L) group. Data were reported as mean (±SD). Student's t- and Wilcoxon tests were used to compare data. Receiver operating characteristic (ROC) curves tested the utility of BD-4 in differentiating minor from major injury in the study groups. Results Four hundred eighty-nine trauma patients (mean age, 36 [± 18] yr) were enrolled; 82% were male, and 34% had penetrating injury. Major-(20%) compared with minor-(80%) injury patients were significantly (p = 0.0001) more acidotic (BD-0 mean difference: ,3.3 mmol/L; 95% confidence interval [CI] =,2.5 to ,4.2). The high-volume group (n = 174) received 3,342 (±1,821) mL, and the low-volume group (n = 315) received 621 (±509) mL of NS. Areas under the ROC curves for the high-volume (0.63; 95% CI = 0.52 to 0.74) and low-volume (0.73; 95% CI = 0.60 to 0.86) groups were not significantly different from each other. Conclusions Base deficit was able to distinguish minor from major injury after four hours of resuscitation, irrespective of the volume of NS infused. [source] Should liver function tests be included in definitions of metabolic syndrome?DIABETIC MEDICINE, Issue 5 2008Evidence from the association between liver function tests, components of metabolic syndrome, prevalent cardiovascular disease Abstract Aims The definition of metabolic syndrome (MS) continues to be debated and does not include abnormal liver function tests (LFTs). This study aims to determine: (1) the association between the five ATP3 MS diagnostic components and different LFTs, and (2) the association between raised LFTs and prevalent cardiovascular disease (CVD). Methods A total of 1357 patients, without alcoholism or known liver disease, from randomly selected households from rural Victoria, Australia, attended for biomedical assessment. Receiver operating characteristic (ROC) areas under the curve (AUC) were determined for associations between the ATP3 diagnostic components, and between LFTs and ATP3 diagnostic components. Results The range of ROC AUC for ATP3 diagnostic components was 0.60,0.77. Waist had the strongest association and blood pressure the weakest. The strength of association between ATP3 diagnostic components and gamma GT (GGT) was similar (0.63,0.72), but was less for alanine transaminase and aspartate transaminase. Using the ROC-derived GGT cut-off (men 27 IU, women 20 IU), those with MS and a high GGT had more CVD than those with MS and a low GGT, and those without MS (18% vs. 10% vs. 7%, respectively; P < 0.001). Among those with MS, after adjusting for covariates, the odds ratio of CVD was 2.66 (1.18,5.96) for a high GGT compared to a low GGT. CVD was not significantly more prevalent in MS patients with a low GGT compared to non-MS patients. Conclusions We suggest that including a raised GGT in the criteria for MS could increase its predictive nature for CVD. Prospective studies are needed to confirm this finding. [source] ,Numbness of the feet' is a poor indicator for polyneuropathy in Type 2 diabetic patientsDIABETIC MEDICINE, Issue 2 2000L. V. Franse Summary Aims To identify neuropathic sensory symptoms associated with a clinical neurological examination (CNE) and to investigate whether these symptoms could be used as a diagnostic or screening tool for diabetic polyneuropathy in general practice. Methods Five hundred and eighty-eight patients with Type 2 diabetes, recruited from 26 general practices in the Netherlands, underwent a CNE and completed a diabetes symptom checklist that included 10 items on neuropathic sensory symptoms. Linear regression analyses were performed to assess the association between neuropathic symptoms and CNE. Receiver operating characteristic (ROC) curves were created to assess the diagnostic properties of neuropathic symptoms. Results In this population, with a mean age of 66.8 years, 32% were identified with diabetic polyneuropathy according to the CNE. Variables that showed the strongest association with CNE score were age (, = 0.41), symptoms of sensory alteration (, = 0.27), and the item ,numbness of the feet' (, = 0.35) in particular. ROC curves showed that prediction of diabetic polyneuropathy from these symptoms was unsatisfying. The sensitivity and specificity of daily symptoms of ,numbness of the feet' were 28% and 93%, respectively, in patients <,68 years, and 22% and 92%, respectively, in patients ,,68 years. Conclusions Identification of neuropathic sensory symptoms is not useful as a diagnostic or even a screening tool in the assessment of diabetic neuropathy in daily practice. Therefore, the results reported in this paper mandate an annual foot examination by the general practitioner. [source] The Cannabis Use Problems Identification Test (CUPIT): development, reliability, concurrent and predictive validity among adolescents and adultsADDICTION, Issue 4 2010Jan Bashford ABSTRACT Aims To describe the empirical construction and initial validation of the Cannabis Use Problems Identification Test (CUPIT), a brief self-report screening instrument for detection of currently and potentially problematic cannabis use. Design In a three-phase prospective design an item pool of candidate questions was generated from a literature review and extensive expert consultation. The CUPIT internal structure, cross-sectional and longitudinal psychometric properties were then systematically tested among heterogeneous past-year users. Participants Volunteer participants were 212 high-risk adolescents (n = 138) and adults (n = 74) aged 13,61 years from multiple community settings. Measurements The comprehensive assessment battery included several established measures of cannabis-related pathology for CUPIT validation, with DSM-IV/ICD-10 diagnoses of cannabis use disorders as criterion standard. Findings Sixteen items loading highly on two subscales derived from principal components analysis exhibited good to excellent test,retest (0.89,0.99) and internal consistency reliability (0.92, 0.83), and highly significant ability to discriminate diagnostic subgroups along the severity continuum (non-problematic, risky, problematic use). Twelve months later, baseline CUPIT scores demonstrated highly significant longitudinal predictive utility for respondents' follow-up diagnostic group membership. Receiver operating characteristic (ROC) analysis identified a CUPIT score of 12 to be the optimal cut-point for maximizing sensitivity for both currently diagnosable cannabis use disorder and those at risk of meeting diagnostic criteria in the following 12 months. Conclusions The CUPIT is a brief cannabis screener that is reliable, valid and acceptable for use across diverse community settings and consumers of all ages. The CUPIT has clear potential to assist with achievement of public health goals to reduce cannabis-related harms in the community. [source] Validation of the alcohol, smoking and substance involvement screening test (ASSIST)ADDICTION, Issue 6 2008Rachel Humeniuk ABSTRACT Aim The concurrent, construct and discriminative validity of the World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were examined in a multi-site international study. Participants One thousand and 47 participants, recruited from drug treatment (n = 350) and primary health care (PHC) settings (n = 697), were administered a battery of instruments. Measurements Measures included the ASSIST; the Addiction Severity Index-Lite (ASI-Lite); the Severity of Dependence Scale (SDS); the MINI International Neuropsychiatric Interview (MINI-Plus); the Rating of Injection Site Condition (RISC); the Drug Abuse Screening Test (DAST); the Alcohol Use Disorders Identification Test (AUDIT); the Revised Fagerstrom Tolerance Questionnaire (RTQ); and the Maudsley Addiction Profile (MAP). Findings Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-Lite (r = 0.76,0.88), SDS (r = 0.59), AUDIT (r = 0.82) and RTQ (r = 0.78); and significantly greater ASSIST scores for those with MINI-Plus diagnoses of abuse or dependence (P < 0.001). Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems (r = 0.48,0.76). Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. Receiver operating characteristic (ROC) analysis was used to establish cut-off scores with suitable specificities (50,96%) and sensitivities (54,97%) for most substances. Conclusions The findings demonstrated that the ASSIST is a valid screening test for identifying psychoactive substance use in individuals who use a number of substances and have varying degrees of substance use. [source] Use of advanced red blood cell and reticulocyte indices improves the accuracy in diagnosing iron deficiency in pregnant women at termEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 6 2007Mari Ervasti Abstract Objectives:, Detection of iron deficiency during pregnancy with hemoglobin (Hb) and serum measurements is insignificant as the measurements may be affected by e.g. hemodilution or accelerated erythropoiesis. This study tests whether cell indices will give a more reliable measure of iron deficiency in pregnant women at term. Methods:, The population was 202 pregnant women. Using the ADVIA 120 hematology system, Hb, mean cell volume (MCV), percentage of hypochromic red blood cells (%HYPOm) and reticulocytes (%HYPOr), and cellular hemoglobin in reticulocytes (CHr) were tested. Additionally, transferrin saturation (TfSat), ferritin, and transferrin receptor (TfR) were analyzed. Receiver operating characteristic (ROC) curves and area under the ROC curves (AUC) were used as statistical methods. Results:, When TfSat (,11%) was used as the reference test for iron deficiency, %HYPOm and CHr had a sensitivity of 58.1% and 80.7%, while the specificities were 82.6% and 71.3%, respectively. Additionally, the AUC values were %HYPOr 0.80, CHr 0.79, ferritin 0.77, %HYPOm 0.75, TfR 0.67, MCV 0.63 and Hb 0.64. The results provided by the cell indices alone (%HYPOm or CHr) were in good agreement with the results based on the usage of a combination of three commonly used tests (Hb, MCV, ferritin). Conclusions:, This study suggests that the most practical way to diagnose iron deficiency in pregnant women at term is to use cell indices such as CHr and %HYPOm provided by the automated hematological analyzer. Further studies are needed to determine the usefulness of the cell indices in diagnosing iron deficiency longitudinally during the course of pregnancy. [source] Electrophysiological sensory demyelination in typical chronic inflammatory demyelinating polyneuropathyEUROPEAN JOURNAL OF NEUROLOGY, Issue 7 2010Y. A. Rajabally Background:, The presence of electrophysiological demyelination of sensory nerves is not routinely assessed in the evaluation of suspected chronic inflammatory demyelinating polyneuropathy (CIDP). Whether this can be useful is unknown. Methods:, We compared, using surface recording techniques, in 19 patients with typical CIDP and 26 controls with distal large fibre sensory axonal neuropathy, the forearm median sensory conductions, sensory nerve action potential (SNAP) amplitudes and durations and sensory nerve conduction velocities (SNCVs) of median, radial and sural nerves. Results:, Median nerve sensory conduction block (SCB) across the forearm was greater in CIDP patients than in controls (P = 0.005). SNAP durations were longer in CIDP patients for median (P = 0.001) and sural nerves (P = 0.004). Receiver operating characteristic (ROC) curves provided sensitive (>40%) and specific (>95%) cut-offs for median nerve SCB as well as median and sural SNAP durations. SNCVs were significantly slower for median and sural nerves in CIDP patients, but ROC curves did not demonstrate cut-offs with useful sensitivities/specificities. Median SCB or prolonged median SNAP duration or prolonged sural SNAP duration offered a sensitivity of 73.7% for CIDP and specificity of 96.2%. Used as additional parameters, they improved diagnostic sensitivity of the American Academy of Neurology (AAN) criteria for CIDP of 1991, from 42.1% to 78.9% in this population, with preserved specificity of 100%. Discussion:, Sensory electrophysiological demyelination is present and may be diagnostically useful in typical CIDP. SCB detection and SNAP duration prolongation appear to represent more useful markers of demyelination than SNCV reduction. [source] Serum Levels of Leptin As Marker For Patients At High Risk of Gastric CancerHELICOBACTER, Issue 6 2009Lisette G. Capelle Abstract Background:, Serological screening for gastric cancer (GC) may reduce mortality. However, optimal serum markers for advanced gastric precursor lesions are lacking. Aim:, To evaluate in a case,control study whether serum leptin levels correlate with intestinal metaplasia (IM) and can serve as a tool to identify patients at high risk for GC. Materials and Methods:, Cases were patients with a previous diagnosis of IM or dysplasia, controls were patients without such a diagnosis. All patients underwent endoscopy. Fasting serum was collected for the measurement of leptin, pepsinogens I/II, gastrin, and Helicobacter pylori. Receiver operating characteristic (ROC) curves and their area under the curve (AUC) were provided to compare serum leptin levels with other serological markers. Results:, One hundred nineteen cases and 98 controls were included. In cases, the median leptin levels were 116.6 pg/mL versus 81.9 pg/mL in controls (p = .01). After adjustment for age, sex and BMI, leptin levels remained higher in cases than in controls (p < .005). In multivariate analysis, male sex (p = .002), age (<0.001), low pepsinogen levels (p = .004) and high leptin levels (p = .04) were independent markers for the presence of IM. In addition, a ROC curve including age, sex and pepsinogen I levels had an AUC of 0.79 (95% CI (0.73,0.85)). Adding serum leptin levels increased the AUC to 0.81 (95% CI (0.75,0.86)). Conclusions:, High leptin levels are associated with an increased risk of IM. Moreover, serum leptin levels are a significant independent marker for the presence of IM. However, in combination with the serological test for pepsinogen I the additional value of serum leptin levels is rather limited. [source] Active MMP-2 effectively identifies the presence of colorectal cancerINTERNATIONAL JOURNAL OF CANCER, Issue 12 2009Mary Jo Murnane Abstract Fully active MMP-2 is expressed at such low levels in human tissues that studies often fail to confirm its value as a cancer marker despite strong associations with malignancy. Our study utilized careful extraction, accurate activity measurements, standardization to purified controls and a new statistical metric to determine whether active MMP-2 is an effective indicator of colorectal cancer compared to pro-MMP-2 or pro-MMP-9. MMP-2 and MMP-9 activities were analyzed in matched normal and cancer samples from 269 patients by gelatin zymography, computer-assisted image analysis, serial dilutions of strong samples and standardization to controls. An index of effect size was designed for comparative evaluation of active MMP-2, pro-MMP-2 and pro-MMP-9 activities. For each gelatinase, mean activity and protein levels/mg soluble protein in normal mucosa and colorectal cancer were calculated for the first time with respect to commercial standards. Active MMP-2 activity, detected in 99% of colorectal cancers, was higher in 95% of cancers (on average 10-fold) than in normal mucosa. Levels of pro-MMP-2 and pro-MMP-9, but not active MMP-9, activities were also significantly higher in cancers versus normal. However, active MMP-2 activity provided the most effective test for the presence of cancer (p < 0.0.0001) with an effect size statistically significantly larger than for either pro-MMP-2 or pro-MMP-9. Receiver operating characteristic (ROC) curves demonstrated that a cut-off for active MMP-2 of >44 SDU activity/mg soluble protein (>180 pg/mg), which is three times mean normal levels, would permit detection of colorectal cancer with an estimated sensitivity of 84% and estimated specificity of 93%. © 2009 UICC [source] Sensitivity and Specificity of the Mini-Mental State Examination for Identifying Dementia in the Oldest-Old: The 90+ StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2007Kristin Kahle-Wrobleski PhD OBJECTIVES: To evaluate the sensitivity and specificity of the Mini-Mental State Examination (MMSE) in identifying dementia in the oldest-old when stratified by age and education. DESIGN: Cross-sectional. SETTING: Research clinic and in-home visits. PARTICIPANTS: Population-based sample of adults aged 90 and older (n=435) who are enrolled in the 90+ Study, a longitudinal, population-based study. MEASUREMENTS: Neurological examination to determine dementia diagnosis, MMSE, and demographic data. RESULTS: Receiver operating characteristic (ROC) analyses indicated that the MMSE had high diagnostic accuracy for identifying dementia in subjects aged 90 and older across different age and education groups (area under the ROC curve values ranged from 0.82 to 0.98). A range of possible cutoff values and corresponding sensitivity and specificity are provided for the following age groups: 90,93, 94,96, and ,97. Age groups were subdivided by educational attainment (,high school, vocational school or some college, college degree or higher). In subjects aged 90 to 93 with a college degree or higher, the suggested MMSE cutoff score is ,25 (sensitivity=0.82, specificity=0.80). In those aged 94 to 96 with a college degree or higher, the suggested cutoff is ,24 (sensitivity=0.85, specificity=0.80). Those aged 97 and older with an education of high school or less had the lowest suggested cutoff ,22 (sensitivity=0.80, specificity=0.76). CONCLUSION: Overall, the MMSE had good sensitivity and specificity across all age and educational groups. Optimal cutoff points were lower in the older age groups and those with less education, primarily to preserve specificity. This screening instrument is appropriate for use with the oldest-old. [source] Evaluation of an indirect serum ELISA and a bacteriological faecal culture test for diagnosis of Salmonella serotype Dublin in cattle using latent class modelsJOURNAL OF APPLIED MICROBIOLOGY, Issue 2 2004L.R. Nielsen Abstract Aims:, To evaluate a conventional bacteriological test based on faecal culture and an indirect serum ELISA for detection of S. Dublin infected cattle. To compare the predictive values of the two tests in relation to the prevalence. Methods and Results:, A total of 4531 paired samples from cattle in 29 dairy herds were analysed for presence of S. Dublin bacteria in faeces and immunoglobulins directed against S. Dublin lipopolysaccharide in an indirect serum ELISA. Sensitivity and specificity were estimated at two ELISA cut-off values using a validation method based on latent class models, which presumably provides less biased results than traditional validation methods. Stratification of data into three age groups gave significantly better estimates of test performance of the ELISA. Receiver operating characteristic (ROC) curves were constructed for comparison of overall performance of the ELISA between the three age groups. The sensitivity of the faecal culture test was low (6,14%). ELISA appeared to have a higher validity for animals aged 100,299 days of age than older or younger animals. Overall, the negative predictive value of the ELISA was 2,10 times higher than for the faecal culture test at realistic prevalence of infection in the test population. Conclusions:, The diagnostic sensitivity of the faecal culture test for detection of S. Dublin is poor, the specificity is 1. The superior sensitivity and negative predictive value of the serum ELISA makes this test preferable to faecal culture as an initial screening test and for certification of herds not infected with S. Dublin. Significance and Impact of the Study:, A quantitative estimate of the sensitivity of a faecal culture test for S. Dublin in a general population was provided. ELISA was shown to be an appropriate alternative diagnostic test. Preferably, samples from animals aged 100,299 days of age should be used as these give the best overall performance of the ELISA. Plots of ROC curves and predictive values in relation to prevalence facilitates optimisation of the ELISA cut-off value. [source] Serum cystatin C may predict the early prognostic stages of patients with type 2 diabetic nephropathyJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 5 2003Ayumi Shimizu Abstract We determined the relationship between levels of serum cystatin C or serum creatinine (s-Cr) and prognostic stages of type 2 diabetic nephropathy. Serum samples from 174 patients with type 2 diabetes were obtained from Juntendo University Hospital, Tokyo and Juntendo Urayasu Hospital, Chiba, Japan. They were classified into four groups according to the Report of the Ministry of Health and Welfare of Japan as follows: Stage I (normoalbuminuric stage), Stage II (microalbuminuric stage), Stage IIIA (macroalbuminuric stage without renal dysfunction), Stage IIIB (macroalbuminuric stage with renal dysfunction), and Stage IV (renal failure stage). Among these patients, 68 were Stage I, 29 Stage II, 32 Stage IIIA, 17 Stage IIIB, and 28 Stage IV. The levels of serum cystatin C were measured using the Dade Behring Cystatin C assay with automated Dade Behring Nephelometer II (BNII) (Dade Behring Marburg GmbH, Germany). The mean levels of serum cystatin C in Stage IIIA were significantly higher than those in Stage I or II (P<0.00001, P<0.0005, respectively). The mean levels of serum cystatin C in Stage IIIB and Stage IV were also significantly higher than those in Stage I (P<0.00001). However, the mean levels of serum creatinine (s-Cr) in Stage IIIA were not significantly higher than those in Stage I or II. The levels of s-Cr in Stage IIIB and Stage IV were significantly higher than those in Stage I (P<0.00001). Receiver operating characteristic (ROC) plots demonstrated that the area under the curve (AUC) of cystatin C (0.76) was greater than that of s-Cr (0.66). As an early prognostic marker of type 2 diabetic nephropathy, serum cystatin C was better than s-Cr in terms of sensitivity and specificity. It appears that the levels of serum cystatin C may predict early prognostic stages of patients with type 2 diabetic nephropathy. J. Clin. Lab. Anal. 17:164,167, 2003. © 2003 Wiley-Liss, Inc. [source] Risk prediction for Down's syndrome in young pregnant women using maternal serum biomarkers: determination of cut-off risk from receiver operating characteristic curve analysisJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2007Hsiao-Lin Hwa MD PhD Abstract Objective, The aim of this study was to establish a predictive model for Down's syndrome using maternal age as well as maternal serum levels of alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG), and to identify an optimal cut-off risk in women under the age of 35 years to improve sensitivity. Methods, Logistic regression models were utilized to predict fetal Down's syndrome as a function of maternal age and logarithm of levels of AFP as well as hCG using training data of 20 pregnancies with fetal Down's syndrome and 9730 unaffected pregnancies. Validation was performed using data of another nine affected pregnancies and 3496 unaffected pregnancies. Receiver operating characteristic (ROC) curves were plotted. Results, Based on the newly established logistic regression equations, the optimal cut-off risk from the ROC curve analysis was at 1:499, with a 17.8% false-positive rate and a 90.0% sensitivity. A suboptimal cut-off risk was estimated at 1:332, with a 12.0% false-positive rate and an 80% sensitivity. Conclusion, A predictive model for Down's syndrome was developed using logistic regression. By ROC curve analysis and clinical consideration, the cut-off risk for young pregnant women could be determined. [source] Comparison of dual to single contrast bolus magnetic resonance myocardial perfusion imaging for detection of significant coronary artery diseaseJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 1 2010Jan G.J. Groothuis MD Abstract Purpose: To investigate the incremental diagnostic value of dual-bolus over single-contrast-bolus first pass magnetic resonance myocardial perfusion imaging (MR-MPI) for detection of significant coronary artery disease (CAD). Materials and Methods: Patients (n = 49) with suspected CAD underwent first pass adenosine stress and rest MR-MPI and invasive coronary angiography (CA). Gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) was injected with a prebolus (1 mL) and a large bolus (0.1 mmol/kg). For the single-bolus technique, the arterial input function (AIF) was obtained from the large-contrast bolus. For the dual-bolus technique, the AIF was reconstructed from the prebolus. Absolute myocardial perfusion was calculated by Fermi-model constrained deconvolution. Receiver operating characteristic (ROC) analysis was used to investigate diagnostic accuracy of MR myocardial perfusion imaging for detection of significant CAD on CA at vessel-based analysis. Results: The area under the curve (AUC) of the minimal stress perfusion value for the detection of significant CAD using the single-bolus and dual-bolus technique was 0.85 ± 0.04 (95% confidence interval [CI], 0.77,0.93) and 0.77 ± 0.05 (95% CI, 0.67,0.86), respectively. Conclusion: In this study the dual-bolus technique had no incremental diagnostic value over single-bolus technique for detection of significant CAD with the used contrast concentrations. J. Magn. Reson. Imaging 2010;32:88,93. © 2010 Wiley-Liss, Inc. [source] Prostate cancer detection with multi-parametric MRI: Logistic regression analysis of quantitative T2, diffusion-weighted imaging, and dynamic contrast-enhanced MRIJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 2 2009Deanna L. Langer MSc Abstract Purpose To develop a multi-parametric model suitable for prospectively identifying prostate cancer in peripheral zone (PZ) using magnetic resonance imaging (MRI). Materials and Methods Twenty-five radical prostatectomy patients (median age, 63 years; range, 44,72 years) had T2-weighted, diffusion-weighted imaging (DWI), T2-mapping, and dynamic contrast-enhanced (DCE) MRI at 1.5 Tesla (T) with endorectal coil to yield parameters apparent diffusion coefficient (ADC), T2, volume transfer constant (Ktrans) and extravascular extracellular volume fraction (ve). Whole-mount histology was generated from surgical specimens and PZ tumors delineated. Thirty-eight tumor outlines, one per tumor, and pathologically normal PZ regions were transferred to MR images. Receiver operating characteristic (ROC) curves were generated using all identified normal and tumor voxels. Step-wise logistic-regression modeling was performed, testing changes in deviance for significance. Areas under the ROC curves (Az) were used to evaluate and compare performance. Results The best-performing single-parameter was ADC (mean Az [95% confidence interval]: Az,ADC: 0.689 [0.675, 0.702]; Az,T2: 0.673 [0.659, 0.687]; Az,Ktrans: 0.592 [0.578, 0.606]; Az,ve: 0.543 [0.528, 0.557]). The optimal multi-parametric model, LR-3p, consisted of combining ADC, T2 and Ktrans. Mean Az,LR-3p was 0.706 [0.692, 0.719], which was significantly higher than Az,T2, Az,Ktrans, and Az,ve (P < 0.002). Az,LR-3p tended to be greater than Az,ADC, however, this result was not statistically significant (P = 0.090). Conclusion Using logistic regression, an objective model capable of mapping PZ tumor with reasonable performance can be constructed. J. Magn. Reson. Imaging 2009;30:327,334. © 2009 Wiley-Liss, Inc. [source] Chronic hepatitis: Role of diffusion-weighted imaging and diffusion tensor imaging for the diagnosis of liver fibrosis and inflammationJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 1 2008Bachir Taouli MD Abstract Purpose To determine the diagnostic performance of liver apparent diffusion coefficient (ADC) measured with conventional diffusion-weighted imaging (CDI) and diffusion tensor imaging (DTI) for the diagnosis of liver fibrosis and inflammation. Materials and Methods Breathhold single-shot echo-planar imaging CDI and DTI with b-values of 0 and 500 second/mm2 was performed in 31 patients with chronic liver disease and 13 normal volunteers. Liver biopsy was performed in all patients with liver disease with a median delay of two days from MRI. Fibrosis and inflammation were scored on a 5-point scale (0,4). Liver ADCs obtained with CDI and DTI were compared between patients stratified by fibrosis stage and inflammation grade. Receiver operating characteristic (ROC) curve analyses were conducted to evaluate the utility of the ADC measures for prediction of fibrosis and inflammation. Results Patients with liver fibrosis and inflammation had significantly lower liver ADC than subjects without fibrosis or inflammation with CDI and DTI. For prediction of fibrosis stage , 1 and stage , 2, area under the ROC curve (AUC) of 0.848 and 0.783, sensitivity of 88.5% to 73.7%, and specificity of 73.3% to 72.7% were obtained, for ADC ,1.40 × 10,3 mm2/second and ,1.30 × 10,3 mm2/second (using CDI), respectively. For prediction of inflammation grade , 1, AUC of 0.825, sensitivity of 75.0%, and specificity of 78.6% were obtained using ADC , 1.30 × 10,3 mm2/second (using CDI). CDI performed better than DTI for diagnosis of fibrosis and inflammation. Conclusion Liver ADC can be used to predict liver fibrosis and inflammation with acceptable sensitivity and specificity. J. Magn. Reson. Imaging 2008;28:89,95. © 2008 Wiley-Liss, Inc. [source] Cystatin C as a marker of renal function immediately after liver transplantationLIVER TRANSPLANTATION, Issue 2 2006Gianni Biancofiore To verify whether cystatin C may be of some use as a renal function marker immediately after orthotopic liver transplantation (OLT), we compared serum cystatin C (SCyst), serum creatinine (Scr), and creatinine clearance (Ccr) levels with the glomerular filtration rate (GFR). On postoperative days 1, 3, 5, and 7, SCyst and Scr was measured in simultaneously drawn blood samples, whereas Ccr was calculated using a complete 24-hour urine collection. The GFR was determined on the same days by means of iohexol plasma clearance (I-GFR). The correlation between 1/SCyst and I-GFR was stronger than that of 1/Scr or Ccr (P< 0.01). In the case of moderate reductions in I-GFR (80-60 mL/minute/1.73 m), Scr remained within the normal range, whereas the increase in Scyst was beyond its upper limit; for I-GFR reductions to lower levels (59-40 mL/minute/1.73 m), Scr increased slightly, whereas Scyst was twice its upper normal limit. When we isolated all of the I-GFR values on days 3, 5, and 7 that were ,30% lower than that recorded on the first postoperative day, SCyst(P< 0.0001) and Scr (P< 0.01) levels were increased, whereas Ccr remained unchanged (P= 0.09). Receiver operating characteristic (ROC) area-under-the-curve analysis showed that the diagnostic accuracy of Scyst was better than that of Scr and Ccr. Scyst levels of 1.4, 1.7, and 2.2 mg/L respectively predicted I-GFR levels of 80, 60, and 40 mL/minute/1.73 m. In conclusion, cystatin C is a reliable marker of renal function during the immediate post-OLT period, especially when the goal is to identify moderate changes in GFR. Liver Transpl 12:285,291, 2006. © 2006 AASLD. [source] Asthma Control Test correlates well with the treatment decisions made by asthma specialistsRESPIROLOGY, Issue 4 2009Fanny W.S. KO ABSTRACT Background and objective: Poor assessment of asthma control results in suboptimal treatment. Identifying parameters that accurately assess control will benefit treatment decisions. The Asthma Control Test (ACT) is a five-item questionnaire for the assessment of asthma control. This study evaluated its correlation with the treatment decisions made by asthma specialists in an outpatient clinic setting, and compared its performance with other conventional parameters including spirometry, PEF rate (PEFR), fractional exhaled nitric oxide (FeNO) and BHR. Methods: The 383 (122 men) study subjects completed a 1-month diary on symptoms and PEFR before the assessment. All subjects then completed the ACT together with same-day spirometry and FeNO measurement. BHR to methacholine was performed in 73 subjects in the week before assessment. Asthma specialists, blinded to the results of the ACT, FeNO and BHR (but not spirometry and PEFR), assessed the patients' level of control according to the 2006 version of the Global Initiative for Asthma guidelines and made appropriate treatment decision. Results: The group mean (SD) age was 46.1 (13.4) years with pre-bronchodilator FEV1 84.72 (20.81) % predicted. Receiver operating characteristic (ROC) curve analysis found that an ACT score of ,20 best correlated with uncontrolled asthma (area under curve (AUC) = 0.76) with a sensitivity of 70.5%, specificity 76.0%, positive predictive value 76.2% and negative predictive value 70.2% for predicting step-up of asthma therapy. On ROC analysis, the ACT score had the highest AUC (0.81 (P < 0.001)) for changing asthma therapy when compared with FeNO, spirometry, PEFR and BHR parameters Conclusions: The ACT correlated better with treatment decisions made by asthma specialists than spirometry, PEFR and FeNO. [source] ORIGINAL ARTICLE: Endometrial Osteopontin mRNA Expression and Plasma Osteopontin Levels are Increased in Patients with EndometriosisAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 4 2009SiHyun Cho Problem, The aim of this study was to evaluate osteopontin (OPN) mRNA expression in eutopic endometrium and plasma OPN levels in patients with endometriosis. Method of study, A total of 79 patients with histologically confirmed endometriosis and 43 patients without endometriosis participated in this study. OPN mRNA expression in endometrial tissues was measured by real-time quantitative polymerase chain reaction (PCR) and plasma concentrations of OPN were quantified using a specific commercial sandwich enzyme-linked immunosorbent assays (ELISA). Results, Osteopontin mRNA expression in endometrial tissue was significantly higher in women with endometriosis than in controls (P = 0.010). The mean plasma levels of OPN (mean ± S.E.M.) in patients with endometriosis and controls were 407.31 ± 37.80 ng/mL and 165.84 ± 19.29 ng/mL, respectively (P < 0.001). Receiver operating characteristic (ROC) analysis for plasma OPN revealed an area under the curve (AUC) of 0.894, with a sensitivity of 93.0%, specificity of 72.4%, positive likelihood ratio of 3.37, and negative likelihood ratio of 0.1 using a cut-off value of 167.68 ng/mL. Conclusion, Osteopontin may be involved in the pathogenesis of endometriosis and plasma OPN may be a useful non-invasive marker for the diagnosis of endometriosis. [source] ORIGINAL RESEARCH,OUTCOMES ASSESSMENT: Validation of the Female Sexual Distress Scale-Revised for Assessing Distress in Women with Hypoactive Sexual Desire DisorderTHE JOURNAL OF SEXUAL MEDICINE, Issue 2 2008Leonard DeRogatis PhD ABSTRACT Introduction., The concept of sexually related personal distress is currently central to the diagnosis of all female sexual dysfunctions (FSD). In the current study, we have focused on validating a slightly revised version of the Female Sexual Distress Scale (FSDS), the FSDS-Revised (FSDS-R), to enhance the sensitivity of the instrument with patients suffering from hypoactive sexual desire disorder (HSDD). In addition, we have attempted to extend the validation generalizability of the scale by demonstrating that both instruments possess reliability and discriminative validity in premenopausal women with HSDD. Aim., To assess the validity of the revised version of the FSDS, the FSDS-R, for measuring sexual distress in women with HSDD. Methods., A prospective methodological study carried out at 27 centers in North America enrolled 296 women aged 18,50 years with HSDD, another female sexual dysfunction (FSD), or no FSD. The subjects completed the FSDS-R at baseline, day 7, and day 28, with a 30-day recall at baseline and with a 7-day recall on days 7 and 28. Main Outcome Measures., Receiver operating characteristic (ROC) analyses of FSDS, FSDS-R, and FSDS-R item 13 were used for the differentiation of HSDD from no FSD, while intraclass correlation coefficient (ICC) was used to estimate test,retest reliability. Cronbach's coefficient alpha was used to measure the internal consistency of the FSDS-R and Pearson's correlation coefficient to assess FSDS, FSDS-R, and FSDS-R item 13 with different recall periods (7 and 30 days). Results., Mean total FSDS, FSDS-R, and FSDS-R item 13 scores with either recall period were significantly higher (P < 0.0001) in women with FSD or HSDD than in women with no FSD, showing both tests had discriminant validity. ROC analysis confirmed these findings, while an ICC of >0.74 showed the test,retest reliability of both scales, including FSDS-R item 13 alone, and Cronbach's coefficient alpha of >0.86 confirmed the internal consistency of both tests. Conclusions., Consistent with the FSDS, the FSDS-R demonstrated good discriminant validity, high test,retest reliability, and a high degree of internal consistency in measuring sexually related personal distress in women with HSDD. FSDS-R item 13 alone also demonstrated good discriminant validity and test,retest reliability. DeRogatis L, Clayton A, Lewis-D'Agostino D, Wunderlich G, and Fu Y. Validation of the female sexual distress scale revised for assessing distress in women with hypoactive sexual desire disorder. J Sex Med 2008;5:357,364. [source] Predicting the outcome of prostate biopsy: comparison of a novel logistic regression-based model, the prostate cancer risk calculator, and prostate-specific antigen level aloneBJU INTERNATIONAL, Issue 5 2009David J. Hernandez OBJECTIVES To develop a logistic regression-based model to predict prostate cancer biopsy at, and compare its performance to the risk calculator developed by the Prostate Cancer Prevention Trial (PCPT), which was based on age, race, prostate-specific antigen (PSA) level, a digital rectal examination (DRE), family history, and history of a previous negative biopsy, and to PSA level alone. PATIENTS AND METHODS We retrospectively analysed the data of 1280 men who had a biopsy while enrolled in a prospective, multicentre clinical trial. Of these, 1108 had all relevant clinical and pathological data available, and no previous diagnosis of prostate cancer. Using the PCPT risk calculator, we calculated the risks of prostate cancer and of high-grade disease (Gleason score ,7) for each man. Receiver operating characteristic (ROC) curves for the risk calculator, PSA level and the novel regression-based model were compared. RESULTS Prostate cancer was detected in 394 (35.6%) men, and 155 (14.0%) had Gleason ,7 disease. For cancer prediction, the area under the ROC curve (AUC) for the risk calculator was 66.7%, statistically greater than the AUC for PSA level of 61.9% (P < 0.001). For predicting high-grade disease, the AUCs were 74.1% and 70.7% for the risk calculator and PSA level, respectively (P = 0.024). The AUCs increased to 71.2% (P < 0.001) and 78.7% (P = 0.001) for detection and high-grade disease, respectively, with our novel regression-based models. CONCLUSIONS ROC analyses show that the PCPT risk calculator modestly improves the performance of PSA level alone in predicting an individual's risk of prostate cancer or high-grade disease on biopsy. This predictive tool might be enhanced by including percentage free PSA and the number of biopsy cores. [source] Relative afferent pupillary defect in glaucoma: a pupillometric studyACTA OPHTHALMOLOGICA, Issue 5 2007Lada Kalaboukhova Abstract. Purpose:, To study the presence of relative afferent pupillary defect (RAPD) in patients with glaucoma with the help of a custom-built pupillometer. Methods:, Sixty-five participants were recruited (32 with open-angle glaucoma and 33 healthy subjects). All underwent standard clinical examination including perimetry and optic disc photography. Pupillary light reflexes were examined with a custom-built pupillometer. Three video sequences were recorded for each subject. Alternating light stimulation with a duration of 0.5 seconds was used, followed by a 1 second pause. Mean values of pupil area ratio (PAR), pupil contraction velocity ratio (PCVR), and pupil dilation velocity ratio (PDVR) were calculated. Receiver operating characteristic (ROC) curves were constructed for each of the three parameters. Intra-individual variability was estimated. Results:, PAR and PDVR differed significantly between the group with glaucoma and the control group (P < 0.0001). PAR was more sensitive for glaucoma detection than the other pupillometric parameters (PCVR and PDVR). The area under the receiver operating characteristic curve was largest for PAR. At a fixed specificity of 90%, sensitivity for PAR was 86.7%. Conclusion:, Measuring RAPD with infrared computerized pupillometry can detect optic neuropathy in glaucoma with high sensitivity and specificity. The method is fast and objective. Pupil area amplitude measurements were superior to pupil velocity measurements for the detection of RAPD in glaucoma [source] | |||||||||||||||||||||||||||||||||||||||||||||||||