Best Balance Of Sensitivity Research Articles

Psychometric properties of the OCI-4: a brief screening tool for perinatal obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) has an elevated prevalence among pregnant and postpartum women, with negative impacts on both mother and child. There is a need for brief, efficient screening tools for OCD in perinatal care because OCD is underrecognized. We evaluated the psychometric properties of the 4-item Obsessive Compulsive Inventory (OCI-4), and investigated it as a screening measure, in a perinatal sample. Pregnant women were assessed at 20- and 34-weeks' gestation, 6 weeks postpartum, and 6 months postpartum. Reliability was assessed via test-retest analyses, and validity was examined through correlations with established measures. Criterion-related validity and diagnostic sensitivity were also examined. The OCI-4 demonstrated good test-retest reliability, convergent and discriminant validity, and criterion-related validity. The measure also showed moderate to high diagnostic sensitivity. A score of 3 provided the best balance of sensitivity and specificity for screening. The OCI-4 is an effective screener that should be used for identifying OCD symptoms in perinatal settings. Despite the need for further study, its ease of use and quick administration make it a valuable tool for early detection and referral for assessment intervention.

Tooth surface loss: causes, management, and prevention.

Tooth wear, also referred to as tooth surface loss, occurs due to causes other than caries. This involves the loss of hard tissues, namely enamel, dentin, and/or cementum. Types of tooth wear/tooth surface loss are abrasion, abfraction, attrition, and erosion. These multifactorial conditions can be caused by factors such as lifestyle, diet, or even habits, and may not be symptomatic. The focus of this article is to provide clinicians with detailed examples and explanations of the causes of tooth loss to aid in early diagnosis. Through early identification, the preventive measures outlined can be implemented to avoid excessive tooth wear. The provision of a treatment flowchart and general treatment recommendations aims to help clinicians determine when to restore these lesions and the most appropriate treatment measures for the four types of wear. The PubMed (MEDLINE) search engine was used to gather information on teeth restricted to a 5-year period (26 August 2018 to 25 July 2022). Only English-language studies and reviews with the best balance of sensitivity and specificity were considered. A Boolean search of the PubMed dataset was implemented to combine a range of keywords: ("tooth wear" OR tooth attrition OR tooth erosion OR tooth abrasion OR tooth abfraction). Additional articles were selected through Google Scholar. By this process, many articles and studies were obtained, and the 48 most relevant published studies were chosen and used in the current review. Tooth wear affects an increasing number of individuals and can have detrimental effects physically, mentally, and emotionally. It is important to stress early diagnosis and management of tooth wear through monitoring, prevention, and treatment where indicated.

Evaluation of a self-reported G8 screening tool on Epic MyChart for older patients with cancer.

e13766 Background: The Geriatric 8 (G8) is a screening tool validated for cancer patients to identify those in need of a comprehensive geriatric assessment (CGA). It evaluates eight domains encompassing mobility, polypharmacy, age, and self-rated health. The existing original-G8 requires administration by a healthcare professional, limiting its accessibility and practicality. An electronic, patient-reported version could broaden its reach, enhancing care coordination. This study focuses on the implementation and evaluation of a self-reported G8 tool on Epic MyChart and its alignment with the original-G8. Methods: The MyChart-G8 underwent adaptation from the original-G8, retaining all domains while optimizing questions for patient self-completion and adhering to health communication design principles. We introduced MyChart-G8 across our Jefferson health system for all patients aged ≥ 65 with a new cancer diagnosis. For a subset of patients, an oncology nurse or medical assistant also administered the original G8 during the new patient visit rooming process. Agreement between MyChart-G8 and original-G8 for individual items was measured using Kappa statistics. Diagnostic accuracy of MyChart-G8 compared to the original-G8 was also assessed. Results: Our cohort comprised 203 older cancer patients who completed both MyChart-G8 and the original-G8. The frequency of abnormal scores (≤14) for the original-G8 and MyChart-G8 was 40.0% and 67.7%, respectively. Discrepancies between the two tools were partly attributed to less than moderate agreement for three individual items: neuropsychological problems (Kappa 0.15), BMI (Kappa 0.27), and self-rated health (Kappa 0.31). A MyChart-G8 cutoff of 14.5 demonstrated the best balance of sensitivity (0.86 ± 0.13) and specificity (0.57 ± 0.06) when compared to the original G8. Conclusions: The incorporation of self-reported G8 assessments into Epic MyChart is feasible and implementable. Persistent challenges arise in accurately assessing self-reported problems among older adult cancer patients in the electronic format, potentially resulting in MyChart over-flagging abnormalities. The introduction of the Practical Geriatric Assessment (PGA) presents an opportunity to streamline the CGA. By subsequently conducting a PGA for individuals identified as vulnerable through the MyChart G8, we can confirm frailty domains, inform treatment decisions, and address impairments through targeted interventions. This integrated, stepped-up assessment approach holds significant potential to optimize resource utilization, enhance patient engagement, and tailor individualized treatments, ultimately with the goal of maximizing treatment outcomes. The Sidney Kimmel Cancer Center is in the process of developing a decentralized model of PGA using MyChart G8 as a step-up approach across the Jefferson Health enterprise.

Ag nanopines over Al nanoneedle arrays enable high SERS sensitivity and reproducibility for molecular sensing

In this study, highly uniform 3D Al nanoneedle arrays (AlNNAs) decorated with Ag nanopines are synthesized by anodization of Al foil with prior nanoimprinting and subsequent electrodeposition method, demonstrating remarkable surface-enhanced Raman scattering (SERS) property. The AlNNAs possess a highly ordered periodicity of 1 μm and nanoneedle height of 800 nm, making it an optimal supporting matrix to host Ag-NPs as SERS substrate. Such well-ordered Ag@AlNNAs SERS substrate with precisely electrodeposited Ag nanopines generate high density SERS host spots and abundant sites to adsorb target molecules. As a result, Ag@AlNNAs exhibit high sensitivity for rhodamine 6 G down to 10–13 M and good signal reproducibility with a relative standard deviation of 7.2 %, as well as an average enhancement factor of 4.23 × 109. For practical detection of pollutants, 10–8 M adenine, 10–12 M bisphenol in water, and melamine (10–7 M) in opaque milk are clearly identified by using the Ag@AlNNAs sensor. This study opens a bright way to fabricate SERS substrate with a good balance of sensitivity, reproducibility and cost, indicating promising potential for environmental monitoring and food safety.

Methylation markers for anal cancer screening: A repeated cross-sectional analysis of people living with HIV, 2015-2016.

People living with HIV (PLWH) are at highest risk of anal cancer and will benefit from optimized screening for early disease detection. We compared host DNA methylation markers in high-grade squamous intraepithelial lesions (HSIL) versus samples negative for intraepithelial lesions (NILM) or low-grade intraepithelial lesions (LSIL) in PLWH. We recruited PLWH identifying as male aged ≥18 years undergoing high-resolution anoscopy (HRA) in Seattle, Washington, 2015-2016. Anal brush samples were collected for HPV detection, genotyping, and pyrosequencing methylation (host genes ASCL1, PAX1, FMN2, and ATP10A); clinical data were abstracted from medical records. We assessed associations between methylation and presence and extent of HSIL using generalized estimating equation logistic regression, adjusting for age, CD4 count and HIV viral load. Marker panels using HPV DNA and methylation were also evaluated to predict prevalent HSIL. We analyzed 125 samples from 85 participants (mean age 50.1; standard deviation 11.0 years). ASCL1 (adjusted odds ratio [aOR] per 1 unit increase mean percent methylation: 1.07, 95% CI: 1.01-1.13) and FMN2 (aOR per 1 unit increase mean percent methylation: 1.14, 95% CI: 1.08-1.20) methylation were significantly associated with HSIL versus NILM/LSIL. ASCL1 (aOR: 1.06, 95% CI: 1.01-1.11) and FMN2 (aOR: 1.13, 95% CI: 1.08-1.17) methylation were positively associated with increasing HSIL extent. A panel combining methylation (ASCL1 and FMN2) and HPV DNA (HPV16, HPV18, and HPV31) demonstrated best balance of sensitivity (78.2%) and specificity (73.9%) for HSIL detection compared with methylation or HPV alone. Increasing levels of DNA methylation of ASCL1 and FMN2 were positively associated with HSIL detection in PLWH. Host gene methylation testing shows promise for HSIL screening and triage.

Observations from a decade of oligonucleotide bioanalysis by LC-MS.

There is a growing need for efficient bioanalysis of oligonucleotide therapeutics. This broad class of molecules presents numerous challenges relative to traditional small molecule therapeutics. Methodologies including ligand-binding assays or polymerase chain reaction may be fit-for-purpose in many instances, but liquid chromatography coupled to mass spectrometry (LC-MS) often delivers the best balance of sensitivity and selectivity. Over the last decade, we have engaged with many such molecules and derived insights into challenges and solutions. Herein, we provide four case studies illustrating challenges we have encountered. These issues include low or variable analyte recovery, poor resolution from related species, chromatographic abnormalities or challenging sensitivity. We present a summary of considerations, based on these experiences, to assist others working in the area.

Clinical evaluation of code-based algorithms to identify patients with pulmonary arterial hypertension in healthcare databases.

Pulmonary arterial hypertension (PAH) is a rare subgroup of pulmonary hypertension (PH). Claims and administrative databases can be particularly important for research in rare diseases; however, there is a lack of validated algorithms to identify PAH patients using administrative codes. We aimed to measure the accuracy of code-based PAH algorithms against the true clinical diagnosis by right heart catheterization (RHC). This study evaluated algorithms in patients who were recorded in two linkable data assets: the Stanford Healthcare administrative electronic health record database and the Stanford Vera Moulton Wall Center clinical PH database (which records each patient's RHC diagnosis). We assessed the sensitivity and specificity achieved by 16 algorithms (six published). In total, 720 PH patients with linked data available were included and 558 (78%) of these were PAH patients. Algorithms consisting solely of a P(A)H-specific diagnostic code classed all or almost all PH patients as PAH (sensitivity >97%, specificity <12%) while multicomponent algorithms with well-defined temporal sequences of procedure, diagnosis and treatment codes achieved a better balance of sensitivity and specificity. Specificity increased and sensitivity decreased with increasing algorithm complexity. The best-performing algorithms, in terms of fewest misclassified patients, included multiple components (e.g., PH diagnosis, PAH treatment, continuous enrollment for ≥6 months before and ≥12 months following index date) and achieved sensitivities and specificities of around 95% and 38%, respectively. Our findings help researchers tailor their choice and design of code-based PAH algorithms to their research question and demonstrate the importance of including well-defined temporal components in the algorithms.

Cardiac magnetic resonance imaging-derived septum swing index detects pulmonary hypertension: A diagnostic study.

Because of pressure differences between the pulmonary artery and aorta, the ventricular septum moves in a swinging motion that is commonly observed on cardiac MR (CMR) cine sequences in patients with pulmonary hypertension (PH). We aimed to assess the use of septum swing index (SSI) derived by CMR for detecting PH. We retrospectively identified consecutive patients with suspected PH who underwent right heart catheterization (RHC) and CMR at a PH referral center between July 2019 and December 2020. The diagnostic accuracy of SSI for identifying PH (mean pulmonary artery pressure [mPAP] ≥ 25 mmHg) was assessed by receiver operating characteristic curves, sensitivity, specificity, and positive and negative predictive values. A total of 105 patients (mean age: 47.8 ± 15.0 years; 68 females) were included in the final analysis. SSI and mPAP were negatively correlated in the total study population and patients with PH, but not in patients without PH. SSI was an independent predictor of PH (adjusted odds ratio: 12.9, 95% confidence interval: 3.6 to 45.5, P = 0.003). The area under the curve for SSI was 0.91, with a cut-off value of 0.9673 yielding the best balance of sensitivity (86.4%), specificity (88.2%), positive predictive value (97.4%), negative predictive value (55.6%), and accuracy (86.7%) for detecting PH. Septum swing index was lower in patients with PH and is a simple, reliable method for detecting PH.

Enhancing Cervical Cancer Prevention in South African Women: Primary HPV mRNA Screening with Different Genotype Combinations.

Cervical cancer prevention in regions with limited access to screening and HPV vaccination necessitates innovative approaches. This study explored the potential of a test-and-treat strategy using mRNA HPV tests to impact cervical cancer prevention in a high-prevalence HIV population. A cervical screening study was conducted at three South African hospitals involving 710 under-screened, non-pregnant women (25 to 65 years) without known cervical diseases. Cytology, HPV testing, colposcopy, and biopsies were performed concurrently. Histopathologists determined final histological diagnoses based on biopsy and LLETZ histology. mRNA-HPV-genotyping for 3 (16, 18, 45) to 8 (16, 18, 31, 33, 35, 45, 52, 58) high-risk types was performed on leftover liquid-based cytology material. The preventive potential of the test-and-treat approach was estimated based on published data, reporting the causative HPV types in cervical cancer tissue from South African women. Treatment was provided as needed. The HPV positivity rate more than doubled from 3-type (15.2%; 95% CI: 12.6-17.8) to 8-type mRNA (31.5%; 95% CI: 28.8-34.9) combinations, significantly higher among HIV-positive women. CIN3+ prevalence among HIV-positive women (26.4%) was double that of HIV-negative women (12.9%) (p < 0.01). The 6-type combination showed the best balance of sensitivity, specificity and treatment group size, and effectiveness to prevent cervical cancer. A 4-type combination (16, 18, 35, 45) could potentially prevent 77.6% (95% CI: 71.2-84.0) of cervical cancer burden by treating 20% and detecting 41.1% of CIN3 cases in the study group. Similarly, a 6-type combination (16, 18, 31, 33, 35, 45), treating 25% and including 62% of CIN3 cases, might prevent 85% of cervical cancer cases (95% CI: 79.6-90.6) among HIV-positive and negative women. Employing mRNA HPV tests within a test-and-treat approach holds huge promise for targeted cervical cancer prevention in under-screened populations. Testing for mRNA of the 6 highest-risk HPV types in this population and treating them all is projected to effectively prevent progression from CIN3 to invasive cervical cancer while reducing overtreatment in resource-constrained settings.

A-208 An Improved Formula for Predicting Low LDL-C Based on an Enhanced Sampson-NIH Equation

Abstract Background Low-density lipoprotein cholesterol (LDL-C) is used to assess atherosclerotic cardiovascular disease (ASCVD) risk and to manage lipid-lowering therapy. Proprotein convertase subtilisin/kexin (type 9) serine protease (PCSK9) inhibitors decrease LDL-C by up to 70% when used in conjunction with statins. Due to cost, insurance companies restrict their use. To be eligible for PCSK9 therapy, a patient must have pre-existing ASCVD and LDL-C &amp;gt; 70 mg/dL, while on a maximally tolerated dose of statins. Most clinical laboratories calculate LDL-C by the Friedewald Equation (FWLDL-C), which utilizes results from the standard lipid panel (total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C)). However, this often leads to an underestimation of LDL-C, especially when TG concentrations are elevated. More accurate equations have recently been developed, such as the Martin (MLDL-C), Sampson-NIH (SLDL-C) and extended Martin (ext-MLDL-C) equations. Using LDL-C determined by the beta-quantification reference method (BQ), we developed the following enhanced version of the Sampson-NIH Equation (eSLDL-C), which includes apoB as an independent variable: eSLDL-C = TC/1.15-(HDL-C)/1.25-TG/6.98-(TG × NonHDL-C)/1115 + TG2/8903.23 + (TG × ApoB)/1237 + ApoB/4.54–4.73 Methods Results for clinically ordered ApoB, BQ, and lipid panels were used. To test the accuracy of the various equations, we compared BQLDL-C to FWLDL-C, MLDL-C, extMLDL-C, SLDL-C and eSLDL-C by regression analysis (N = 12 101, TG &amp;lt; 800). Accuracy of each equation was compared to the BQ reference method for classifying patients (LDL-C ≤ 150, n = 9374) as either being below or above the 70 mg/dL treatment decision threshold for PCSK9 therapy. Results The eSLDL-C equation performed substantially better than the other equations for estimating low LDL-C (BQLDL-C ≤ 100 mg/dL, TG 5–800 mg/dL, n = 4115), with a mean absolute difference (MAD) of 3.80 mg/dL (compared to SLDL-C: 6.05; FWLDL-C: 8.71; MLDL-C: 6.43; extMLDL-C: 6.39). It also had the best overall normalized Matthew’s Correlation Coefficient (nMCC) for the best balance of sensitivity and specificity for identifying patients that are above the 70 mg/dL treatment threshold (eSLDL-C-94.7% (92.2% spec, 98.5% sen), SLDL-C-90.7% (94.8% spec, 95.5% sen), FWLDL-C-88.2% (98.0% spec, 92.7% sen), MLDL-C-90.3% (88.9% spec, 96.5% sen), and extMLDL-C-90.1% (88.4% spec, 96.5% sen)). In our dataset with 1125 subjects being below the 70 mg/dL threshold by BQLDL-C, FWLDL-C misclassified an additional 601 subjects below this threshold (Negative Predictive Value 65%). MLDL-C and extMLDL-C misclassified 289 subjects falsely low, whereas eSLDL-C only has 126 subjects falsely classified lower than the 70 mg/dL threshold. Conclusion We show that the enhanced Sampson-NIH equation, which includes apoB, estimates low LDL-C more accurately than other equations. The use of the new equation would improve access to those patients who might benefit from PCSK9 therapy but have falsely low LDL-C by the FWLDL-C equation or other LDL-C equations. The new equation is also more specific than the MLDL-C and extMLDL-C equations and would, therefore, also reduce the overutilization of PCSK9 therapy by these particular equations for those patients who do not require it, according to the reference BQ method and current guidelines.

The Application of CT Radiomics in the Diagnosis of Vein Wall Invasion in Patients With Renal Cell Carcinoma Combined With Tumor Thrombus.

The objective of this study was to explore the application of radiomics combined with machine learning to establish different models to assist in the diagnosis of venous wall invasion in patients with renal cell carcinoma and venous tumor thrombus and to evaluate the diagnostic efficacy. We retrospectively reviewed the data of 169 patients in Peking University Third Hospital from March 2015 to January 21, who was diagnosed as renal mass with venous invasion. According to the intraoperative findings, 111 patients were classified to the venous wall invasion group and 58 cases in the non-invasion group. ITK-snap was used for tumor segmentation and PyRadiomics 3.0.1 package was used for feature extraction. A total of 1598 features could be extracted from each CT image. The patients were divided into training set and testing set by time. The elastic-net regression with 4-fold cross-validation was used as a dimension-reduction method. After feature selection, a support vector machines (SVM) model, a logistic regression (LR) model, and an extra trees (ET) model were established. Then the sensitivity, specificity, accuracy, and the area under the curve (AUC) were calculated to evaluate the diagnostic performance of each model on the testing set. Patients before September 2019 were divided into the training set, of which 88 patients were in the invasion group and 42 patients were in the non-invasion group. The others were in the testing set, of which 32 patients were in the invasion group and 16 patients were in the non-invasion group. A total of 34 radiomics features were obtained by the elastic-net regression. The SVM model had an AUC value of 0.641 (95% CI, 0.463-0.769), a sensitivity of 1.000, and a specificity of 0.062. The LR model had an AUC value of 0.769 (95% CI, 0.620-0.877), a sensitivity of 0.913, and a specificity of 0.312. The ET model had an AUC value of 0.853 (95% CI, 0.734-0.948), a sensitivity of 0.783, and a specificity of 0.812. Among the 3 models, the ET model had the best diagnostic effect, with a good balance of sensitivity and specificity. And the higher the tumor thrombus grade, the better the diagnostic efficacy of the ET model. In inferior vena cava tumor thrombus, the sensitivity, specificity, accuracy, and AUC of ET model can be improved to 0.889, 0.800, 0.857, 0.878 (95% CI, 0.745-1.000). Machine learning combined with radiomics method can effectively identify whether venous wall was invaded by tumor thrombus and has high diagnostic efficacy with an AUC of 0.853 (95% CI, 0.734-0.948).

Determination of sensitivities and specificities of cerebrospinal fluid free light chains to diagnose multiple sclerosis- a multicentric case-control study.

CSF free light chains help diagnose multiple sclerosis, but no data is available on the Asian population. Our objective was to study the diagnostic utility of CSF free light chains for diagnosing multiple sclerosis in Indian patients. Prospective multicentric case-control study. Cases included those who were tested for oligoclonal bands and fulfilled the modified McDonald criteria 2017 for multiple sclerosis and clinically isolated syndromes. Those tested for oligoclonal bands (OCB) but with other diagnoses- inflammatory and non-inflammatory were included as controls. Clinical details were collected from electronic medical records. CSF and serum kappa and lambda free light chains were measured, apart from oligoclonal bands, immunoglobulin, and albumin in paired serum and CSF samples. There were 70 patients (31 cases and 39 controls). The mean age was 43.41(SD 16.073) years, and 43(61.4%) were females. CSF kappa showed highest specificity 97.4%, at a cut off 2.06mg/L (sensitivity 71%) and highest sensitivity 90.3%, at a cut off 0.47mg/L (specificity 79.5%). Best balance of sensitivity and specificity for CSF kappa was seen at a cut-off of ≥ 0.63mg/L {sensitivity 87·1 (CI - 70.17-96.37), and specificity 87·18 (CI -72.57-95.70)}. The ratio of Kappa/lambda showed highest specificity of 100%(similar to OCB) with a sensitivity of 71% at a cut off of 1.72. The ratio of sum of kappa and lambda light chains, and Qalb (∑CSF FLC/Qalb), showed the highest specificity (94.87%)among the blood brain barrier corrected ratios. This study showed that the diagnostic utility of CSF kappa was comparable to OCB to diagnose multiple sclerosis in sensitivity, but not specificity, so can be a screening test before testing for OCB in our population.

(255) Operating Characteristics of Sperm Concentration and FSH for Predicting Chromosomal Abnormalities

Abstract Introduction Microdeletions of the Y-chromosome (Yq) and karyotype abnormalities are frequent causes of male factor infertility. Current AUA/EUA guidelines recommend obtaining Yq microdeletion analysis, karyotype, and genetic counseling in men with non-obstructive azoospermia or severe oligospermia (&amp;lt;5 mil/mL). A recent retrospective cohort study suggests that Yq microdeletions are primarily found at a sperm concentration &amp;lt; 0.5 mil/mL and that by lowering the concentration threshold for genetic testing, specificity could be increased and relative financial cost decreased without adversely affecting the sensitivity. Studies have shown that FSH is the best predictor of NOA in combination with testicular volume as well as a significant predictor of microdeletion presence. Identification of Yq microdeletions and karyotype abnormalities have implications when counseling patients (and their partners) about the likelihood of retrieving sperm and need for further genetic counseling. Objective We hypothesized that the combination of sperm concentration and FSH would better predict the presence of chromosome abnormalities in infertile men. Methods A retrospective cohort study was conducted with subjects who were referred to a military tertiary Urology clinic between 2010 to 2020 and who underwent an infertility evaluation to include genetic testing (karyotype, Y-chromosome analysis), hormone profile (FSH), and at least one semen analysis. Sperm density and FSH were analyzed as independent predictors of chromosomal abnormalities using logistic regression. Receiver operating characteristics were generated for each independent variable that achieved significance in regression. Results A total of 356 patients met inclusion criteria. Over the ten-year period, the prevalence of Y-chromosome microdeletions and karyotype abnormalities was 3.3% (n=12) and 8.4% (n=30), respectively. The ability to predict chromosomal abnormality based on logistic regression was statistically significant for each independent variable. The area under the curve for sperm concentration and FSH was found to be statistically better in combination than concentration alone (0.71 vs 0.66, p=0.033). The best balance of sensitivity and specificity (i.e. for a diagnostic test) for concentration and FSH were found at cut-points of 8.345 mIU/mL, respectively. To optimize performance as a screening test and maintain sensitivity &amp;gt;90%, the cut points for concentration and FSH were 2.74 mIU/mL, respectively. There was no difference in sensitivity for concentration between 2-7 mil/mL and no abnormalities were found if concentration exceeded 7 mil/mL; thus a cutoff of 7 mil/mL would capture 100% of all chromosome abnormalities. Conclusions Based on receiver operating characteristics, lowering the threshold for chromosomal analysis to a sperm concentration of &amp;lt;1 mil/mL maintains acceptable performance as a screening test for genetic abnormality, with resulting cost savings expected. Incorporating FSH into this decision appears to improve both sensitivity and specificity in prediction of chromosomal abnormalities. Our military single-institution ten-year cohort, exemplifies the potential improvement in patient selection and results that can be achieved if the sperm concentration is lowered from the current cutoff Disclosure No

Is a brief screen for personality disorder clinically useful for the detection of impairment in personality functioning in adolescents?

The Standardized Assessment of Personality-Abbreviated Scale (SAPAS) has been used extensively to screen for personality disorders (PD), including adolescents. Yet, it is unclear how well the SAPAS performs in screening for impairment in personality functioning (IPF), Criterion A of the alternative Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition model for PD (AMPD) in adolescent samples. We examined the performance of the SAPAS in detecting IPF at a diagnostic threshold for PD in the AMPD. A consecutive clinical sample of adolescents in Bern, Switzerland (N = 293), were first administered the SAPAS, then the Semistructured Interview for Personality Functioning Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (STiP-5.1). A receiver operating characteristic (ROC) analysis was used to determine the diagnostic accuracy of the SAPAS in relation to the STiP-5.1. ROC regression analyses were conducted to determine if other variables moderated the discriminant performance of the SAPAS. Internal consistency of the SAPAS was low (α = .54) and overall discriminatory accuracy was moderate (area under the curve = .73). The optimum cut-off point was 5, with the best balance of sensitivity and specificity (63.22 and 69.90, respectively), correctly classifying 67.92% of participants. Agreement between the SAPAS and the STiP-5.1 using this cut-off was low (κ = .30). Age yielded statistically significant effects on the discriminant performance of the SAPAS-performance improving among older adolescents. Findings suggest that the SAPAS may not be the optimal method of screening for Criterion A IPF among adolescents in clinical settings but might also be more suited to Criterion B. Our findings call for a developmentally adapted screener for early detection of PD represented by IPF in adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Test Characteristics of Stool Color for Predicting Infection with Vibrio Cholerae in Patients with Acute Diarrhea

Introduction:Recurring outbreaks of cholera coupled with lack of laboratory diagnostic capacity in low resource settings fuels clinicians’ reliance on clinical case definitions and highlights the importance of accurate diagnostic guidelines. While “rice-water” stool color is the hallmark predictor of cholera, few have examined the diagnostic accuracy of this assessment. This study assesses the sensitivity, specificity and positive and negative predictive value (PPV; NPV) of classifying stool color as “rice”, “clear” (i.e. watery) or “rice or clear” stool by either the patient or nurse for diagnosing cholera.Method:From March 2019-2020, a random sample of patients presenting to the International Centre for Diarrhoeal Diseases Research, Bangladesh with acute diarrhea who had a stool sample obtained were included in this analysis (N=2135).Results:Of the 1198 (56.1%) of patients that had culture growth, 641 (53.5%) were positive for Vibrio cholerae. “Rice” stool was reported by 518 (23.8%) patients and 640 (29.5%) nurses, while “clear” stool was reported by 1081 (49.8%) patients and 353 (16.3%) nurses. When observed by nurses, both “rice” (76%) and “clear” (85%) stool were reasonably specific but not very sensitive for cholera (44% and 20%, respectively). The combined “rice or clear” colored stool had the best balance of sensitivity (65%) and specificity (61%) with a PPV of 42% and NPV of 80%. When reported by patients, “rice” stool had high specificity for cholera (76%) but low sensitivity (25%), while “clear” stool had both poor sensitivity (54%) and specificity (51%).Conclusion:Current international guidance that recommends classifying watery (clear) stool as cholera in outbreaks may still miss many patients with culture confirmed cholera even when the stool color is observed by trained health professionals and is likely not useful at all self-reported by patients. The combination of “rice or clear” diarrhea may provide somewhat more accurate assessments.

MP30-10 OPERATING CHARACTERISTICS OF SPERM CONCENTRATION AND FSH FOR PREDICTING CHROMOSOMAL ABNORMALITIES

You have accessJournal of UrologyCME1 Apr 2023MP30-10 OPERATING CHARACTERISTICS OF SPERM CONCENTRATION AND FSH FOR PREDICTING CHROMOSOMAL ABNORMALITIES Colin McLain, Matthew Christman, Eric Biewenga, and Donald Crain Colin McLainColin McLain More articles by this author , Matthew ChristmanMatthew Christman More articles by this author , Eric BiewengaEric Biewenga More articles by this author , and Donald CrainDonald Crain More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003258.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current AUA/EUA guidelines recommend obtaining Yq microdeletion analysis, karyotype, and genetic counseling in men with non-obstructive azoospermia or severe oligospermia (<5 mil/mL). A recent retrospective cohort study suggests that Yq microdeletions are primarily found at a sperm concentration < 0.5 mil/mL and that by lowering the concentration threshold for genetic testing, specificity could be increased and relative financial cost decreased without adversely affecting the sensitivity. Studies have shown that FSH is the best predictor of non-obstructive azoospermia (NOA) in combination with testicular volume as well as a significant predictor of microdeletion presence. We hypothesized that the combination of sperm concentration and FSH would better predict the presence of chromosome abnormalities in infertile men. METHODS: A retrospective cohort study was conducted with subjects who were referred to a military tertiary Urology clinic between 2010 to 2020 and who underwent an infertility evaluation to include genetic testing, hormone profile, and at least one semen analysis. Sperm density and FSH were analyzed as independent predictors of chromosomal abnormalities using logistic regression. Receiver operating characteristics were generated for each independent variable that achieved significance in regression. RESULTS: 356 patients met inclusion criteria. Over the ten-year period, the prevalence of Y-chromosome microdeletions and karyotype abnormalities was 3.3% (n=12) and 8.4% (n=30), respectively. The ability to predict chromosomal abnormality based on logistic regression was statistically significant for each independent variable. The area under the curve for sperm concentration and FSH was found to be statistically better in combination than concentration alone (0.71 vs 0.66, p=0.033). The best balance of sensitivity and specificity (i.e. for a diagnostic test) for concentration and FSH were found at cut-points of <0.215 mil/mL and >8.345 mIU/mL, respectively. To optimize performance as a screening test and maintain sensitivity >90%, the cut points for concentration and FSH were <1 mil/mL and >2.74 mIU/mL, respectively. There was no difference in sensitivity for concentration between 2-7 mil/mL and no abnormalities were found if concentration exceeded 7 mil/mL. CONCLUSIONS: Our military single-institution ten-year cohort, exemplifies the potential improvement in patient selection and results that can be achieved if the sperm concentration is lowered from the current cutoff as well as possible addition of FSH to algorithm. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e394 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Colin McLain More articles by this author Matthew Christman More articles by this author Eric Biewenga More articles by this author Donald Crain More articles by this author Expand All Advertisement PDF downloadLoading ...

Development of a machine learning algorithm based on administrative claims data for identification of ED anaphylaxis patient visits.

Epidemiologic studies of anaphylaxis commonly rely on International Classification of Diseases (ICD) codes to identify anaphylaxis cases, which may lead to suboptimal epidemiologic classification. We sought to develop and assess the accuracy of a machine learning algorithm using ICD codes and other administrative data compared with ICD code-only algorithms to identify emergency department (ED) anaphylaxis visits. We conducted a retrospective review of ED visits from January 2013 to September 2017. Potential ED anaphylaxis visits were identified using 3 methods: anaphylaxis ICD diagnostic codes (method 1), ICD symptom-based codes with or without a code indicating an allergic trigger (method 2), and ICD codes indicating a potential allergic reaction only (method 3). Amachine learning algorithm was developed from administrative data, and test characteristics were compared with ICD code-only algorithms. A total of 699 of 2191 (31.9%) potential ED anaphylaxis visits were classified as anaphylaxis. The sensitivity and specificity of method 1 were 49.1% and 87.5%, respectively. Method 1 used in combination with method 2 resulted in a sensitivity of 53.9% and a specificity of 68.7%. Method 1 used in combination with method 3 resulted in a sensitivity of 98.4% and a specificity of 15.1%. The sensitivity and specificity of the machine learning algorithm were 87.3% and 79.1%, respectively. ICD coding alone demonstrated poor sensitivity in identifying cases of anaphylaxis, with venom-related anaphylaxis missing 96% of cases. The machine learning algorithm resulted in a better balance of sensitivity and specificity and improves upon previous strategies to identify ED anaphylaxis visits.

Performance of the GAD-7 in adults with dissociative seizures

PurposeLittle is known about the accuracy of the GAD-7, a self-report anxiety measure, in detecting generalised anxiety disorder (GAD) in people with dissociative seizures (DS). We evaluated the reliability, validity and uniformity of the GAD-7 using a diagnosis of GAD on the Mini-International Neuropsychiatric Interview as a reference. MethodsWe assessed 368 adults with DS at the pre-randomisation phase of the CODES trial. Factor analysis for categorical data assessed GAD-7 uniformity. Diagnostic accuracy was assessed by estimating the area under the curve (AUC). We evaluated discriminant validity, reviewed data on convergent validity and calculated internal consistency. We explored correlations between GAD-7 scores and monthly DS frequency, frequency of severe seizures and measures of behavioural and emotional avoidance. ResultsInternal consistency of the GAD-7 was high (α = 0.92). Factor analysis elicited one main factor and general measurement invariance. Diagnostic accuracy was fair (AUC = 0.72) but the best balance of sensitivity and specificity occurred at a cut-off of ≥12 and still had a specificity rate of only 68%. Discriminant and convergent validity were good. GAD-7 scores correlated positively with DS frequency, severe seizure frequency, behavioural and emotional avoidance (all p < 0.001). ConclusionFindings regarding internal consistency and factor structure parallel previous psychometric evaluations of the GAD-7. Correlations between GAD-7 scores and DS occurrence/severity and avoidance are evidence of the concept validity of GAD-7 and provide further support for a fear-avoidance treatment model for DS. However, the utility of the GAD-7 as a diagnostic instrument for generalised anxiety disorder is limited in patients with DS.

Clinical Performance of Real-Time Polymerase Chain Reaction for Strongyloides stercoralis Compared with Serology in a Nonendemic Setting.

Strongyloides stercoralis is a nematode endemic to subtropical and tropical regions that may cause asymptomatic carriage, peripheral eosinophilia, cutaneous, gastrointestinal, and pulmonary disease, or hyperinfection syndrome. Conventional diagnostic methods for strongyloidiasis include feces microscopy and culture, with low sensitivity in chronic infection due to the low helminth burden, and serology, which may be prone to false-negative results with immunocompromise and false-positive results with other infections and immunological disorders. We evaluated a laboratory-developed real-time polymerase chain reaction (RT-PCR), detecting the 18S SSU ribosomal RNA gene, compared with conventional diagnostic methods, using serology via ELISA as the gold-standard. The population studied included tertiary hospital inpatients and outpatients residing in a nonendemic area. Seven hundred fifty unfixed stool specimens submitted sequentially between 2014 and 2018 were tested for S. stercoralis via microscopy and RT-PCR. Agar plate culture (APC), Harada-Mori culture (HMC), and ELISA were performed in conjunction with 141, 135, and 177 of the specimens, respectively. RT-PCR yielded 13 positive and 730 negative results, with inhibition in seven specimens. ELISA yielded 53 positive, 18 equivocal, and 106 negative results. Results for direct diagnostic methods obtained after treatment with ivermectin were excluded from the performance analysis. Compared with ELISA, RT-PCR, microscopy, APC, and HMC exhibited sensitivities of 38%, 6%, 3%, and 0%, respectively, and specificities of 100%. Given the low sensitivities commensurate with testing a population with remote infection and thus low parasite burden, we recommend a combination of serological and molecular diagnostic testing to achieve the best balance of sensitivity and specificity.

Comparative pilot study about HPV test with partial genotyping in primary screening versus other strategies for cervical cancer population screening, CRYGEN 16/18 study

IntroductionThe early detection of cervical cancer requires the implementation of molecular screening programmes for human papillomavirus (HPV). However, there are discrepancies in the optimization of screening protocols. The performance of 10 primary screening strategies based on molecular, cytological or combined techniques is now evaluated. Material and MethodsA blind, prospective, and interventional study was designed in 1.977 35-year-old women. The molecular determination was carried out by the Cobas 4800 HPV platform. Cytological analysis were performed on the same samples without knowledge of the result of the molecular assay. All women in whom HPV-16/HPV-18 was detected or presented cytological alteration together with detection of other high-risk genotypes (HPVhr) were referred to colposcopy. ResultsThe molecular assay detected the presence of HPVhr genotypes in 12.5% of the women, while only 8.1% of the cytologies were pathological. Among the patients referred to colposcopy, in 19.5% high-grade lesions were observed, being HPV-16 present in 65.3% of them. In six of these high-grade lesions (associated with HPV-16 in all cases), cytology was reported as normal. The follow-up one year later, of women with normal cytology and HPVhr detection a HSIL/CIN2+ lesion was detected (associated to HPV-33). In the comparative study with other strategies, the protocol called CRYGEN 16/18 yielded the best balance of sensitivity and specificity with the least referral to colposcopy. ConclusionsPerforming molecular detection of HPVhr with partial first-line genotyping of at least HPV-16, with direct referral to colposcopy, increases the detection rate of HSIL/CIN2+ lesions.