Clear Cutoff Research Articles

Are the Sanctified Becoming the Pornified? Religious Conservatism, Commitment, and Pornography Use, 1984–2016*

ObjectivesAmericans are generally increasing in their pornography viewership. While devout, theologically conservative Christians have been among the most ardent opponents to pornography's dissemination and use historically, there is a growing—but thus far untested—assumption that they too are following this same trend. This study examines (1) whether committed or conservative Christians are increasing in rates of porn viewership similar to other Americans and (2) when potential religious divergences in porn viewership started.MethodsWe fit a series of binary logistic regression models using data from the 1984–2016 General Social Surveys.ResultsHolding other variables constant, American evangelicals are indeed increasing in their reported porn viewership at rates identical to other Americans. Frequent church attendees and biblical literalists, however, show a divergent trend, with both remaining constant in their reported porn viewership across time. Analyses also show clear cutoff points for the divergence starting in the mid‐1990s, roughly when Internet pornography became available.ConclusionsFindings suggest that, all else being equal, Americans who merely identify with conservative Christianity are indeed increasing in their porn viewership, but among the most faithful and theologically conservative Americans, they are no more likely to report viewing pornography than they were over 30 years ago.

A study on evaluation of waist height ratio as a screening tool for obesity

Introduction:Childhood obesity has become a single marker for children at risk for development of various non-communicable diseases later in life. This study is conducted to estimate the prevalence of obesity and the risk factors associated with it and to evaluate Waist Height Ratio(WHtR)as a screening tool to identify obesity in children. Materials and Methods:Across sectional study of children between 10 and 15 years of age from upper socioeconomic class from 2 urban schools. Results: The prevalence of obesity is 11.7% and prevalence of asymptomatic hypertension is 12%. The Waist height ratio is more than 0.5 in 21.2%. About 50.5% of obese and 40.5% of overweight children had a WtHR of >0.5. Waist Height Ratio correlated significantly with all 5 risk factors taken for the study. Conclusion: The prevalence of obesity in children between 10 to 15 years of age in this study is 11.7%. The Waist Height Ratio correlated significantly with the risk factors. Larger studies specific to Indian children are needed to make a clear cutoff value for WHtR to improve the sensitivity of screening.

EBV-positive diffuse large B-cell lymphoma, not otherwise specified: 2018 update on diagnosis, risk-stratification and management.

Epstein Barr virus-positive (EBV+) diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS) is an entity included in the 2016 WHO classification of lymphoid neoplasms. EBV+ DLBCL, NOS, is an aggressive B-cell lymphoma associated with chronic EBV infection, and a poor prognosis with standard chemotherapeutic approaches. The diagnosis is made through a careful pathological evaluation. Detection of EBV-encoded RNA is considered standard for diagnosis; however, a clear cutoff for positivity has not been defined. The differential diagnosis includes plasmablastic lymphoma, DLBCL associated with chronic inflammation, primary effusion lymphoma, HHV8+ DLBCL, NOS, and EBV+ mucocutaneuos ulcer. The International prognostic index (IPI) and the Oyama score can be used for risk-stratification. The Oyama score includes age >70 years and presence of B symptoms. The expression of CD30 is emerging as a potential adverse, and targetable, prognostic factor. Patients with EBV+ DLBCL, NOS, should be staged and managed following similar guidelines than patients with EBV-negative DLBCL. EBV+ DLBCL, NOS, however, has a worse prognosis than EBV-negative DLBCL in the era of chemoimmunotherapy. There is an opportunity to study and develop targeted therapy in the management of patients with EBV+ DLBCL, NOS.

Therapeutic Drug Monitoring Guides the Management of Crohn's Patients with Secondary Loss of Response to Adalimumab.

Managing loss of response (LOR) in Crohn's disase (CD) patients remains challenging. Compelling evidence supports therapeutic drug monitoring (TDM) to guide management in patients on infliximab, but data for other biologics are less robust. We aimed to asses if empiric dose escalation led to improved clinical outcome in addition to TDM-guided optimization in CD patients with LOR to adalimumab (ADA). Retrospective chart review of patients followed between 2014 and 2016 at McGill IBD Center with index TDM for LOR to ADA was performed. Primary outcomes were composite remission at 3, 6, and 12 months in those with empiric adjustments versus TDM-guided optimization. There were 104 patients (54.8% men) who were included in the study. Of this group, 81 patients (77.9%) had serum level (SL) ≥5µg/ml at index TDM with a median value of 12µg/ml (IQR 6.1-16.5). There were 10 patients (9.6%) who had undetectable SL with high anti-ADA antibodies and 48 (46.2%) received empiric escalation. TDM led to change in treatment in 58 patients (55.8%). Among them, 28 (48.3%) had discontinued ADA, 12 (21.7%) had addition of immunomodulator or steroid, and 18 (31%) had ADA dose escalation. Empiric dose escalation before TDM-based optimization was not associated with improved outcomes at 3, 6, and 12 months, irrespective of SL levels. Clear SL cutoff associated with composite remission was not identified. Our data do not support empiric dose adjustment beyond that based on the result of the TDM in patients with LOR to ADA. TDM limits unnecessary dose escalation and provides appropriate treatment strategy without compromising clinical outcomes. 10.1093/ibd/izy044_video1izy044.video15768828880001.

Overactivity of Alternative Pathway Convertases in Patients With Complement-Mediated Renal Diseases.

Overactivation of the alternative pathway of the complement system is associated with the renal diseases atypical hemolytic uremic syndrome (aHUS) and C3 glomerulopathy (C3G). C3 nephritic factors (C3NeF) play an important role in C3G pathogenesis by stabilizing the key enzymatic complex of complement, the C3 convertase. However, the reliability of assays detecting these autoantibodies is limited. Therefore, in this study, we validated and optimized a prototype hemolytic method for robust detection and characterization of factors causing convertase overactivity in large patient cohorts. The assay assesses convertase activity directly in the physiological milieu of serum and therefore is not restricted to detection of stabilizing autoantibodies such as C3NeF but may also reveal genetic variants resulting in prolonged convertase activity. We first defined clear cutoff values based on convertase activity in healthy controls. Next, we evaluated 27 C3G patient samples and found 16 positive for prolonged convertase activity, indicating the presence of factors influencing convertase stability. In three patients, the overactive convertase profile was persistent over disease course while in another patient the increased stability normalized in remission. In all these four patients, the convertase-stabilizing activity resided in the purified immunoglobulin (Ig) fraction, demonstrating the autoantibody nature. By contrast, the Igs of a familial aHUS patient carrying the complement factor B mutation p.Lys323Glu did not reveal convertase stabilization. However, in serum prolonged convertase activity was observed and segregated with the mutation in both affected and unaffected family members. In conclusion, we present a robust and reliable method for the detection, characterization, and evaluation over time of factors prolonging convertase activity (C3NeF or certain mutations) in patient cohorts. This assay may provide new insights in disease pathogenesis and may contribute to the development of more personalized treatment strategies.

IMPACT OF LEFT VENTRICULAR EJECTION FRACTION BETWEEN 50 AND 60% VERSUS ≥60% ON MORTALITY AFTER AORTIC VALVE REPLACEMENT FOR SEVERE AORTIC STENOSIS

Left ventricular ejection fraction (LVEF) is a major prognostic indicator for the outcome of patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS). Currently, LVEF of 50% is defined as low normal for AS. However, a clear cut off value of LVEF related to the best outcome after

Semi-quantitative Analysis of EBUS Elastography as a Feasible Approach in Diagnosing Mediastinal and Hilar Lymph Nodes of Lung Cancer Patients

This study aimed to semi-quantitatively evaluate the elastographic imaging color distribution of mediastinal and hilar lymph nodes (LNs), and explored its utility in helping define malignant and benign LNs for lung cancer patients. We prospectively collected patients who underwent preoperative mediastinal staging of suspected lung cancer by EBUS-TBNA. We analyzed the elastography color distribution of each LN and calculated the blue color proportion (BCP). The LN elastographic patterns were compared with the final EBUS-TBNA pathological results. A receiver operating characteristic (ROC) curve was constructed to evaluate the diagnostic value of BCP. We sampled and analyzed 79 LNs from 60 patients. The average BCP in malignant LNs was remarkably higher than that in benign LNs (57.1% versus 30.8%, P < 0.001). The area under the ROC curve (AUC) for the BCP was 0.86 (95% CI: 0.78–0.94). The best cutoff BCP for differentiating between benign and malignant LNs was determined as 36.7%. All the 16 LNs (20.3%) with a BCP lower than 27.9% were diagnosed as benign tissues. Our study suggests that elastography is a feasible technique that may safely help to predict LN metastasis during EBUS-TBNA. We found a clear BCP cutoff value to help define positive and negative LNs.

Thickness‐dependent optical and structural properties of polytetrafluoroethylene/zinc oxide films by radio frequency magnetron sputtering

AbstractPTFE/ZnO films with varying ZnO thickness were prepared by RF magnetron sputtering under high vacuum (100W RF power). The PTFE/ZnO films show slight enhancement in transmission in the visible range as compared to bare ZnO films. There is a clear UV light cutoff (rapid fall below 380 nm with negligible transmission below ~300 nm) after 10‐min deposition of ZnO, which remains unaffected by further depositing PTFE. Transmission data reveal that absorption edge falls in the range of 300–380 nm, below which, the transmission reduced to only ~0.02% giving an optical density of 4 (for the film deposited for 20 min [total thickness ~415 nm]) in the 200–250 nm range. As the ZnO layer thickness increases, the polycrystallinity increases and simultaneously, roughness increases. It leads to a change in crystallite orientations and also in the distribution of grains on film surface. Corresponding AFM image shows island‐like growth, leading to an intermixed ZnO/PTFE layer. The roughness of surface in lower as well as higher thickness range is found to be high (~8–9 nm) except the film in which continuous layer seems to be grown. Based on this, a layer model was developed that consists of glass substrate, native oxide SiO2 layer on this substrate, then a dense ZnO layer followed by mixed PTFE/ZnO layer which is then covered by top PTFE as evident from the ellipsometry fitting. Overall results suggest that by choosing proper thicknesses and number of layers, such thin films might be used in antireflection coatings with UV protection below 400 nm. Based on these experimental results, an optimized simulated layer model consisting of suitable layer thicknesses of ZnO and PTFE has been suggested to achieve high transmission in the visible wavelength region.

Roles of Transit-Time Flow Measurement for Coronary Artery Bypass Surgery.

Transit-time flow measurement (TTFM) has been increasingly applied to detect graft failure during coronary artery bypass grafting (CABG), because TTFM is less invasive, more reproducible, and less time consuming. Many authors have attempted to validate TTFM and to gain the clear cutoff values and algorithm in TTFM to predict graft failure. The TTFM technology has also been shown to be a useful tool to investigate CABG graft flow characteristics and coronary circulation physiology. It is important to recognize the practical roles of TTFM in the cardiac operating room by review and summarize the literatures.

Circulating miR-21, miR-210 and miR-146a as potential biomarkers to differentiate acute tubular necrosis from hepatorenal syndrome in patients with liver cirrhosis: a pilot study.

Acute kidney injury (AKI) in cirrhotic patients may be functional (hepatorenal syndrome [HRS]) or structural (acute tubular necrosis [ATN]). The differentiation between these two conditions remains challenging; no definite biomarker with a clear cutoff value had been declared. miRNAs seem to be attractive innovative biomarkers to identify the nature of kidney injury in cirrhotic patients. This study aimed to investigate the possibility of using miR-21, miR-210 and miR-146a as differentiating markers between HRS and ATN. This pilot case control study included 50 patients with liver cirrhosis; 25 with HRS and another 25 with ATN beside 30 healthy controls. Real-time qPCR was used to measure the circulating miRNA tested. Higher levels of miR-21 were observed in both ATN and HRS vs. controls with statistically significant difference between ATN and HRS. The means were 9.466±3.21 in ATN, 2.670±1.387 in HRS and 1.090±0.586 in controls. miR-146a and miR-210 were both significantly lower in ATN and HRS compared to controls with statistically significant differences between ATN and HRS. The means of miR-210 were 1.020±0.643, 1.640±0.605 and 3.0±0.532 in ATN, HRS and controls, respectively. The means of miR-146a were 2.543±1.929, 4.98±1.353 and 6.553±0.426 in ATN, HRS and controls, respectively. ROC analyses proved that the three studied mi-RNAs can be used as differentiating biomarkers between ATN and HRS with the best performance observed with mi-21 achieving specificity and sensitivity equal 96%. miR-21, miR-210 and miR-146a may be candidate differentiating markers between HRS and ATN in cirrhotic patients.

Prevalence and outcome of pulmonary arterial hypertension in newborns with perinatal asphyxia

Background: Pulmonary arterial hypertension (PAH) in adults is usually described as mean pulmonary artery pressures of 25 mmHg or more at rest. However, clear cutoff value is not well defined in neonatal age group. Persistent pulmonary hypertension of newborn (PPHN) can be defined as a failure of normal fall in pulmonary vascular resistance at or shortly after birth, leading to shunting of unoxygenated blood into the systemic circulation across foramen ovale or ductus arteriosus. Objective: To study the prevalence and outcome of Pulmonary arterial Hypertension in newborns with perinatal asphyxia. Materials and Methods: This was a prospective observational study in which newborns up to 1 month of age having a history and clinical/laboratorial features of perinatal asphyxia were included in the study. Both inborn and outborn newborns admitted in our Neonatal Intensive Care Unit/neonatal high dependency unit were enrolled in the study. Relevant investigations as and when required for management were done. Echocardiography was done after 48 h of birth, and the findings were noted for the presence of PAH. Second echocardiographic screening was done at 6 weeks of life in all cases. Results: A total number of neonates screened were 41, of which 18 (43.9%) cases had PAH. Out of 18 cases, 8 (44.4%) had a reversal of shunt at the level of patent ductus arteriosus/patent foramen ovale and hence were cases of PPHN. Eleven neonates expired before 6 weeks of age and rest seven cases were screened at 6 weeks. Only one case showed the persistence of PAH at 6 weeks. Conclusion: Perinatal asphyxia was found to have a significant association with the development of PAH, and the mortality was high in neonates with perinatal asphyxia once it is complicated by the development of PAH.

Treatment of Hyperuricemia in Chronic Kidney Disease.

Hyperuricemia may be a major contributor to the development or progression of chronic kidney disease (CKD). Although there is no clear cutoff uric acid (UA) value associated to the risk for kidney damage, it appears to be an increased risk as UA rises. Lifestyle interventions such as exercise, weight reduction, low consumption of purine-rich meat, or avoiding high fructose intake are recommended for all hyperuricemic patients. Lowering urate drugs such as allopurinol or febuxostat may be an option as a renoprotective agent; yet, randomized clinical trials evaluating the safety and efficacy of these drugs are limited to a small number of single-center studies. Several ongoing clinical trials aim to evaluate the safety and efficacy of these drugs. As of today, there is insufficient evidence to recommend the widespread use of UA-lowering therapy to prevent or slow down the progression of CKD. The purpose of this review is to summarize the evidence and future perspectives about the treatment of hyperuricemia in the prevention and progression of CKD.

Parafibromin, APC, and MIB-1 Are Useful Markers for Distinguishing Parathyroid Carcinomas From Adenomas.

Differentiation of parathyroid carcinoma (PC) from parathyroid adenoma (PA) relies solely on the pathologic determination of invasion of surrounding structures and/or distant metastasis. Parathyroid lesions with atypical histologic features with no demonstration of invasion or metastasis present a diagnostic dilemma. Different authors report a parafibromin and adenomatous polyposis coli (APC) loss or reduction in PC cases. High proliferative activity of MIB-1 and increased galectin 3 expression are reported in PC. There is no clear cutoff for the sensitivity, specificity, or predictive value for all these markers. The immunohistochemical expression of parafibromin, APC, MIB-1, and galectin 3 was studied in 73 adenomas, 21 PCs, and 3 atypical adenomas. The presence or absence of each marker was identified through the use of a comprehensive scoring system based on multiplying the percentage of tumor cells stained (0 to 100) and the staining intensity (0 to 3) on each biopsy. The highest score that any slide could reach was 300. A cutoff of >100 was used to consider the specimen positive for parafibromin, APC, or galectin 3 staining. MIB-1 proliferation indices were calculated using image cytometry; proliferation indices >5% were considered positive. We identified parafibromin loss in 7/21 (33%) carcinomas and 1/73 (1%) adenomas. Loss of APC was seen in 20/21 (95%) carcinomas and 38/73 (52%) adenomas. MIB-1 indices were elevated in 18/21 (86%) carcinomas. MIB-1 indices were <5% in all (100%) adenomas. MIB-1 indices were elevated in 2/3 (67%) atypical adenomas. Our study presents a clear cutoff to determine the practicality of using parafibromin, APC, and MIB-1 as immunohistochemical markers to differentiate between PCs and PAs. Loss of parafibromin and a high MIB-1 index are both independently sensitive and specific markers for the diagnosis of PC. Loss of APC was only specific for PC. This panel of markers provides a novel, useful approach in the diagnosis and differentiation of PCs from PAs.

Clinical management outcomes of childhood glaucoma suspects.

PurposeTo investigate the outcomes of childhood glaucoma suspects.DesignRetrospective case series.MethodsRecords of childhood glaucoma suspects were identified using financial claims data; medical history, baseline biometric and exam findings were recorded. Conversion from suspect to glaucoma was determined based on the Childhood Glaucoma Research Network criteria. The study adheres to the tenets of the Declarations of Helsinki.Results214 subjects were enrolled, with median age at initial presentation of 6.37 years (interquartertile range: Q1 = 2.46, Q3 = 8.90). 22 (10.2%) subjects developed glaucoma, 64 (29.9%) had ocular hypertension but no glaucoma, 9 (4.2%) had high-risk condition or syndrome without either ocular hypertension or glaucoma after a mean follow up of 39 +/- 34 months. Neither a family history of glaucoma nor patient gender was significantly different between the groups. 40.2% of subjects (86 of 214) had two or more episodes of intraocular pressure (IOP) > 21 mmHg, among which 25.6% (22 of 86) developed glaucoma after a mean duration of 32.8 +/- 33.5 months.ConclusionsUp to 25% of children with 2 or more episodes of elevated IOP may develop glaucoma. In 50% of suspects who converted to glaucoma, elevated IOP was not present at the initial evaluation. There is no significant difference in gender, family history, or baseline central corneal thickness between suspects who developed glaucoma compared to the rest. While suspects who converted to glaucoma had higher average, maximum and minimum IOP measurements, there is no clear cutoff between the groups.

Scaling Analysis and Its Implication for Asphaltene Deposition in a Wellbore

Summary The study presented here uses order-of-one—or o(1)—scaling analysis to identify dimensionless groups specific to asphaltene deposition along production tubing. The precipitation and subsequent deposition of asphaltene can lead to significant complications related to oilfield production. Aside from the many complications within a reservoir as well as surface equipment, the reduction in cross-sectional area caused by its deposition leads to increased pressure losses, reductions in volumetric flow capacity, and possible flow perturbations within a wellbore. Attempts to mitigate these adverse effects have focused on both hindering the precipitation of asphaltene and preventing its deposition after precipitated. The study used here attempts to quantify various hydrodynamic controls specific to asphaltene deposition. With o(1) scaling analysis, four independent dimensionless groups were generated from momentum and mass-balance equations relating hydrodynamic effects to the rate of asphaltene deposition. The dimensionless group π4 was of particular interest because of its inherent relationship to the rate of deposition. This group was compared with both data and existing correlations taken from literature, and noticeable trends in the deposition rate with respect to average stream velocity were observed. One of the most important trends discerned by these comparisons was a clear distinction whereby the rate of asphaltene deposition, related through π4, decreases with increasing Reynolds numbers (Re) in lower ranges, but actually increases in higher ranges. Although the data did not cover the specific region of transition, various correlations suggest a clear cutoff between what was deemed a favorable regime, or Regime I, and a nonfavorable regime, or Regime II.

Turbulent kinetic energy budget in the boundary layer developing over an urban-like rough wall using PIV

In the present work, a boundary layer developing over a rough-wall consisting of staggered cubes with a plan area packing density λp = 25% is studied within the wind tunnel using Particle Image Velocimetry (PIV) to investigate the Turbulent Kinetic Energy (TKE) budget. To access the full TKE budget, an estimation of the dissipation (ε) using both the transport equation of the resolved-scale kinetic energy and Large-Eddy (LE) PIV models based on the use of a subgrid-scale model following the methodology used in large-eddy simulations is employed. A low-pass filter, larger than the Taylor microscale, is applied to the data prior to the computation of the velocity gradients ensuring a clear cutoff in the inertial range where the models are valid. The presence of the cube roughness elements has a significant influence on the TKE budget due to the region of strong shear that develops over the cubes. The shear layer is shown to produce and dissipate energy, as well as transport energy through advection, turbulent transport, and pressure transport. The recirculation region that forms through the interaction of the shear layer and the canopy layer, which is the region below the height of the cube roughness, creates rapid longitudinal evolution of the mean flow thereby inducing weak production. Finally, through stochastic estimation of the conditional average, it is shown that localized regions of backscatter (energy transfer from unresolved to resolved scales) and forward scatter (energy transfer from resolved to unresolved scales) occur as a result of coherent vortical structures.

A single center study: Aβ42/p-Tau181 CSF ratio to discriminate AD from FTD in clinical setting.

Abnormal levels of beta amyloid (Aβ42) and tau protein concentrations in the cerebral spinal fluid (CSF) have been largely described in Alzheimer's disease (AD). Thus, CSF analysis of these biomarkers has been incorporated in recent AD diagnostic criteria, and it is increasingly performed for neurodegenerative dementia diagnostic workout in clinical setting. Nevertheless, the precise biomarkers CSF features in neurodegenerative dementia, either AD or Frontotemporal dementia (FTD), are still not fully clear today. This is mainly due to lack of CSF clear cutoff values due to a well-known intersite (but even intrasite) variability of CSF procedures, ranging from collection to analysis. Applying CSF biomarker ratios, rather than their single values could represent a useful tool, especially for the differential diagnosis of different forms of dementia. We explored clinical values of six CSF ratios (by combining Aβ42 and tau) in order to better discriminate between AD and FTD; we identified Aβ42/p-Tau181 ratio as a potential good candidate for helping differentiating AD from FTD in the clinical practice.

How to define the hemodynamic significance of an equivocal iliofemoral artery stenosis: Review of literature and outcomes of an international questionnaire.

Purpose The goal of the study was to review current literature regarding the diagnosis of equivocal (50-70%) iliofemoral artery stenosis and compare these findings with the daily practice of an international panel of endovascular experts. Methods The Medline Database was searched for relevant publications, and an electronic survey was sent to experts in the field covering the following topics: definition of an equivocal iliofemoral artery stenosis, angiographic visualization and investigation protocols of an equivocal stenosis, intra-arterial pressure measurements, and definition of hemodynamic significance of an equivocal iliofemoral artery stenosis using a physiologic measure. Results Of the 37 invited endovascular experts, 21 (53.8%) agreed to participate in the survey. Analysis of existing literature shows that the level of evidence for diagnosing equivocal iliofemoral artery stenosis is mediocre and is not being implemented by experts in the field. Conclusion Studies have shown that a stenosis of between 50% and 70% iliofemoral lumen diameter reduction shows a wide range of trans-stenotic pressure gradients. Equivocal iliofemoral artery stenosis can best be identified using three-dimensional quantitative vascular analysis software. Although evidence for a clear hemodynamic cutoff point is weak, performing trans-lesion intra-arterial pressure measurements at rest and during maximal hyperemia is preferred. Diagnosing iliofemoral artery stenosis solely on lumen diameter reduction is inadequate.

Gravity Stress Radiographs and the Effect of Ankle Position on Deltoid Ligament Integrity and Medial Clear Space Measurements.

External rotation and gravity stress radiographs have been described to distinguish stable supination-external rotation-II (SER-II) ankle fractures from unstable SER-IV fractures. It has been previously shown that both external rotation and gravity stress views are equivalent in their ability to diagnose deltoid ligament injury. It has also been shown that the position of the ankle influences the external rotation stress radiograph. However, no data of ankle position exist for gravity stress radiographs. Eight fresh-frozen cadaveric ankles were dissected and destabilized sequentially according to the SER mechanism of ankle fractures, starting with the anterior inferior tibiofibular ligament, distal fibula osteotomy at the level of the syndesmosis, posterior inferior tibiofibular ligament, superficial deltoid ligament, and finally the deep deltoid ligament. Fluoroscopic radiographs were taken with gravity stress views in both neutral and plantarflexion. Measurements of both dorsal and the medial clear space were taken for each stage. The difference between the dorsal and medial clear space was measured. Positive predictive value (PPV) with a medial clear space cutoff of 5 mm was 80% in plantarflexion and 72.72% in neutral with a negative predictive value (NPV) of 100% in both positions. Using a 6-mm cutoff, the PPV improved to 100% and NPV remained 100% for both neutral and plantarflexion. When the difference measurement is used, a 1.0-mm difference yielded a PPV of 72% and an NPV of 100% in both neutral and plantarflexion. With a 1.5-mm cutoff, the PPV and NPV were 100% for both positions. The position of the ankle during gravity stress radiographs does not influence the clinical effectiveness of the images. Using larger references for stability, the PPV can be improved.

Financial Benefits of Rapid Student Loan Repayment: An Analytic Framework Employing Two Decades of Data

This study analyzes the benefits of rapid student loan repayment, defined here as borrowers who repaid their cumulative undergraduate loan debt in half the time of the expected repayment cycle (10 years). Drawing from data on borrowers in two nationally representative samples, I first explain the analytic framework employed to identify rapid loan repayers, then examine whether rapid loan repayment is associated with financial benefits in terms of salary, homeownership, and non–poverty level, identifying how rapid loan repayers differ from their non–rapid loan repayer and nonborrower counterparts. Results show salary benefits associated with rapid loan repayment and indicate that among rapid loan repayers, cumulative loan debt generally did not surpass $15,000. These findings suggest that policy-makers may consider the adoption of shorter repayment plans with clear eligibility cutoff amounts as an alternative to the more common 10-year fixed plan.