Cut-off Criteria Research Articles

Direct transpedal pressure measurement during transpedal below-the-knee interventions in critical limb ischemia.

The aim of this study was to assess the feasibility of the distal pressure measurement during transpedal below-the-knee interventions in chronic limb-threatening ischemia (CLTI) and to assess the hemodynamic response after percutaneous transluminal angioplasty. The clinical and angiographic data of 137 consecutive patients treated via transpedal access in CLTI (Rutherford 4-6) were evaluated. Distal pedal pressure (PP) at the end of the pedal sheath was measured and the pedal-to-aortic pressure index (PAPI) was also calculated before and after the intervention. Good angiographic results was achieved in 131 patients (95.6%) in the femoro-popliteal and at least in one below-the-knee artery. Significant differences were found in PP and PAPI between before- and after-intervention values (103.2 ± 41.6 mmHg vs. 138.2 ± 37.8 mmHg and 0.74 ± 0.29 vs. 1.03 ± 0.34), respectively. Post-procedural PP and PAPI were significantly higher in patients who underwent good and borderline/unsuccessful intervention 141.7 [135.8-147.6] versus 82.6 [33.8-131.5] mmHg and 1.05 [1-1.1] versus 0.53 [0.2-0.8], respectively. PP's are significantly different in various Rutherford classification groups. Among the studied parameters, postprocedural PAPI was found to have the best discriminatory power to predict 3-month amputation (c-statistic: 0.749, 95% CI: 0.546-0.952, p = .016, sensitivity: 57.1%, specificity: 92.3% using the cut-off criterion ≤0.58). Major adverse event was detected in 17 patients at 3 months follow up (12.4%), including 7 major amputations (5.1%). Transpedal pressure and pedal-to-aortic pressure index significantly increased during transpedal below-the-knee angioplasty and final pressure and index correlates significantly with limb salvage.

Molecular interaction of 4-amino-N’-(benzoyloxy)-N-(2,4- dimethylphenyl)-1,2,5-oxadiazole-3-carboximidamide with the methotrexate binding site of human DHFR, and its implication in rheumatoid arthritis

Purpose: To identify an improved lead molecule for the human dihydrofolate reductase (DHFR) inhibition that ‘sits’ in the same binding cavity as methotrexate by high throughput computationalscreening.Methods: The 3-D structure of the DHFR binding site was examined using ‘CASTp3.0’. Structure based in silico screening of about 5 million drug candidates housed in the MCULE database was performed. The obtained molecule-hits were ranked in accordance with their VINA scores, made to pass through drug-likeness filters, ΔG cut-off criterion, toxicity-checker and finally ‘zero RO5 criterion’.Results: The ‘top molecule’, namely, 4-amino-N'-(benzoyloxy)-N-(2,4-dimethylphenyl)-1,2,5-oxadiazole- 3-carboximidamide, displayed robust binding with human DHFR through 21 amino acid residues (ΔG = - 9.6 kcal/mol) while 10 of these residues were the same as those displayed by ‘methotrexate binding interactions’. It passed through relevant drug screening filters including the ‘Toxicity Checker’.Conclusion: This research work describes the molecular interaction of human DHFR with an improved lead molecule named, 4-amino- N’-(benzoyloxy)-N-(2,4-dimethylphenyl)-1,2,5-oxadiazole-3- carboximidamide, with a ΔG of -9.6 kcal/mol, thus satisfying adequate ADME features for further in vitro and in vivo validation in the context of rheumatoid arthritis.
 Keywords: Dihydrofolate reductase, In silico screening, Methotrexate, Rheumatoid arthritis, DHFR

The clinical relevance of early identification and treatment of sleep disorders in mental health care: protocol of a randomized control trial

BackgroundSleep disorders are a risk factor for developing a variety of mental disorders, have a negative impact on their remission rates and increase the risk of relapse. Early identification and treatment of sleep disorders is therefore of paramount importance. Unfortunately, in mental health care sleep disorders are often poorly recognized and specific treatment frequently occurs late or not at all. This protocol-paper presents a randomized controlled trial investigating the clinical relevance of early detection and treatment of sleep disorders in mental health care. The two aims of this project are 1) to determine the prevalence of sleep disorders in different mental disorders, and 2) to investigate the contribution of early identification and adequate treatment of sleep disorders in individuals with mental disorders to their sleep, mental disorder symptoms, general functioning, and quality of life.MethodsPatients newly referred to a Dutch mental health institute for psychiatric treatment will be screened for sleep disorders with the self-assessment Holland Sleep Disorders Questionnaire (HSDQ). Patients scoring above the cut-off criteria will be invited for additional diagnostic evaluation and, treatment of the respective sleep disorder. Participants will be randomly assigned to two groups: Immediate sleep diagnostics and intervention (TAU+SI-T0), or delayed start of sleep intervention (TAU+SI-T1; 6 months after inclusion). The effect of sleep treatment as add-on to treatment as usual (TAU) will be tested with regard to sleep disorder symptoms, general functioning, and quality of life (in collaboration with a psychiatric sleep centre).DiscussionThis trial will examine the prevalence of different sleep disorders in a broad range of mental disorders, providing information on the co-occurrence of specific sleep and mental disorders. Further, this study is the first to investigate the impact of early treatment of sleep disorders on the outcome of many mental disorders. Moreover, standard sleep interventions will be tailored to specific mental disorders, to increase their efficacy. The results of this trial may contribute considerably to the improvement of mental health care.Trial registrationThis clinical trial has been retrospectively registered in the Netherlands Trial Register (NL8389; https://www.trialregister.nl/trial/8389) on February 2th, 2020.

Identification of key biomarkers associated with cell adhesion in multiple myeloma by integrated bioinformatics analysis

BackgroundMultiple Myeloma (MM) is a hematologic malignant disease whose underlying molecular mechanism has not yet fully understood. Generally, cell adhesion plays an important role in MM progression. In our work, we intended to identify key genes involved in cell adhesion in MM.MethodsFirst, we identified differentially expressed genes (DEGs) from the mRNA expression profiles of GSE6477 dataset using GEO2R with cut-off criterion of p < 0.05 and [logFC] ≥ 1. Then, GO and KEGG analysis were performed to explore the main function of DEGs. Moreover, we screened hub genes from the protein–protein interaction (PPI) network analysis and evaluated their prognostic and diagnostic values by the PrognoScan database and ROC curves. Additionally, a comprehensive analysis including clinical correlation analysis, GSEA and transcription factor (TF) prediction, pan-cancer analysis of candidate genes was performed using both clinical data and mRNA expression data.ResultsFirst of all, 1383 DEGs were identified. Functional and pathway enrichment analysis suggested that many DEGs were enriched in cell adhesion. 180 overlapped genes were screened out between the DEGs and genes in GO terms of cell adhesion. Furthermore, 12 genes were identified as hub genes based on a PPI network analysis. ROC curve analysis demonstrated that ITGAM, ITGB2, ITGA5, ITGB5, CDH1, IL4, ITGA9, and LAMB1 were valuable biomarkers for the diagnosis of MM. Further study demonstrated that ITGA9 and LAMB1 revealed prognostic values and clinical correlation in MM patients. GSEA and transcription factor (TF) prediction suggested that MYC may bind to ITGA9 and repress its expression and HIF-1 may bind to LAMB1 to promote its expression in MM. Additionally, pan-cancer analysis showed abnormal expression and clinical outcome associations of LAMB1 and ITGA9 in multiple cancers.ConclusionIn conclusion, ITGA9 and LAMB1 were identified as potent biomarkers associated with cell adhesion in MM.

Interpreting MAIA Microperimetry Using Age- and Retinal Loci-Specific Reference Thresholds.

PurposeMacular Integrity Assessment (MAIA) microperimetry is used widely in clinical trials and routine practice to assess paracentral scotoma. Current interpretation of MAIA is based on an assumed uniform 25 decibel (dB) cutoff for normal function irrespective of subject age and retinal location. We examined this convention by establishing an age- and loci-specific reference in healthy eyes and comparing this to the <25 dB cutoff.MethodsRetrospective MAIA results from healthy eyes were analyzed for prevalence of loci with <25 dB. At each locus, a new reference cutoff was derived from quantile regression of sensitivity against age at the 2.5th percentile. Two clinical cases of serial MAIA testing were analyzed using the new approach and compared to the <25 dB cutoff.ResultsFifty-four and 56 age-matched (range: 16–75 years) healthy eyes underwent small (37 loci) and large (68 loci) grid testing, respectively. Retinal sensitivity <25 dB was found in 5% of the small grid (1998 data points) and 10% of the large grid (3808 data points). These were found predominantly in older subjects and at the central point or in the perifoveal region. Quantile regression at each individual locus showed age-related decline with a median gradient of 0.6 dB/decade.ConclusionsWe caution against using <25 dB cutoff in MAIA interpretation and advocate an age- and loci-specific cutoff criterion.Translational RelevanceOur study suggests that MAIA interpretation is influenced by the criterion used for defining abnormal pointwise measurement.

Pre-surgical assessment of mediastinal lymph node metastases in Stage IA non-small-cell lung cancers

ObjectiveEvaluation of sensitivity and specificity of CT and fluorodeoxyglucose-positron emission tomography for pre-surgical staging of mediastinal lymph node metastases (N2/N3) of non-small-cell-lung-cancers ≤30 mm. MethodsWe reviewed a total of 263 patients from a prospective cohort study, who underwent resection including mediastinal lymph nodes, for first primary non-small-cell-lung-cancer ≤30 mm in maximum diameter on pre-surgical CT. Cutoff criteria for short-axis diameter on CT of the largest N2/N3 node of 10, 15, and 20 mm and positron emission uptake of 2.5, 3.0, and 4.0 were evaluated using Area-Under-the-Curve (AUC) assessment. Accuracy criterion was used to determine the optimal cutoffs. ResultsOf 263 patients, 9 had nonsolid, 42 part-solid, and 212 solid non-small-cell-lung-cancers. Post-surgically, none of the 51 patients with nonsolid or part-solid cancers had mediastinal lymph node metastases. Among the 212 patients with solid cancers, 23 had N2 node metastases. For the 212 patients with solid cancers, the AUC for CT lymph node measurements was 0.67 (95% CI: 0.57–0.77), significantly higher (p = 0.001) than chance alone, while the AUC for SUVmax measurements, 0.56 (95% CI: 0.48–0.65), was not (p = 0.13). Optimal CT cutoff was >20 mm had low sensitivity of 30.4% (95% CI: 11.6%–49.2%) but high specificity of 99.5% (95% CI: 98.4%–100.0%). ConclusionBased on these results, clinical Stage IA for non-small-cell-lung-cancers with nonsolid, part-solid, or solid consistency should be based on pre-surgical CT maximum tumor diameter and lymph node short-axis measurements on CT ≤20 mm. Further prospective evaluation of these clinical Stage IA staging criteria is needed.

Serum-derived three-circRNA signature as a diagnostic biomarker for hepatocellular carcinoma

BackgroundHepatocellular carcinoma (HCC) is a common tumor characterized by high morbidity and mortality rates. The importance of circRNA in cancer diagnosis has been established. The study aimed to identify differentially-expressed circRNAs (DECs) in human blood exosomes from patients with HCC and to investigate their diagnostic value.MethodsThe circRNA expression profiles of HCC and normal human blood samples were downloaded and processed from the exoRBase database. At the cutoff criteria of a fold change (FC) > 2.0 and P < 0.05, DECs were screened utilizing the limma package in the R software. A receiver operator characteristic curve (ROC) was used to study its diagnostic value. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) analysis was performed to confirm the three-circRNAs expression in the blood samples with HCC. Various bioinformatics tools were used to characterize the potential biological pathways induced by circRNAs.ResultsCompared with the normal samples, seven up-regulated and five down-regulated circRNAs were determined in the HCC samples. ROC analyses demonstrated that hsa_circ_0004001, hsa_circ_0004123, hsa_circ_0075792, and a combination of the three biomarkers exhibited higher sensitivity and specificity. The qRT-PCR confirmed that the three circRNAs were upregulated in the blood samples with HCC. Chi squared tests implied that the expression of three circRNAs was positively correlated with the TNM stage and tumor size. The circRNAs participated in VEGF/VEGFR, PI3K/Akt, mTOR, and Wnt signaling pathways by targeting miRNAs.ConclusionsThe study established the existence of seven up-regulated and five down-regulated circRNAs in HCC. Additionally, hsa_circ_0004001, hsa_circ_0004123, hsa_circ_0075792, and a combination of the three were utilized as valuable diagnostic biomarkers in HCC.

Multilevel CFA with Ordered Categorical Data: A Simulation Study Comparing Fit Indices Across Robust Estimation Methods

ABSTRACT Within a multilevel confirmatory factor analysis framework, we investigated the ability of commonly used fit indices to discriminate between correctly specified models and misspecified models. Receiver operating characteristics (ROC) analyses were used to evaluate the performance of fit indices. Combining ROC analyses with checks of the convergence rates across Monte Carlo replications and ANOVA for investigating the variation in fit scores across replications, we found converging evidence for the utility of the investigated fit indices. Optimal thresholds based on maximizing sensitivity and specificity for detection of the true model were identified by the highest sensitivity and specificity and found to vary across different robust estimation methods (i.e., MLR, ULSMV, and WLSMV). The estimation method and sample size influenced the performance of common fit indices to detect misspecification of the level-1 model. All fit indices investigated performed poorly for detecting misspecification of the level-2 model when the level-2 sample size was below 100. We offer recommendations of commonly reported fit indices to use (and not use), cutoff criteria to use for specific estimation methods, and cautions about the use of recommended cutoff criteria for ML-CFA.

Comparison of EWGSOP-1and EWGSOP-2 diagnostic criteria on prevalence of and risk factors for sarcopenia among Iranian older people: the Bushehr Elderly Health (BEH) program.

This study proposed to compare the prevalence and risk factors for sarcopenia by EGWSOP-1 and EWGSOP-2 diagnostic criteria in Iran. This cross-sectional study was conducted based on the data collected during the Bushehr Elderly Health (BEH) Program, stage II. Sarcopenia was defined as 3 definitions: EWGSOP-1(with Iranian cut off), EWGSOP-2(with Iranian cut off), EWGSOP-2(with European cut off) definition. We evaluated the age-standardized prevalence of sarcopenia in both genders. Regression analysis was used to show the associations in the adjusted models. Among 2426 participants, age-standardized prevalence of sarcopenia, and severe sarcopenia by EWGSOP-1 were 19.7%, and 12.9%, in men and 13.6%, and 16.7% in women, respectively. When we used EWGSOP-2 (with Iranian cut-off) criteria, these values were 10.5%, and 12.7% among men and 7.13% and 16.5% in women, respectively. The prevalence sarcopenia and severe sarcopenia by EWGSOP-2 (with European cut-off) were 12.7%, and 13.4% in men and 5.42%, and 13.7% in women, respectively. In both genders, getting older and high-fat mass were positively associated with sarcopenia, and BMI had a significant inverse association in both genders and all defintions. Results showed that a prevalence of sarcopenia varied largely by using different criteria, in both sexes. EWGSOP2- defined sarcopenia prevalence was lower than that defined using EWGSOP-1 criteria due to different diagnostic factors to detect sarcopenia. Some adverse outcomes should be considered for evaluating sarcopenia to compare the accuracy of EWGSOP-1 and EWGSOP-2.

Spatiotemporal Controllability and Environmental Risk Assessment of Genetically Engineered Gene Drive Organisms from the Perspective of European Union Genetically Modified Organism Regulation.

ABSTRACTGene drive organisms are a recent development created by using methods of genetic engineering; they inherit genetic constructs that are passed on to future generations with a higher probability than with Mendelian inheritance. There are some specific challenges inherent to the environmental risk assessment (ERA) of genetically engineered (GE) gene drive organisms because subsequent generations of these GE organisms might show effects that were not observed or intended in the former generations. Unintended effects can emerge from interaction of the gene drive construct with the heterogeneous genetic background of natural populations and/or be triggered by changing environmental conditions. This is especially relevant in the case of gene drives with invasive characteristics and typically takes dozens of generations to render the desired effect. Under these circumstances, “next generation effects” can substantially increase the spatial and temporal complexity associated with a high level of uncertainty in ERA. To deal with these problems, we suggest the introduction of a new additional step in the ERA of GE gene drive organisms that takes 3 criteria into account: the biology of the target organisms, their naturally occurring interactions with the environment (biotic and abiotic), and their intended biological characteristics introduced by genetic engineering. These 3 criteria are merged to form an additional step in ERA, combining specific “knowns” and integrating areas of “known unknowns” and uncertainties, with the aim of assessing the spatiotemporal controllability of GE gene drive organisms. The establishment of assessing spatiotemporal controllability can be used to define so‐called “cut‐off criteria” in the risk analysis of GE gene drive organisms: If it is likely that GE gene drive organisms escape spatiotemporal controllability, the risk assessment cannot be sufficiently reliable because it is not conclusive. Under such circumstances, the environmental release of the GE gene drive organisms would not be compatible with the precautionary principle (PP). Integr Environ Assess Manag 2020;16:555–568. © 2020 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC)

Lexical bundle use and crosslinguistic influence in academic texts

This study aimed to investigate any crosslinguistic influence of L1 Turkish on L2 English. To realize this goal, a three-million-word specialized research article corpus, which contained one million words for each group of L1 English, L2 English, and L1 Turkish articles, was compiled. The analyses yielded 79 four-word lexical bundles for the L1 English corpus and 119 four-word lexical bundles for the L2 English corpus with a 20-frequency occurrence per million words cut-off criteria, and dispersion in at least 10% of the research articles. Following the structural and functional analyses of the lexical bundles, any potential crosslinguistic influence was also scrutinized through the detection-based approach, which revealed that Turkish authors were likely to transfer 54 of 119 (45%) bundles from their native language of Turkish to their L2 English. This does not refer to incorrect or ungrammatical usage of the L2 English bundles by Turkish authors, but might relate to the frequent and diverse usage of lexical bundles of nonnative authors. Since this divergent usage might hinder academic professionals to establish efficient communication with members of the scientific community, scrutiny of the lexical bundles for educational sciences is expected to reveal implications for novice academic writers.

Predicting arterio-venous fistula failure by urea-method derived access blood flow in chronic hemodialysis patients.

Dialysis access is an essential part of hemodialysis. Determining the access blood flow (Qa) can help predict arterio-venous fistula thrombosis. Qa determination by the urea method, which was previously described in the past is simple and is available in most of the dialysis units but was not be able to predict arterio-venous fistula thrombosis. To compare the efficacy of Qa determination by the urea method and by ultrasound dilution methods in predicting arterio-venous fistula failure. Qa was measured by urea method and by ultrasound dilution simultaneously, every 3 months for a period of 1 year, in stable chronic hemodialysis patients with arterio-venous fistula. Arterio-venous fistula failure determined by clinical parameters and confirmed by Doppler ultrasound before sending the patient for interventional angioplasty. This study enrolled a total of 16 patients, with 63% being male, 75% with lower-arm arterio-venous fistula and around 43% with previously done angioplasty. 59-Qa measurements were done, and 6 patients underwent angioplasty (one patient for severe upper limb edema, one for access thrombosis, and four for access dysfunction). Qa determination by the urea method had non-significantly lower Qa, (745 mL/min (interquartile range: 509-1143) and 779 mL/min (interquartile range: 530-1160), (p = 0.58)) and high correlation (r = 0.83, p < 0.001) to Qa by ultrasound dilution. The cut-off criteria with its sensitivity and specificity in predicting the access failure were 440 mL/min, 66.67%, and 96.15% for Qa determination by the urea and 400 mL/min, 66.67% and 90.38% for Qa by ultrasound dilution, respectively, with no difference in the area under the receiver operating characteristic curve. Measurement of Qa determination by the urea method is well correlated with Qa by ultrasound dilution and can be used to predict vascular access failure.

Detection of Amblyogenic Refractive Error Using the Spot Vision Screener in Children.

Vision screenings are conducted to detect significant refractive errors, amblyopia, and ocular diseases. Vision screening devices are desired to have high testability, sensitivity, and specificity. Spot has demonstrated high testability, but previous reports suggest that the Spot has low sensitivity for detecting amblyogenic hyperopia and moderate sensitivity for amblyogenic astigmatism. This study assessed the concurrent validity of detecting amblyogenic refractive errors by the Spot (v.1.1.50; Welch Allyn Inc., Skaneateles Falls, NY) compared with cycloplegic retinoscopy. A total of 475 subjects (24 to 96 months) were screened by Spot and then received a masked comprehensive examination. Sensitivity and specificity, Bland-Altman plot, receiver operating characteristic area under the curve, and paired t test were evaluated by comparing the results of the Spot (v1.1.50) using the manufacturer referral criteria with the results of the comprehensive examination using the 2013 American Association for Pediatric Ophthalmology and Strabismus criteria. The Spot (v.1.1.50) referred 107 subjects (22.53%) for the following: 18.73% (89/475) astigmatism, 4.63% (22/475) myopia, 0.42% (2/475) hyperopia, and 2.11% (10/475) anisometropia. The sensitivity and specificity of the Spot vision screener for detecting amblyogenic risk factors were 86.08% (95% confidence interval [CI], 76.45 to 92.84%) and 90.15% (95% CI, 86.78 to 92.90%). Areas under the curve were 0.906 (95% CI, 0.836 to 0.976) for hyperopia, 0.887 (95% CI, 0.803 to 0.972) for spherical equivalent, and 0.914 (95% CI, 0.866 to 0.962) for astigmatism. A modified hyperopia criteria cutoff of greater than +1.06 D improved the sensitivity from 25 to 80% with 90% specificity. The current cutoff criterion, greater than -1.75 D, for astigmatism seemed optimal. This study shows that the Spot vision screener accurately detects low spherical refractive errors and astigmatism. Lowering the hyperopia cutoff criteria from the current Spot screener referral criteria improves the sensitivity with desired (high) specificity.

Magnitude distribution complexity and variation at The Geysers geothermal field

SUMMARYEarthquake magnitude (size) distribution is a major component required for seismic hazard assessment and therefore, the accurate determination of its functional shape and variation is a task of utmost importance. Although often considered as stationary, the magnitude distribution at particular sites may significantly vary over time and space. In this study, the well-known Gutenberg–Richter (GR) law, which is widely assumed to describe earthquake magnitude distribution, is tested for a case study of seismicity induced by fluid injection at The Geysers (CA, USA) geothermal field. Statistical tests are developed and applied in order to characterize the magnitude distribution of a high quality catalogue comprising seismicity directly associated with two injection wells, at the north western part of The Geysers. The events size distribution variation is investigated with respect to spatial, temporal, fluid injection and magnitude cut-off criteria. A thorough spatio-temporal analysis is performed for defining seismicity Clusters demonstrating characteristic magnitude distributions which significantly differ from the ones of the nearby Clusters. The magnitude distributions of the entire seismic population as well as of the individual Clusters are tested for their complexity in terms of exponentiality, multimodal and multibump structure. Then, the Clusters identified are further processed and their characteristics are determined in connection to injection rate fluctuations. The results of the analysis clearly indicate that the entire magnitude distribution is definitely complex and non-exponential, whereas subsequent periods demonstrating significantly diverse magnitude distributions are identified. The regional seismicity population is divided into three major families, for one of which exponentiality of magnitude distribution is clearly rejected, whereas for the other two the GR law b-value is directly proportional to fluid injection. In addition, the b-values of these Families seem to be significantly magnitude dependent, a fact that is of major importance for seismic hazard assessment implementations. To conclude, it is strongly suggested that magnitude exponentiality must be tested before proceeding to any b-value calculations, particularly in anthropogenic seismicity cases where complex and time changeable processes take place.

A transdisciplinary protocol evaluating auditory processing disorder (APD) in children using speech and non-speech stimuli and tools for common co-morbidities: time to re-evaluate APD diagnostic criteria

Purpose Effective combination of speech and non-speech tests, using pass–fail cut-off criteria consistent with that used to diagnose co-morbidities, in evaluating APD are explored. Method Retrospective- analysis of 80 children, 8 to 12 years-old, undergoing APD assessment. Filtered Words, Auditory Figure Ground 0 dB, Competing Words, Competing Sentences and Time Compressed Sentences from SCAN-3:C battery were used as speech tests and non-speech tests included Dichotic Digits, Gap Detection and Frequency Pattern. Comorbidities evaluated were language impairment, attention-deficit-hyperactivity disorder and impaired manual dexterity, using cut-off ≤ 10th centile in appropriate tools. Results Seventy-three participants (91.25%) were diagnosed with APD (≤ 9th centile in at least two tests) using speech plus non-speech tests. Speech tests alone diagnosed 60 (82%) and additional low linguistic load/non-speech tests helped in identifying the other 13 (18%). Sixty-six participants (82.5%) had APD plus co-morbidities, seven (8.75%) had APD only and the other seven (8.75%) had comorbidities without APD. Conclusions Initial evaluation by SCAN-3 battery followed by non-speech tests if necessary, will reduce test duration and improve child friendliness. Overlap between APD and comorbidities consistent with the literature is achieved if consistent pass/fail cut-off are used. The use of comorbidities to compare APD diagnostic criteria need to be explored.

Updating and Road-testing Life Cycle Inventory Data Review Criteria: Toward Global Consensus and Guidance On Data Quality Assessment.

Data quality of life cycle inventory background databases should be ensured in order to be useful for life cycle assessment (LCA) studies. However, databases do not always have procedures to evaluate the quality of the data sets in place. The Global Guidance Principles for LCA Databases of the United Nations Environment Programme (UNEP) in collaboration with the Society of Environmental Toxicology and Chemistry (SETAC) provide, among others, recommendations to enhance data quality through improved documentation and review. Flagship 2a in Phase 3 of the UNEP/SETAC Life Cycle Initiative aimed to enable the practical implementation of these recommendations with the development of review criteria and the testing of these criteria on 3 national databases. After a pilot-testing phase, this project entered a more mature road-testing exercise, of which the results are presented in this paper. The review criteria have been updated and provide more emphasis on goal and scope documentation completeness and include a new cluster of criteria that evaluate the materiality of the data set. The updated criteria have been applied to national databases of Thailand, Australia, and Chile. All databases would benefit from additional documentation, for example, on system boundaries, the reference model, sampling procedures, and cut-off criteria. Furthermore, conducting the review was enabled by extensive documentation and data accessibility in LCA software. Communication of the criteria to the database managers enabled them to anticipate data quality requirements of the global LCA community and improve the data sets in advance. Reviewers sometimes had a different interpretation of the criteria, which suggests that there is room for additional fine-tuning of the process guidance and exemplification of review criteria. This project has demonstrated that the criteria are applicable to and provide useful feedback for databases with different levels of maturity and contribute to improving quality of life cycle inventory (LCI) data. Integr Environ Assess Manag 2020;16:517-524. © 2020 SETAC.

A Practical Approach to Condition Assessment of Asphalt-Covered Concrete Bridge Decks on Korean Expressways by Dielectric Constant Measurements Using Air-Coupled GPR.

The main objectives of this study are to investigate the variations of the dielectric constant of concrete on Korean expressways by using a 1 GHz air-coupled Ground Penetrating Radar (GPR) system and to develop a practical approach to the condition assessment of concrete bridge decks with asphalt overlay on Korean expressways by dielectric constant measurements. A total of 684 GPR investigations of 601 actual concrete bridge decks, which are in service between 2 and 43 years, were carried out during the period between 1999 and 2013. Statistical analysis revealed that the dielectric constant of asphalt-covered concrete bridge decks reduced with service age and this trend continued until service age of over 40 years. As a result, this study provides a practical dielectric constant curve that could be used for condition evaluation of top concrete in asphalt-covered bridge decks with consideration of concrete age. Based on regression analyses of the GPR field survey data and experiences through the field survey, a double cut-off dielectric constant criterion was proposed for condition assessment of asphalt-covered concrete bridge decks on Korean expressways. In addition, a GPR field survey was performed at an actual bridge on the Yeongdong expressway in Korea to test the proposed GPR signal interpretation method. The field survey results provide fundamental data to better understand the variation of the dielectric constant of concrete in actual bridges with asphalt overlay and to develop a practical approach to condition assessment of asphalt-covered concrete bridge decks on Korean expressways by dielectric constant measurements using air-coupled GPR.

The impact of pre-procedure heart rate on adverse clinical outcomes in patients undergoing percutaneous coronary intervention: Results from a 2-year follow-up of the GLOBAL LEADERS trial

Background and aimsThe prognostic impact of pre-procedure heart rate (PHR) following percutaneous coronary intervention (PCI) has not yet been fully investigated. This post-hoc analysis sought to assess the impact of PHR on medium-term outcomes among patients having PCI, who were enrolled in the “all-comers” GLOBAL LEADERS trial. Methods and resultsThe primary endpoint (composite of all-cause death or new Q-wave myocardial infarction [MI]) and key secondary safety endpoint (bleeding according to Bleeding Academic Research Consortium [BARC] type 3 or 5) were assessed at 2 years. PHR was available in 15,855 patients, and when evaluated as a continuous variable (5 bpm increase) and following adjustment using multivariate Cox regression, it significantly correlated with the primary endpoint (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03–1.09, p < 0.001). Using dichotomous cut-off criteria, a PHR>67 bpm was associated with increased all-cause mortality (HR 1.38, 95%CI 1.13–1.69, p = 0.002) and more frequent new Q-wave MI (HR 1.41, 95%CI 1.02–1.93, p = 0.037). No significant association was found between PHR and BARC 3 or 5 bleeding (HR 1.04, 95% CI 0.99–1.09, p = 0.099). There was no interaction with the primary (p-inter = 0.236) or secondary endpoint (p-inter = 0.154) when high and low PHR was analyzed according to different antiplatelet strategies. ConclusionsElevated PHR was an independent predictor of all-cause mortality at 2 years following PCI in the “all-comer” GLOBAL LEADERS trial. The prognostic value of increased PHR on outcomes was not affected by the different antiplatelet strategies in this trial.

Validation of the swimming competence questionnaire for children

ABSTRACT Two studies were employed to test the reliability and validity of the Swimming Competence Questionnaire (SCQ) among primary school children. Study 1 was a cross-sectional survey in 4959 primary school children. Study 2 was a pre-post-test quasi-experiment among 1609 primary school children who underwent a 20-lesson learn-to-swim programme. In Study 1, exploratory structural equation modelling revealed excellent goodness-of-fit and scale reliability for a two-factor model comprising distance and skill factors, which supported the construct and convergent validity. SCQ scores were significantly and positively correlated with swimming outcomes (i.e., self-efficacy, intention, swimming frequency), which supported SCQ’s concurrent and criterion validity. Average variance extracted for the SCQ factors exceeded cut-off criteria supporting discriminant validity. In Study 2, pre-test SCQ scores correlated significantly and positively with the SCQ scores, self-efficacy, intention, and swimming frequency at post-test, which supported SCQ’s test-retest reliability and predictive validity. Positive intraclass correlation between SCQ scores and coach ratings at post-test provided evidence for SCQ’s inter-rater reliability. SCQ scores significantly improved at post-test, which supported SCQ’s ecological validity. In conclusion, findings indicate that the SCQ is a valid and reliable measure to assess primary school children’s swimming competence, in terms of swimming distance and basic water survival skills.

Nature and extent of hearing loss in HIV-infected children: A scoping review

IntroductionAntiretroviral therapy (ART) has had a major impact on life expectancy from HIV as many people now live with it as a chronic disease. Chronic HIV has been associated with a range of comorbid disabilities and health conditions, one of which is hearing loss. Undiagnosed and untreated hearing loss, particularly in children, has been linked to poorer spoken language skills, with subsequent effects on academic performance. MethodsThis systematic scoping review aimed to summarize the available peer-reviewed literature on hearing loss in HIV-infected children, specifically to describe its extent and nature. The review followed the framework proposed by Arksey and O'Malley. Key search terms included hearing loss (and synonyms), child (and synonyms), and HIV. Electronic databases (EBSCOhost Research Platform, PubMed, Web of Science and Scopus databases) were searched for any relevant articles published from January 1, 2000 to June 30, 2019. Reference lists of included articles were pearled for additional relevant articles not already identified. Each stage of the selection process was conducted independently by two authors. The results were then collated by a third author who also resolved any discrepancies. Extracted data included sample descriptors, audiologic tests, hearing loss prevalence, hearing loss descripts, and factors associated with hearing loss. ResultsSeventeen articles were included; 10 from Africa, four from South America, two from North America and the remaining article from Asia. Although most of the articles reported on pure tone audiometry, the samples as well as the cut-off criteria for normal hearing were heterogenous. Prevalence of hearing loss varied across articles (from 6% to 84%). Conductive hearing loss occurred more frequently than sensorineural or mixed hearing loss. ART use and ear infection were reported as significant in three of five articles that reported on significant associates of HIV-related hearing loss. ConclusionThere was a modest volume of research from a limited number of countries. Heterogeneity in sampling and audiometric methods precluded a clear understanding of potential associations between chronic HIV-related hearing loss and contributing factors.