Composite Scoring System Research Articles

Ergonomic Analysis of an AssemblyWorkstation to Identify Time Consuming AndFatigue Causing Factors to Improve TheProductivity

The industrial success greatly depends on the quality and delivery time. In order to achieve this industry should implement new techniques which will increase the quality, productivity and decrease worker fatigue. One such technique is ergonomics. This paper addresses the application of ergonomics in improving the quality of work life, reducing musculoskeletal disorders and increasing productivity. The existing workstation was studied and suggestion was given to improve the method for productivity by reducing shoulder and wrist injury and fatigue. A good ergonomic work station design showed a better interaction between man–machine systems. The new approach of studying the operations by Ergonomics assessment Work sheet includes Rula assessment, Work-place assessment and Composite Scoring system, by considering these factors, problems regarding the MSDs is reduced. It is observed that the newly designed workstation improved working posture and resulted in reduced postural stress on operator’s bodies and consequently reduced prevalence of MSDs symptoms

Predicting placebo response in adolescents with major depressive disorder: The Adolescent Placebo Impact Composite Score (APICS)

ObjectiveThe aim of this study was to construct a composite scoring system to predict the probability of placebo response in adolescents with Major Depressive Disorder (MDD). MethodParticipants of the current study were 151 adolescents (aged 12–17 years) who were randomized to the placebo arm (placebo transdermal patches) of a randomized controlled trial (RCT) comparing the selegiline transdermal patch with placebo (DelBello et al., 2014). The primary outcome of response was defined as a CGI-I score of 1 or 2 (very much or much improved) at week 12 (study-end) or exit. As a first step, a multiple logistic mixed model was used to estimate the odds of placebo response from each predictor in the model, including age, CDRS-R total at baseline (depressive symptom severity), history of recurrent depression (yes vs. no), sex (female vs. male), and race (non-Caucasian vs. Caucasian). On the basis of the initial logistic mixed model analysis, we then constructed an Adolescent Placebo Impact Composite Score (APICS) that became the sole predictor in a re-specified Bayesian logistic regression model to estimate the probability of placebo response. Finally, the AUC for the APICS was tested against a nominal area of 0.50 to evaluate how well the APICS discriminated placebo response status. ResultsAmong the 151 adolescents, with a mean age of 14.6 years (SD = 1.6) and a mean baseline CDRS-R total of 60.6 (SD = 12.1), 68.2% were females, 50.3% was Caucasian, and 39.7% had a history of recurrent depression. Placebo response rate was 58.3%. Based on the logistic mixed model, the re-specified equation with the highest discriminatory ability to estimate the probability of placebo response was APICS = age + (0.32 × CDRS-R Total at baseline) + (−2.85 × if female) + (−5.50 × if history of recurrent depression) + (−5.85 × if non-Caucasian). The AUC for this model was 0.59 (p = .049). Within a Bayesian decision-theoretic framework, in 95.5% of the time, the 10,000 posterior Monte Carlo samples suggested that as APICS decreased the probability of placebo response increased. The observed APICS and related probability of responding to placebo in this adolescent sample ranged from 14.1 = 74.1% (in placebo responders) to 39.1 = 41.8% (in placebo non-responders). ConclusionThe APICS model estimates the probability of placebo response in adolescents with MDD with a modest degree of accuracy (AUC = 0.59) and with a reasonable degree of positive predictive value (74.5%), and is based on five previously identified patient characteristics of placebo response from prior meta-analytic studies (Bridge et al., 2009; Cohen et al., 2010) of randomized placebo-controlled trials of antidepressants in youth with MDD. Calculation of the APICS should be restricted to the range of the adolescent ages (12–17 years) and CDRS-R total scores (17–113); thus, the APICS can assume possible calculated values and related probability of responding to placebo ranging from about 3 (84%) to 53 (25%). The APICS Bayesian logistic model, based on a given aggregate patient profile, has a range of predicted probabilities of placebo response that is fairly wide, albeit truncated, but potentially meaningful for predicting the probability of placebo response among adolescent youth with MDD. The ability of the APICS to objectify the probability of placebo response in adolescents with MDD could be accounted for in the clinical research design of the trial itself and perhaps aid clinicians in treatment strategy for youth who are more likely to experience placebo response.

The coagulopathy of acute sepsis

Sepsis, defined by the presence of infection and host inflammation, is a lethal clinical syndrome with an increasing mortality rate worldwide. In severe disease, the coagulation system becomes diffusely activated, with consumption of multiple clotting factors resulting in disseminated intravascular coagulation (DIC). When present, DIC portends a higher mortality rate. Understanding the mechanisms that tie inflammation and diffuse thrombosis will allow therapeutic interventions to be developed. The coagulopathy of acute sepsis is a dynamic process that is time and disease burden specific. Whole-blood testing of coagulation may provide more clinically useful information than the classical tests. Natural anticoagulants that regulate thrombosis are downregulated in sepsis. Patients may benefit from the modulation of the coagulation system when systemic inflammation and hypercoagulopathy exist. Proper timing of anticoagulant therapy may ultimately lead to decreased incidence of multisystem organ dysfunction. The pathogenesis of coagulopathy in sepsis is driven by an upregulation of procoagulant mechanisms and simultaneous downregulation of natural anticoagulants. Inflammation caused by the invading organism is a natural host defense that cannot be eliminated during treatment. Successful strategies to prevent multisystem organ dysfunction center on stratifying patients at high risk for DIC and restoring the balance of inflammation and coagulation. The prevention of DIC in septic patients is a key therapeutic target in preventing death from multisystem organ failure. Stratifying patients for therapy using thromboelastometry, specific markers for DIC, and composite scoring systems is an area of growing research.

(785) - Perioperative Prognostic Factors for Fontan Patients Undergoing Orthotopic Heart Transplant

Although the Fontan procedure offers a long-term palliative option for single-ventricle patients, orthotopic heart transplantation (OHT) remains the definitive treatment for a failing Fontan circuit. We hypothesized that there are a set of perioperative variables associated with increased risk of postoperative adverse outcomes. 36 post-Fontan patients were identified as having undergone OHT at UCLA Medical Center from 1991 to 2014. Data was collected retrospectively and analyzed. The primary endpoint was designated as either perioperative mortality, extended postoperative hospital stay (>30 days), or readmission within 2 weeks of discharge. 17 of 36 patients reached the primary endpoint; 8 patients suffered perioperative death after OHT, 6 patients experienced extended hospital stays, and 4 patients were readmitted within 2 weeks after discharge. Of the patients that suffered the primary outcome, 11 of these patients had an extended preoperative hospital stay (>10 days), 7 patients had an elevated MELD-XI score (≥18), and 8 patients had an extended perioperative cardiopulmonary bypass time (>4 hours). Patients with an elevated MELD-XI score (p=0.0128) or an extended cardiopulmonary bypass time (p=0.0002) carried a significantly higher risk of reaching the primary endpoint. A composite scoring system of eight criteria was used to stratify the risk of patients suffering the primary endpoint. Patients with scores of ≥3, 2, and 0-1 had a 91.1%, 33.3%, and 25% risk of reaching the primary endpoint, respectively. Patients with a score of ≥3 had a relative risk of 3.6 over patients with 0-1 points (95% CI, 1.53-8.67; p=0.0013). Failing Fontan patients undergoing OHT with elevated preoperative MELD-XI scores and/or extended perioperative cardiopulmonary bypass times are at greater risk of experiencing adverse outcomes after transplant. Additionally, a novel scoring system was devised for optimized risk stratification of suffering an adverse outcome after OHT, in which a score of ≥3 was predictive of poorer outcomes. This scoring system may allow for potential improvements in recipient evaluation during the listing process.

Predictors of Multigland Disease in Primary Hyperparathyroidism: A Scoring System with 4D-CT Imaging and Biochemical Markers.

Multigland disease represents a challenging group of patients with primary hyperparathyroidism. Additional lesions may be missed on imaging because they are not considered or are too small to be seen. The aim of this is study was to identify 4D-CT imaging and biochemical predictors of multigland disease. This was a retrospective study of 155 patients who underwent 4D-CT and successful surgery with a biochemical cure that compared patients with multigland and single-gland disease. Variables studied included the size of the largest lesion on 4D-CT, the number of lesions prospectively identified on 4D-CT, serum calcium levels, serum parathyroid hormone levels, and the Wisconsin Index (the product of serum calcium and parathyroid hormone levels). Imaging findings and the Wisconsin Index were used to calculate a composite multigland disease scoring system. We evaluated the predictive value of individual variables and the scoring system for multigland disease. Thirty-six patients with multigland disease were compared with 119 patients with single-gland disease. Patients with multigland disease had significantly lower Wisconsin Index scores, smaller lesion size, and a higher likelihood of having either multiple or zero lesions identified on 4D-CT (P ≤ .01). Size cutoff of <7 mm had 85% specificity for multigland disease, but including other variables in the composite multigland disease score improved the specificity. Scores of ≥4, ≥5, and 6 had specificities of 81%, 93%, and 98%, respectively. The composite multigland disease scoring system based on 4D-CT imaging findings and biochemical data can identify patients with a high likelihood of multigland disease. Communicating the suspicion for multigland disease in the radiology report could influence surgical decision-making, particularly when considering re-exploration in a previously operated neck or initial limited neck exploration.

Distal Sensorimotor Neuropathy: Improvements in Diagnosis.

Neurological complications of diabetes are common, affecting up to 50% of people with diabetes. In these patients, diabetic sensorimotor neuropathy (DSPN) is by far the most frequent complication. Detecting DSPN has traditionally been a clinical exercise that is based on signs and symptoms. However, the appearance of morphometric and neurophysiological techniques along with composite scoring systems and new screening tools has induced a paradigm change in the detection and stratification of DSPN and our understanding of its natural history and etiopathogenesis. These newer techniques have provided further evidence that changes in small nerve fiber structure and function precede large fiber changes in diabetes. Although useful, the challenge for the use of these new techniques will be their sensitivity and specificity when widely adopted and ultimately, their ability to demonstrate improvement when pathogenic mechanisms are corrected. Concurrently, we have also witnessed an emergence of simpler screening tools or methods that are mainly aimed at quicker detection of large fiber neuropathy in the outpatient setting. In this review, we have focused on techniques and tools that receive particular attention in the current literature, their use in research and potential use in the clinical environment.

Sedative effects of intramuscular alfaxalone administered to cats.

The sedative effects of intramuscular (IM) alfaxalone in 2-hydroxypropyl-beta-cyclodextrin (alfaxalone-HPCD) were evaluated in cats. The cats were treated with alfaxalone-HPCD in five occasions with a minimum 14-day interval between treatments: an IM injection of 1.0 mg/kg (IM1), 2.5 mg/kg (IM2.5), 5 mg/kg (IM5) or 10 mg/kg (IM10), or an intravenous injection of 5 mg/kg (IV5). The sedative effects were evaluated subjectively using a composite measurement scoring system (a maximum score of 16). Cardio-respiratory variables were measured non-invasively. The median sedation scores peaked at 10 min (score 9), 15 min (score 14), 10 min (score 16), 10 to 20 min (score 16) and 2 to 5 min (score 16) after the IM1, IM2.5, IM5, IM10 and IV5 treatments, respectively. The IM5 treatment produced longer lasting sedation, compared to the IV5 treatment. Durations of maintenance of lateral recumbency after the IM10 treatment (115 ± 22 min) were longer than those after the IM2.5 (40 ± 15 min), IM5 (76 ± 21 min) and IV5 treatments (50 ± 5 min). Cardio-respiratory variables remained within clinically acceptable ranges, except for each one cat that showed hypotension (<60 mmHg) after the IM10 and IV5 treatments. Tremors, ataxia and opisthotonus-like posture were observed during the early recovery period after the IM2.5, IM5, IM10 and IV5 treatments. In conclusion, IM alfaxalone-HPCD produced dose-dependent and clinically relevant sedative effect at 2.5 to 10 mg/kg in healthy cats. Hypotension may occur at higher IM doses of alfaxalone-HPCD.

Anaesthetic, analgesic and cardiorespiratory effects of intramuscular medetomidine-ketamine combination alone or with morphine or tramadol for orchiectomy in cats

ObjectivesTo compare the anaesthetic, analgesic and cardiorespiratory effects of intramuscular (IM) medetomidine and ketamine administered alone or combined with morphine or tramadol, for orchiectomy in cats. Study designRandomised, blinded, prospective clinical study. AnimalsThirty client-owned cats. Materials and methodsCats (n = 10 in each group) received a combination of medetomidine (60 μgkg−1) and ketamine (10 mg kg−1) alone (MedK); combined with morphine (0.2 mg kg−1) (MedKM), or combined with tramadol (2 mg kg−1) (MedKT) IM. Time of induction, surgical and recovery events were recorded, and physiological parameters measured and recorded. Analgesia was evaluated with a visual analogue scale, a composite scoring system and the von Frey mechanical threshold device, every hour from three to eight hours post-drug administration injection. Data were analyzed with a linear mixed model, Kruskal–Wallis or Chi-square tests (p < 0.05). ResultsMedian (IQR) induction and recovery times (minutes) were not significantly (p = 0.125) different between groups: 5.6 (2.7–8.0), 7.4 (5.1–9.6) and 8.0 (5.8–14.9) for induction and 128.5 (95.1–142.8), 166.4 (123.1–210.0) and 142.9 (123.4–180.2) for recovery, with MedK, MedKT and MedKM, respectively. Two cats (MedKM) required alfaxalone for endotracheal intubation. In all groups, three or four cats required additional isoflurane for surgery. Arterial oxygen tension overall (mean ± SD: 66 ± 2 mmHg) was low. Surgery resulted in increased systolic arterial blood pressure (p < 0.001), haemoglobin saturation (p < 0.001), respiratory (p = 0.003) and heart rates (p = 0.002). Pain scores did not differ significantly between groups. Von Frey responses decreased over time; changes over time varied by treatment (p < 0.001), MedK returning to baseline values more rapidly than MedKM and MedKT. No cat required rescue analgesics. Conclusion and clinical relevanceAll three protocols can provide adequate anaesthesia and analgesia for orchiectomy in cats. However, rescue intervention to maintain surgical anaesthesia may be required in some cats. Oxygen supplementation is advised.

Pilot validation of objective malnutrition—inflammation scores in pediatric and adolescent cohort on chronic maintenance dialysis

Background:In recognition of the challenges inherent with the use of single-item indices for the diagnosis of malnutrition–inflammation morbidity in pediatric dialysis patients, to enhance accuracy, we validated a composite scoring system in a pilot study. The objective malnutrition—inflammation score seeks to validate the use of a composite scoring system as a tool for assessing malnutrition—inflammation burden in a pediatric dialysis population.Methods:We enrolled 20 patients on hemodialysis (n = 14) and peritoneal dialysis (n = 6) over a period of 12 months. We derived composite scores from selected indices of renal pathology, nutrition, dialysis adequacy, protein catabolism, and dialysis modality. We assessed reliability by a test–retest method and measured validity by defining the relationship of the indices with serum C-reactive protein in a multiple regression analysis. We calculated sensitivity, specificity, accuracy, and precision for the malnutrition—inflammation score.Results:The mean age was 12.8 years (standard deviation = 6.1), and male–female ratio was 12:8. Patients (n = 8) with elevated serum C-reactive protein (>0.3 mg/dL) had higher composite score for malnutrition—inflammation morbidity. Similarly, the pediatric cohort on hemodialysis had higher score than those on peritoneal dialysis. Upon reliability testing, a low value of typical error (0.07) and high correlation coefficient (r = 0.95) supported validity of the instrument. Moreover, multiple regression analysis showed a strong predictive relationship (R2 = 0.9, p = 0.03) between the indices and serum C-reactive protein. Sensitivity of malnutrition—inflammation score was 62.5%, specificity was 83%, accuracy was 75%, and precision was 71%.Conclusion:Using criterion-validation method, we established the potential use of multi-diagnostic approach to quantify malnutrition—inflammation morbidity in a pediatric dialysis cohort. Given the small sample size, large-scale population-specific studies are needed to ratify these findings and to demonstrate its clinical effectiveness.

Fertility Scoring Index: Cimar's Novel System to Predict assisted Reproductive Technology Success

ABSTRACTBackgroundAbout 15% of all couples are infertile and require fertility treatment. With constantly improving clinical and laboratory procedures, pregnancy rates of about 30% per transfer are routinely reported. In non-donor-oocyte cycles, the percentage ofin vitrofertilization/intracytoplasmic sperm injection (IVF/ ICSI) cycles that result in pregnancy ranges from 18 to 45%, depending on several factors (Society for Assisted Reproductive Technology 2009). But a patients concern is about the success rate—‘What is my chance of getting pregnant’? For the success in IVF/ICSI—embryo transfer cycle there are many variables thought to be directly related to the implantation and successful outcome.Aims and objectivesTo identify independent predictors ICSI outcome.To make a composite predictive scoring system—For patient selection and counseling for assisted reproductive technology (ART).That may prove critical in counseling poor prognosis patients, about their prognosis or against IVF treatment (e.g. patients with least benefits in undergoing IVF can opt for donor oocytes/surrogacy, etc. without wasting a cycle in trial and error).Optimizing treatment by developing more customized individually tailored treatment plan with consideration to predictive factors.Study designThe research was approved by the institutional review board. A retrospective ongoing study was performed, over a period of 3 years at a well established infertility institution. A sample size of 1020 patients was considered from two hospitals of the same institution. The patients were stimulated by different protocols specific to each patients age, AFC, etc [Polycystic ovarian syndrome (PCOS) patients showing hyperresponse in follicular study-antagonist protocol]; though a majority underwent long agonist protocol. They were evaluated and the outcome was assessed through logistic regression analysis. Several variables were taken into consideration—to name a few; age, previous pregnancy outcome, previous ART treatment if any, E2/LH/P4 [baseline values and on the day of human chorionic gonadotropin (hCG)], etc. A preferential scoring was derived to obtain a predictive scoring for pregnancy outcome.ResultsA pregnancy predicting scoring was arrived at. On considering several variables, the cut off score represented a 50% success rate of IVF/ICSI cycle.ConclusionBearing in mind that fertility is independent of hospital protocols and primarily dependent on the individual woman, the derived predictive scoring can be applied to individual cohort of patients under infertility treatment and has excellent discrimination ability for assessing the likelihood of pregnancy outcome. Application of this scoring will allow individualized treatment decision-making for patients under infertility treatment.How to cite this articleGracias RH, Thalakottoor LF, Gopinath P, Karunakaran GK. Fertility Scoring Index: Cimar's Novel System to Predict Assisted Reproductive Technology Success. Int J Infertil Fetal Med 2014;5(2):44-57.

Methodological challenges in the use of hip-specific composite outcomes: linking measurements from hip fracture trials to the International Classification of Functioning, Disability and Health Framework

The prevalence of hip-specific outcome measures in randomized trials reflects what directs our outcome assessment following a hip fracture. The present study provides an overview on the most commonly-used hip-specific outcome instruments used for postoperative assessment of hip fracture with respect to their covered contents. This can facilitate the selection of appropriate items for specific purposes in clinical as well as research settings. We used the International Classification of Functioning, Disability and Health (ICF) model to distinguish concepts within the instrument. All items from the questionnaires were categorized into one of three categories using the ICF linking rules for a standardized approach. The hip-specific composites measures were also compared to other types of prevalent measures: generic and patient-based instruments. All of the items in the instruments could be mapped to the ICF. We report the highest frequency of ICF activity and participation (71%) within the Harris hip score (HHS) which is similar to the frequency of ICF content found in the generic measures (82%). Hip-specific composites focused mostly on walking and moving long and short distances, while in patient-reported measures there was a concentration on the concept of sensation of pain and pain in body parts. The prevalent use of the HHS, over the other hip-specific instruments, could be attributed to its likeness in concept to other generic measures. The dominance of the ICF category of activity and participation reflects what is important to clinicians treating a hip fracture. Composite scores remain problematic as they cut across different ICF concepts. As long as the popularity of composite scoring systems continues, an overall score may not represent the true patient preferences and concerns in clinical trials. Future studies could apply the results from this study for the creation of an ICF category-based item banking or investigators could operationalize the ICF categories within these candidate measures for specific interventions.

Another step in improving the diagnosis of disseminated intravascular coagulation in sepsis

The diagnosis of disseminated intravascular coagulation (DIC) based on composite scoring systems using routinely available coagulation tests has been greatly facilitated. Such scoring instruments not only adequately assess the presence of DIC but also have strong prognostic power for morbidity and mortality. In this issue of Critical Care, Gando and colleagues report on the prospective validation of the Japanese Association of Acute Medicine score for DIC in patients with severe sepsis.

Development and validation of a composite scoring system for robot-assisted surgical training—the Robotic Skills Assessment Score

BackgroundA standardized scoring system does not exist in virtual reality-based assessment metrics to describe safe and crucial surgical skills in robot-assisted surgery. This study aims to develop an assessment score along with its construct validation. Materials and methodsAll subjects performed key tasks on previously validated Fundamental Skills of Robotic Surgery curriculum, which were recorded, and metrics were stored. After an expert consensus for the purpose of content validation (Delphi), critical safety determining procedural steps were identified from the Fundamental Skills of Robotic Surgery curriculum and a hierarchical task decomposition of multiple parameters using a variety of metrics was used to develop Robotic Skills Assessment Score (RSA-Score). Robotic Skills Assessment mainly focuses on safety in operative field, critical error, economy, bimanual dexterity, and time. Following, the RSA-Score was further evaluated for construct validation and feasibility. Spearman correlation tests performed between tasks using the RSA-Scores indicate no cross correlation. Wilcoxon rank sum tests were performed between the two groups. ResultsThe proposed RSA-Score was evaluated on non-robotic surgeons (n = 15) and on expert-robotic surgeons (n = 12). The expert group demonstrated significantly better performance on all four tasks in comparison to the novice group. Validation of the RSA-Score in this study was carried out on the Robotic Surgical Simulator. ConclusionThe RSA-Score is a valid scoring system that could be incorporated in any virtual reality-based surgical simulator to achieve standardized assessment of fundamental surgical tents during robot-assisted surgery.

A parameter weighting scheme for an automated weather effects decision aid

For the past twenty years Army field intelligence analysts and staff weather officers assigned to combat weather teams have utilized a decision support tool called the Integrated Weather Effects Decision Aid (IWEDA). The IWEDA system ingests weather forecast model grids, applies a rules/thresholds database to the grids, and produces color-coded overlays for terrain map backgrounds. These map overlays quickly indicate the severity of the weather impacts on Army weapon and support systems, and have provided a valuable tool for mission commanders to plan battlefield operations. Although it is a useful tool, the basic IWEDA concept has not been updated since its inception, and its capabilities have fallen behind the vastly improved numerical weather prediction models and computing platforms that are available today. Its coarse color-coded map indicators are a simplistic green/amber/red scheme, all weather parameters are treated with equal weight, and there is no means of accounting for how many model parameters are contributing to the adverse weather effects. The current research describes a new composite scoring system by which weather parameters can be assigned different weights; an accounting is made for the number of parameters contributing to the adverse weather, and much greater color granularity can be applied to the IWEDA map overlays. The higher color granularity and adjustable parameter weights are expected to afford much greater flexibility to commanders and intelligence analysts as weather effects are incorporated into planning battlefield operations. The new capability also is suitable for use in comparable operational civilian weather impacts technologies.

Factors influencing the willingness of US women to vaccinate their daughters against the human papillomavirus to prevent cervical cancer

The human papillomavirus (HPV) vaccine helps to prevent cervical cancer. However, research indicates that public acceptance of the vaccine is suboptimal. Our aims were to evaluate the willingness of US women to use the HPV vaccine in their daughters, examine their current understanding of HPV, and determine the impact of HPV knowledge and other socio-demographic factors on their willingness to get their daughters vaccinated. Women aged ≥ 18 years were identified from the US Health Information National Trends Survey. We developed a 6-point composite scoring system based on individual responses to HPV-related questions to characterize personal understanding about HPV. Logistic regression models were constructed to explore the influence of the women's HPV knowledge level and additional socio-demographic factors on the willingness to use HPV in their daughters. There were 804 female respondents: mean age was 44.9 (SD = 2.53) years and 73 % were White. In total, 75 % of women indicated they would vaccinate their daughters against HPV. Mean knowledge score was 4.6 (SD = 0.80). While White race was associated with higher willingness to use the vaccine in their daughters (OR = 1.86, p = 0.04), HPV knowledge level was not (OR = 0.47, p = 0.22). Among US women, HPV knowledge level was high, but it was not associated with the willingness to vaccinate their daughters against HPV. Interventions focused on alleviating racial disparities might better modify the use of the HPV vaccine.

Use of a composite scoring system as a predictor of success in graduate school in a Hispanic‐serving institution

Individual basic criteria (eg. GRE, GPA) commonly used by graduate school admissions committees are often not suitable predictors for success at our institution, possibly due to differences in language and culture. Therefore we developed a composite score (CS) which uses evidence‐based predictors of success to evaluate our incoming applicants to better identify high caliber candidates that are likely to succeed in our program.AimTest the validity of our CS to predict student success in graduate school.MethodsWe developed a CS that assigns numerical values for GPA, GRE, research experience, advanced coursework/degrees, presentations, and publications. We calculated CS for students admitted into our program (2002–2010) and compared these to successful outcomes.ResultsThe average CS was significantly higher in those students completing the graduate program versus drop‐outs (p&lt;0.003) and correlated with success in competing for fellowships and a shorter time to thesis defense. In contrast GPA, SGPA, or GRE did not predict these outcomes.ConclusionsThe CS provides us with a quantitative measure of some of the qualitative factors that better determines the success of the students in our program and allows improved evaluation and selection of the most promising students. R25GM082406

Another step in improving the diagnosis of disseminated intravascular coagulation in sepsis

The diagnosis of disseminated intravascular coagulation (DIC) based on composite scoring systems using routinely available coagulation tests has been greatly facilitated. Such scoring instruments not only adequately assess the presence of DIC but also have strong prognostic power for morbidity and mortality. In this issue of Critical Care, Gando and colleagues report on the prospective validation of the Japanese Association of Acute Medicine score for DIC in patients with severe sepsis.

Clinical, Biochemical and Imaging Parameters that may be Predictive of High Disease Activity, Rapid Progression or Increased Disability in Multiple Sclerosis

Increased ability to predict disease course and response to disease-modifying therapies in multiple sclerosis (MS) would optimise treatment outcomes by guiding selection of patients for a particular therapeutic intervention. Several factors affecting disease progression have been identified, including individual characteristics such as age at onset and race onset of symptoms, early disease outcomes and radiological measures. While studies of magnetic resonance imaging (MRI) prognostic indicators have given mixed results, advances in technology are increasing the predictive power of MRI, and new techniques and outcome measures are providing alternative means of predicting disease course and response to treatment. The search for a predictive biomarker is an area of active research but studies remain poorly validated. Potential biomarkers include neurofilament proteins, microRNAs, gene expression and antibodies. Since it is unlikely that a single factor may predict disease course, a number of composite scoring systems have been proposed, but none have yet received widespread acceptance. However, it seems likely that in the future, a combination of MRI and biochemical biomarkers will provide a foundation for therapeutic decision-marking in MS allowing an individualised approach.

Pathogenesis and management of peripartum coagulopathic calamities (disseminated intravascular coagulation and amniotic fluid embolism)

Acute coagulopathic peripartum calamities are relatively rare but contribute importantly to maternal morbidity and mortality in the Western world. Abruptio placenta, amniotic fluid embolism, and retained fetal or placental material may lead to fulminant intravascular activation of coagulation which results in thromboembolic complications and consumption coagulopathy causing severe hemorrhage. The central underlying pathophysiological pathway in the coagulopathy associated with these syndromes is the occurrence of tissue factor, released from the placenta and amniotic fluid, in the circulation, in combination with low levels of physiological anticoagulant factors during pregnancy. The diagnosis of DIC may be made trough conventional composite scoring systems employing routine coagulation tests, whereas for the diagnosis of amniotic fluid embolism measurement of insulin like growth factor binding protein-1 seems promising. Therapy is aimed at removing the precipitating factor combined with supportive adjunctive treatment options.

O706 COMPOSITE SCORING SYSTEM TO DETECT EARLY INVASIVE OR PREMALIGNANT VULVAL LESIONS

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S509-S509 Free communication (oral) presentations O706 COMPOSITE SCORING SYSTEM TO DETECT EARLY INVASIVE OR PREMALIGNANT VULVAL LESIONS S. Tyagi, S. TyagiSearch for more papers by this authorR. Tripathi, R. TripathiSearch for more papers by this authorS. Batra, S. BatraSearch for more papers by this author S. Tyagi, S. TyagiSearch for more papers by this authorR. Tripathi, R. TripathiSearch for more papers by this authorS. Batra, S. BatraSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61136-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S509-S509 RelatedInformation