Cut-off Set Research Articles

The Paradox of Credit Scoring Model Deterioration

Scoring models are widely renowned and used in financial organizations in a variety of fields, but most importantly – to predict and control credit risk. This article addresses practical problems of scorecards usage after its implementation. With time its predictive power tends to deteriorate, but not always it is applicable to completely rebuild the model fast enough due to lack of time/human/financial resources. Then cut-off, which was set when the scorecard was initially implemented, should be corrected to achieve optimal (i.e. cash-flow maximizing) performance. The literature on ways to maintain the existing model over time and manage the cut-offs is extremely scarce. The article is built on simple yet fundamental analytical explanations of scorecard performance dynamics, derived from practical experience. Results are backed by a numerical example, which shows the efficiency of different managerial decisions regarding cut-off setting in the paradox zone. The main conclusions are the following. In the most common case, the optimal reaction on model deterioration would be to counterintuitively narrow down the reject zone via cut-offs, which results in higher sales amount and even more increased risk ratios, but maximizes cash-flow in given conditions. This is the core of the scoring model deterioration paradox. It arises from the fact that when the scorecard deteriorates the high-risk segments of clients are actually becoming less risky and hence more profitable. This affects cut-offs, which must be applied to reject the riskiest loss-making segment of loan applications.

What Tool for Diagnosis of Latent Tuberculosis Infection in Developing Country with Tuberculosis High Burden: Interferon Gamma Release Assays <i>versus</i> Tuberculin Skin Test in Burkina Faso

Background: The diagnosis and treatment of active tuberculosis and the detection/management of latent tuberculosis infection (LTBI) cases are the two main strategies for the TB control, particularly in endemic countries. Tuberculin skin test (TST) and Interferon Gamma Release Assays (IGRAs) are tools for detection of LTBI. The objective of this study was to evaluate the performance of the TST and QuantiFERON-TB Gold Plus® (QTF-Plus) and to identify a threshold for TST in best agreement with QTF-Plus for LTBI detection in a high TB burden setting. Methods: In July 2020, a cross-sectional analytical study was performed for QFT-Plus using blood samples and TST in 101 individuals with a high risk of TB living in Bobo-Dioulasso, Burkina Faso. A crude comparison between both tests was done and receiver operating characteristic curve was generated to determine TST’s threshold. TST sensitivity, specificity, predictive values and accuracy were calculated. Adjusted agreement between TST and QFT-Plus was evaluated. Results: With the minimum threshold of positivity set at 5 mm for TST, the overall agreement between the latter and QFT-Plus was poor with a Kappa coefficient (κ) rated at 0.319 (95% CI: 0.131 - 0.508). This cut-off yielded a sensitivity of 94.12% (95% CI: 88.53 - 99.71), and very poor specificity of 36.4% (95% IC: 25.0 - 47.80). However, an adjusted cut-off set at 11 mm gave a better specificity of 72.73% (95% CI: 62.1 - 83.30) of TST and improved the PPV (86%). Moreover, concordance between both tests was improved with κ at 0.56 (95% CI: 0.385 - 0.728) and 80.20% of accuracy. Factors associated with discordance between TST (11 mm) and QFT-Plus results were BCG vaccination, OR = 7.53 (95% CI: 1.43 - 139.25), p = 0.05 and chronic cough, OR = 5.07 (95% CI: 1.27 - 20.43), p = 0.01. Conclusions: This study showed that using a minimal cut-off of 11mm for TST significantly improved the concordance between QTF-Plus (IGRA) and TST. Using the cut-off TST of 11 mm would be ideal in low-income countries with a high TB burden, taking into account factors that could contribute to the discrepancy of results.

Assessment of serological tests for antibodies to different antigens of the SARS-CoV-2 virus: comparison of six immunoassays

The new coronavirus SARS-CoV-2 has become a global challenge to medicine and, in particular, laboratory diagnostics. The study of the antibodies’ level to SARS-CoV-2 can be used as a confirmation test in the diagnosis of a disease, but it becomes of paramount importance in assessing population immunity resulting from a disease or vaccination, as well as in selection of convalescent plasma donors. The kits developed in our country and abroad for detecting antibodies to the SARS-CoV-2 virus differ both in the methods of testing and in the used coronavirus antigens to which the antibodies are directed. The aim of this study was to compare the diagnostic sensitivity and specificity of five kits for the detection of IgG antibodies to the SARS-CoV-2 virus, based on different diagnostic methods. Serum samples from 137 COVID-19 convalescents and 166 donors of blood and its components were examined. The control group consisted of 50 blood sera collected at the beginning of 2019 and 19 sera collected in 2018 (before the advent of the SARS-CoV-2 virus) and stored at -70 °C. Testing was carried out in analytical systems: rapid test “COVID-19 IgM/IgG Rapid Test (Colloidal Gold)” (China), on an automatic immunochemical analyzer Abbott Architect™ i2000 and kit “SARS-CoV2-IgG” (Abbot, Chicago , IL USA), by the chemiluminescence method using an automatic analyzer of the CL series and kits of the “Mindray” company (China) “SARS-CoV-2 IgM” and “SARS-CoV-2 IgG” and by the enzyme immunoassay method on the kits of the companies “Diagnostic Systems” Ltd (Russia, Nizhny Novgorod) “DS-IFA-ANTI-SARS-CoV-2-G”, “Xema” Ltd (Federal State Budgetary Institution “National Medical Research Center of Hematology” of the Ministry of Health of Russia) “SARS-CoV-2-IgG-IFA” and “Vector-Best” CJSC (Russia, Novosibirsk)” SARS-COV-2-IgM-IFA-BEST” and “SARS-COV-2-IgG-IFABEST”. When comparing the results of testing 137 plasma samples on the Vector-Best and Mindray kits for IgG antibodies, 127 samples were positive, 7 samples were negative on both kits, the discrepancy was 2.2%. In the study of IgM antibodies, 32.1% were positive, and 52.6% were negative in both kits. The discrepancy rate was 15.3%. Out of 166 samples, 1 serum (0.6%) was negative in 5 kits. On the Mindray kit, IgG antibodies to the antigens of the SARS-CoV-2 virus were detected in 165 samples (99.4%), on Vector-Best – in 164 sera (98.8%), on Diagnostic systems – in 151 (90.96%), on Xema – in 154 (92.8%), and on Abbott – in 155 samples (93.4%). At the same time, 135 (81.33%) samples were positive in all kits, while 30 samples had discordant results (18.07%), and in 9 sera, specific IgG was not detected in 2 or more kits. ROC analysis revealed a high diagnostic value of all tested kits (AUC from 0.908 to 0.998), which indicates a high quality of the separation model of positive and negative samples (p < 0.001). With the cut-off set by the manufacturers, the sensitivity and specificity ranged from 82.8% and 93.3% for the Diagnostic Systems kit to 99.4% and 95.8% for the VectorBest kit. The calculated correlation coefficients were higher between kits with a similar composition of the antigen used in the kits; therefore, it is better to monitor the dynamics of antibodies by diagnostic kits from the same manufacturer.

The Markers of Stress in Swine Oral Fluid.

IntroductionThe study measured the hormonal and protein markers of acute stress, those of oxidative stress and total antioxidant capacity (TAC) in swine oral fluid, determined which of these parameters would be the most appropriate for future livestock welfare assessment and established the time when the samples should be taken.Material and MethodsStress was induced in 7 out of 14 castrated six-week-old Danbred×Duroc pigs by immobilisation on a nasal snare at 8 a.m., 1 p.m., and 6 p.m. and samples were taken both directly after the stressor was applied and 30 min later. The remaining pigs were the control group, which were not immobilised; their samples were taken at the same times. The concentrations of hormones and malondialdehyde (MDA) were measured using liquid chromatography with tandem mass spectrometry, while those of alpha-amylase and TAC were measured using spectrophotometry.ResultsThe levels of cortisol and cortisone increased with statistical significance immediately after the acute stress response and 30 min later. A cut-off value set at 0.25 ng/mL cortisol concentration was capable of distinguishing between the stressed and control groups with 100% accuracy in evening samples and 95% accuracy overall. Prednisolone was not present, and the levels of testosterone and corticosterone were low and not distinctive. Alpha-amylase became significantly more concentrated during stress induction and 30 min later. The TAC and MDA levels rose after the stress but without statistical significance.ConclusionThe most suitable markers of acute stress were cortisol, cortisone and alpha-amylase. Oral fluid is a reliable material for monitoring the level of pigs’ stress and should be collected in the evening.

Circulating mitochondrial DNA copy numbers represent a sensitive marker for diagnosis and monitoring of disease activity in systemic lupus erythematosus

ObjectivesCell-free DNA is involved in the pathogenesis of systemic lupus erythematosus (SLE) but the clinical value of cell-free DNA measurements in SLE is unknown. Our aim was therefore to examine...

Assessment of different diagnostic methods for the identification of subclinical endometritis in dairy cows with pathological puerperium and their reliability to conceive

Abstract The aim of study was to evaluate different methods for subclinical endometritis (SCE) diagnoses and their accuracy to predict pregnancy. The study was performed on 51 postpartum cross breed dairy cows with pathological puerperium. Artificial insemination (AI) was done in spontaneous estrus. Endometrium samples were taken by cytotape (CT), cervical mucus (CM) samples by Metricheck and smears for crystallization degree were obtained at AI day. Blood serum samples for progesterone (P4) concentration determination were taken at AI day and 17 days later. Cows were examined by ultrasound 35 days after AI to confirm pregnancy. Percent (%) of polymorphnuclear leukocytes (PMNs) taken by CT were expressed by ROC curve (with cut-off point set at 1%). Out of the total of 51 cows involved in the study, 13.73% true positive and 41.17% true negative cows were found (54.90%). The content of CM sampled with Metricheck was altered in 11 cows (21.57%), and one of them was pregnant (1.96%). An average macroscopic CM value for pregnant cows was 0.06±0.24 vs. 0.39±0.79 for non-pregnant (p<0.05). An average value of CM crystallization in pregnant cows was 2.50±1.04 vs. 1.85±1.15 in non-pregnant (p<0.05). P4 concentration was not statistically different at AI day, but was statistically significantly higher 17 days later in pregnant cows (p = 0.002). CT alterations may be a reliable diagnostic tool for SCE diagnosis, while macroscopic CM alterations may be used for CE detection. P4 determination is beneficial in pregnancy diagnosis while CM crystallization degree is helpful in determination of best time for AI.

Changes in chronotype and social jetlag during adolescence and their association with concurrent changes in BMI-SDS and body composition, in the DONALD Study

Background/objectivesAdolescence is a critical period for both the development of overweight and the transition toward a later chronotype, often accompanied by an increase in social jetlag. This study assessed whether changes in chronotype and social jetlag, are linked to changes in body composition during adolescence.Subjects/methodsWe used data from the DONALD open cohort study, collected between 2014 and 2019, from 213 adolescents (9–17 years at baseline, 45% females) having at least two measures of chronotype and anthropometry (N = 572). Chronotype was assessed with the Munich Chronotype Questionnaire and defined as: midpoint of sleep corrected for sleep-debt (MSFsc) accumulated over the week (later MSFsc represents later chronotype). Social jetlag (SJL) defines the difference between midpoint of sleep during week and weekend. Calculations for Fat Free Mass Index (FFMI [kg/m2)]) and Fat Mass Index (FMI) [kg/m2)]) were based on body fat percentage, weight, and height. To analyze the associations, we used linear mixed-effect regression models. Finally, the total cohort was split into three biologically relevant age groups (cut-off set at <12 years, ≥12 to ≤15 years and >15 years).ResultsMedian follow-up was 2.1 years. Overall, change toward a later chronotype was significantly related with an increase in FMI (ß: 0.05, 95% CI: 0.01–0.08). A 1 h increase in social jetlag predicted an increase in BMI-SDS of 0.08 SDS units (95% CI: 0.01–0.14) and in FMI of 0.04 kg/m2 (95% CI: 0.003–0.08). Associations were stronger for the age group ≥12 to ≤15 years (p for interaction: <0.001). No relationship was found with FFMI.ConclusionsChanges in MSFsc and SJL during adolescence were associated with concurrent changes in BMI-SDS and FMI. The age ≥12 to ≤15 years appears to be a sensitive period in which chronobiological changes were clearly associated with increasing body fatness.

Intermolecular interaction network in liquid acetone

Molecular dynamics simulations, employing the transferable potentials for phase equilibria-united atom force field, have been performed to explore the structural features of liquid acetone. Topological and dynamical network analyses have been performed on the intermolecular interaction (IMI) networks, which are constructed based on a set of pair energy cutoffs. Topological analysis revealed that the acetone pairs interacting stronger than −10 kJ/mol exist as isolated pairs in a sense that the members of the pair do not interact with other molecules with an energy smaller than −10 kJ/mol. As such, those strongly interacting pairs do not constitute a three-dimensional extended network. As the pair interaction energy cutoff becomes larger than −10 kJ/mol, the IMI network starts to become a three-dimensional extended network and its connectivity increases gradually. Dynamical analysis revealed that the decay function for intermolecular interaction lifetimes is characterized by a nonexponential decay for all the IMI networks such that it decays faster at short-times in comparison to the longer-times. Yet, the duration of the intermolecular interactions can go beyond 1.0 ps for the pairs with the interaction energies larger than −6 kJ/mol. Furthermore, the orientational correlations in the liquid acetone have been examined for a more detailed picture of its structure. It is clearly shown that as the distance between the carbonyl carbons of the two acetones gets smaller, (i) they tend to adopt an anti-parallel dipole orientation, (ii) the planes of the acetones tend to adopt a parallel orientation, and, (iii) such acetone pairs particularly interact more strongly. In the light of these findings, two dimeric structures, stack-type and planar-type, are highlighted. Using density functional theory (DFT) at the mPW2PLYP/def2-TZVP level, the interaction energy in the gas-phase is computed to be −19.85 kJ/mol for the stack-type dimer, which is more stable than the planar-type dimer by 7.7 kJ/mol. Both the gas-phase DFT interaction energy and the computed acetone dipole moment, 2.97 D, are in great agreement with the corresponding experimental data. Furthermore, in accordance with the gas-phase results, the stack-type dimers are found to be more stable than the planar-type dimers also in the liquid-phase as revealed from both the liquid-phase DFT interaction energies and the MD based mean interaction energies. Finally, trimeric structure search in the simulated liquid acetone revealed that of all trimers, 94% belongs to the chain-like trimers, while the remaining 6% belongs to the cyclic trimers.

Comparing the Electrochemical Performance of Organic and Ionic Liquid-Based Electrolytes in Lithium-Oxygen Battery

Lithium-oxygen batteries (LOB) have been considered promising electrochemical energy storage devices to supersede current rechargeable batteries for next generation electric vehicles. Despite having tremendously high theoretical energy density (5200 Wh/kg), the practically achievable energy density (1700 Wh/kg) is far from commercial application till date. There are several challenges associated with Li anode, porous cathode and electrolyte that need to be resolved to achieve better results. The choice of suitable electrolyte for LOB is one of the biggest obstacles in its development. The various electrolytes that have been developed and studied come with limitations which includes thermal and chemical stability at higher voltages, volatility, viscosity, flammability, capability to dissolve incoming oxygen etc. Therefore, in order to improve current performance of battery, these parameters need to be optimized.This study focuses on the influence of organic and ionic liquid (IL)-based electrolytes on electrochemical performance of Li-O2 battery. [Pyr14][TFSI] and two commercially available organic solvents TEGDME and DMSO were investigated in this study. A series of tests were performed at various operating temperatures with the IL. Vulcan XC 72R coated carbon cloth with 30wt% PTFE is used as cathode. 1 mg/cm2 (+/-0.3mg/ cm2) is used as carbon loading. All experiments were conducted with pure oxygen supply at room temperature (unless stated otherwise). Li|Li Symmetric tests were also performed to measure the stability of electrolyte.The IL was tested at three different operating temperatures including room temperature (22°C), 35°C and 75°C. The results indicate that increase in temperature helps improve discharge capacity of battery. The discharge capacity obtained at three operating temperatures were 0.04 mAh/mg, 0.06 mAh/mg and 0.3 mAh/mg respectively. The improvement is in accordance with the fact that increase in temperature reduces IL viscosity and increases oxygen diffusivity. At discharge cut-off voltage of 2V, the discharge cycles did not show mass transfer limitation therefore, the subsequent tests were conducted with cut-off voltage set at 0V. This significantly improved the discharge capacity from 0.3 mAh/mg to 1.1 mAh/mg with discharge cycles limited by mass transfer effect.Two organic electrolytes TEGDME and DMSO were also tested at room temperature (22°C). The discharge capacities obtained were 4.65 mAh/mg and 5.43 mAh/mg. The higher discharge capacity of DMSO could be associated with its unique properties which includes donor number (DN), conductivity and viscosity. The DN for DMSO and TEGDME are 29.8 kcal/mol and 16.6 kcal/mol respectively. Higher DN improves discharge capacity by promoting growth of Li2O2 as bigger toroidal precipitates on cathode surface as opposed to its counterpart which produces Li2O2 insulating film. Similarly, DMSO has higher conductivity (2.11 mS/cm) and lower viscosity (1.94 cP) than TEGDME (0.3 mS/cm,4.05 cP) which improves species mobility.Finally, Li|Li symmetric tests were conducted at room temperature to measure stability of electrolytes. The results indicate, DMSO could cycle 60 cycles without significant surge in overpotential followed by TEGDME (40 cycles) and IL (20 cycles).

The ratio of furosemide dosage to urinary sodium concentration predicts mortality in patients with chronic stable heart failure

The urinary sodium (UNa) concentration is associated with outcomes in patients with acute heart failure (HF). Its impact in individuals with chronic HF is unknown. This study examined the combined effect of diuretic dosage and UNa concentration in chronic HF. The research sample for this retrospective cohort study consisted of ambulatory patients receiving optimized therapy and followed in an HF clinic. The patients were recruited between 2009 and 2012. The exclusion criteria were therapeutic adjustments or hospital admissions in the previous 2 months and renalreplacement therapy. The patients were followed for 5 years; the endpoint was all‑cause mortality. The association between the ratio of furosemide dosage to UNa concentration and 5‑year mortality was studied using a receiver operating characteristic (ROC) curve. The patients were cross‑classified according to daily furosemide dosage (with the cutoff set at 80 mg) and UNa concentration (80 mEq/l). Multivariable Cox regression analysis was used to assess the prognostic impact of the ratio. We analyzed 283 patients with chronic HF (70.3% male; mean age, 69 years). During follow‑up, 134 patients died. The median furosemide dosage was 80 mg/day and the mean UNa concentration was 85 mEq/l. Based on the ROC curve, the best cutoff for the ratio of daily furosemide dosage to UNa concentration was 0.8. Patients with a ratio of 0.8 or higher had an adjusted hazard ratio for 5‑year mortality of 2.85 (95% CI, 1.78-4.58). Patients with a UNa excretion rate of less than 80 mEq/l who wereadministered 80 mg or more of furosemide per day were found to have a worse prognosis (HR, 4.15; 95% CI, 2.31-7.45) when compared with those with a UNa excretion rate of 80 mEq/l or more and less than 80 mg furosemide per day. Combining the diuretic dosage and measurement of UNa excretion can be used to refine risk stratification in chronic HF. The furosemide‑to‑UNa ratio can be a surrogate marker for diuretic resistance and has a prognostic impact in chronic HF.

IMU filter settings for high intensity activities

BackgroundRecommendations for cut-off frequencies for inertial measurement units (IMU) are either based on marker-based motion analysis or based on low intensity activities. The selection of filter cut-off frequencies can impact the extracted variables from the filtered signal. There are no recommendations for IMU filter settings when collecting biomechanical data of high intensity activities. Research questionWhat are appropriate IMU cut-off frequency filter settings for high intensity activities? MethodsTen unimpaired participants were studied during controlled postural perturbations using a microprocessor-controlled treadmill. Disturbances were delivered in forward and backward directions and incrementally increased in both directions until the participant was unable to maintain an upright posture and the trial resulted in a fall. An IMU was placed on their sternum to obtain trunk sagittal kinematics. Custom code was implemented to estimate trunk angle, angular velocity, and linear acceleration about the flexion-extension axis in the trunk IMU coordinate system. The three trials that resulted in falls in each direction for each participant (60 total trials) were analysed. These trials were limited to 500 msec of the disturbance period. The cut-off frequency was calculated for trunk kinematics using 99 percent of the energy spectrum (E99). ResultsThe trunk flexion angle (4 ± 4 Hz) and linear acceleration (35 ± 10 Hz) cut-off frequencies agreed with previously reported values. The cut-off frequency for trunk flexion angular velocity (26 ± 7 Hz) was higher than values previously reported. SignificanceSelection of cut-off frequency should be based on segment accelerations and not simply activity or segment of interest. Deliberate selection and reporting of filter settings in biomechanics research will improve data quality, reliability of inferences, and reproducibility of studies.

Anxiety and depression in athletes assessed using the 12-item General Health Questionnaire (GHQ-12) - a systematic scoping review.

The poor mental health of athletes is a major concern in sport. Typically, the incidence/prevalence of mental health symptoms in athletes is studied using symptom-specific questionnaires. For symptoms of depression/anxiety, one such self-reporting questionnaire is the 12-item General Health Questionnaire (GHQ-12). The aim of this review was to synthesise and compare studies using the GHQ-12 in athletes to inform future research bodies by identifying trends and gaps in the literature. A systematic search of five electronic databases (Google Scholar, PubMed, PsychINFO, Scopus and Web of Science) was conducted on all published studies up to 1 January 2019. Inclusion criteria: (1) participants were able-bodied athletes; (2) studies measured anxiety/depression using the GHQ-12; (3) studies were full original articles from peer-reviewed journals; (4) studies were published in English. Thirty-two studies were included in the review. The prevalence and incidence of symptoms of anxiety/depression ranged from 21-48% and 17-57%, respectively. The majority of studies screening anxiety/depression using the GHQ-12 were cross-sectional. Almost 70% of the studies used the traditional scoring method. The majority of study populations sampled all-male cohorts comprising football (soccer) players. The traditional scoring of 0-0-1-1 should be used with the cut-off set at ≥3. Also, the mean GHQ-12 score should be reported. Potential risk factors for symptoms of anxiety/depression (i.e. recent adverse life events, injury and illness, social support, pressure to perform and career transitioning) and a lack of prospective studies were identified. Future research should also broaden the spectrum of athlete populations used and aim to improve response rates.

Usefulness of a New Transthoracic Echocardiography Score to Assess Right Ventricular Volumes in Patients with Repaired Tetralogy of Fallot.

Quantification of right ventricular (RV) volumes is essential in the follow-up of patients with a repaired tetralogy of Fallot (TOF). Cardiac magnetic resonance imaging (MRI) is the gold standard for RV assessment. However, given its cost and availability, the systematic use of MRI for serial longitudinal follow-up is limited. Herein, we examined the utility of a new two-dimensional (2D) transthoracic echocardiography (TTE) score (the RVDi score), which includes a compilation of 2D RV dimensions indexed to the body surface area, for predicting MRI-derived RV end-diastolic volume (RVEDV) in patients with a repaired TOF. Using our congenital heart clinic database, we retrospectively included 29 adult patients with a repaired TOF between February 2015 and July 2019. The 2D TTE RVDi score was compared with the MRI-derived RVEDV. Sensitivity and specificity values for predicting an RVEDVi > 150ml/m2 were calculated. The TTE RVDi score was highly correlated (r = 0.944) with MRI RVEDVi. A cut-off RVDi score set at 120mm/m2 predicted an RVEDVi > 150ml/m2 with a sensitivity of 83% and specificity of 94%. Use of a simple echocardiographic score based on indexed RV dimensions from 2D standard TTE imaging may complement the assessment of RV volumes in TOF patients.

HPV16 Load Is a Potential Biomarker to Predict Risk of High-Grade Cervical Lesions in High-Risk HPV-Infected Women: A Large Longitudinal French Hospital-Based Cohort Study.

Simple SummaryThis study aimed at assessing HPV16 and HPV18 viral loads to predict the development of cervical high-grade lesion. Among 885 women positive for hrHPV and presenting no or mild cytological abnormalities, HPV16 and HPV18 prevalence was 25.9% and 8.4%, respectively. Of those women, 135 developed a high-grade lesion during the follow-up. Considering an HPV16 viral load cut-off set at 3.2 log10 GE/103 cells a subgroup of women at high risk of developing high-grade cervical lesion (HR = 2.67; 95% CI 1.80–3.97 p ≤ 0.0001) has been identified. Moreover, a composite score based on HPV16 load, cytology and hrHPV detection allowed for CIN2+ risk stratification. To conclude, HPV16 load is a relevant biomarker to identify women at high risk for developing precancerous lesions of the cervix. High-risk HPV (hrHPV) testing has been implemented as a primary screening tool for cervical cancer in numerous countries. However, there is still a need for relevant triage strategies to manage hrHPV positive women to avoid excessive referral to colposcopy. The objective of this study was to assess, in women infected by hrHPV and presenting no or mild cytological abnormalities, HPV16 and HPV18 viral loads to predict the development of cervical high-grade lesion. Among 2102 women positive for hrHPV, 885 had no lesion or mild cytological abnormalities at baseline and had at least one follow-up (FU) visit. HPV16 and HPV18 prevalence was 25.9% and 8.4%, respectively. Of those women, 15% developed a high-grade lesion during the FU. An HPV16 viral load cut-off set at 3.2 log10GE/103 cells permitted to identify a subgroup of women at high risk of developing high-grade cervical lesion (HR = 2.67; 95% CI 1.80–3.97; p ≤ 0.0001). No specific HPV18 viral load threshold could have been defined in regard to the present study. In multivariate analysis, HPV16 load (absence/log10GE/103 cells < 3.2 vs. ≥3.2), RLU/PC 239 (1–100 pg/mL vs. >100 pg/mL) and cytology (normal vs abnormal) were independently associated with a significant increased risk of high-grade lesion development and were used to construct the prognostic score. In conclusion, HPV16 load is a relevant biomarker to identify women at high risk for developing cervical precancerous lesions.

PREDISPOSING-PERSONAL FACTORS ASSOCIATED WITH PASSENGERSAFETY AND SAFE RIDINGBEHAVIORS AMONG CYCLISTS (BODA BODA RIDERS) IN KAMPALA

Background: Motorcycle taxis are common means of transportation in Uganda and sub-Saharan Africa which remains a major neglected public health issue that presently at any time constitutes risk for road traffic accident and injuries in low and middle income countries. This study describes the level of predisposing-personal factors associated with passenger safety and safe riding behaviors among cyclists (bodabodariders) in Kampala and the relationship between age, educational attainment and the risk of road accident. Methodology:The study design was a cross-sectional survey using a validated semi-standard questionnaire to collect data on predisposing-personal factors and safe riding behaviors measured on a 31 and 24-point reference scale respectively from 422 consenting riders in the metropolis. Data from the study was analyzed using statistical package for social sciences (SPSS) and simple descriptive statistics such as means, standard deviations, and proportions were used to describe the data all in 95% confidence interval and Analysis of variance was employed to test differences in measures across age and level of education with a cut-off set at (p≤0.05) significance level. Results: The findings showed thatmajority of the respondents were between age of 25 and 29 (35.5%) where most of them (36.0%) had secondary educational attainment. The mean score for the level of predisposing-personal factors measured on a 31-point reference scale among respondents in our study was 23.9 (CI =23.60 ± 24.20) denoting a prevalence of 77.1%while the mean score for the safe riding behaviors as measured on 24-pointscale was 9.3 (CI =9.10 ± 9.60) which translates to prevalence of 38.8%. The study further revealed that older respondents and riders with non-formal education inconsistently reported lowest scorefor predisposing-personal factors (F=3.54, p=0.007 and F=14.49, p&lt;0.0001), whereas older respondents and riders with tertiary educational attainment constantly displayed lowest scores for safe riding behaviours (F=14.86, p&lt;0.0001 and F=7.15, p&lt;0.0001). Conclusions: The level of predisposing-personal factors associated with road safety and safe riding in terms of knowledge about passenger safety, perception of risk on road accidents and health consequences as well as attitudes toward safety rules and safe riding among respondents in the study is relatively high but the level of their safe riding behaviors is low and quite unsatisfactory.Thus, this calls for education and training exercises by the regulatory agencies on the initiation of safe riding behaviorsamong riders for knowledge without practice is useless.

C-Peptide

Objective: C-peptide has been the most technically appropriate and theoretically reasonable substitute for β-cell activity. In equimolar concentration, insulin and C-peptide are co-secreted into the portal circulation. Methods: A total of 150 participants of diagnosed diabetes mellitus (DM) and 18–45 years aged were studied. Those diabetics were classified into three groups supported by fasting serum C-peptide (FC) level and low FC cluster comprised participants with FC level &lt;0.6 ng/ml. Intermediate FC group comprised subject with FC level &gt;0.6–1.8 ng/ml and high FC group comprised participants with FC &gt;1.8 ng/ml. Results: The cutoff set of C-peptide was taken as 0.3–2.45 ng/ml. The prevalent diabetes among males was 85%–65% female. For the 150 diabetic participants, 18 (12%) were classified as type 1 DM (T1DM), 77 (51.3%) with type 2 DM, and the rest 55 (36.7%) as latent autoimmune diabetes in adults or MODY were perceived. In participants with T1DM, the mean serum C-peptide was slightly lower than in other diabetes forms. Considering the family history of diabetics in our research, detectable C-peptide in people with the family experience of diabetes was identified. Family diabetes history presence was seen in 15.5% of type 1 DM T1DM cases, while 84.5% of the remainder of the cases. Such classification is focused solely on family records and C-peptide rates which are subject to antibody screening, a genetic study for improved identification of the forms of diabetes. Conclusions: This result indicates that the diabetes measure C-peptide should be used in scientifically linked diabetes diagnosis, diabetes period, and subject age for appropriately managing persons with diabetes.

Comparison of the Power of Procalcitonin and C-Reactive Protein to Differentiate between Different Etiologies of Febrile Neutropenia in Patients with Prolonged Profound Neutropenia

Background: The management of febrile neutropenia in case of prolonged profound neutropenia remains challenging as there are many possible infectious and non-infectious causes for fever in these patients. In more than 60% of cases there is no documented infectious etiology and unresolved febrile neutropenia often results in multiple empirical modifications of antibacterial therapy and/or addition of antifungal therapy. Unfortunately, indiscriminate use of broad-spectrum antibiotics can lead to important collateral damage including toxicity, selection of multidrug resistant pathogens and an increased predisposition to other infections such as Clostridium difficile or yeasts/fungi. In this study, we investigated whether procalcitonin (PCT) is superior to C-reactive protein (CRP) in discriminating between different etiologies of fever.Methods: CRP and PCT were tested daily during 93 neutropenic episodes in 66 patients (Table 1). A linear mixed model was performed to evaluate the effects of different variables on the values of CRP and PCT over time. A total of 121 febrile episodes occurred during this study period and were classified into four categories based on clinical and microbiological findings: microbiologically documented infection (MDI); clinically documented infection (CDI); proven or probable invasive fungal disease (IFD); fever of unknown origin (FUO). The values of PCT and CRP on day 2 after onset of fever were considered for analysis of their performance in distinguishing etiologies of fever in receiver operating characteristic (ROC) curves and by calculation of sensitivity, specificity, positive & negative predictive values and efficiency.Results: In 61 out of 93 neutropenic episodes (66.7%) the evolution of PCT and CRP was clearly different. CRP seemed to be a more volatile parameter, rising above its ULN (3 mg/dL) during every neutropenic episode. Its reactivity to stimuli was also quite pronounced with a median of 2 surges above 100 mg/dL per neutropenic episode. In contrast, PCT did not rise above its ULN (0.5 ng/mL) in 50 out of 93 neutropenic episodes (53.8%). The only confounding factor on the evolution of CRP and PCT with a clinically relevant large effect size was administration of antithymocyte globulin (ATG), which led to an 11-fold increase of PCT versus a 2-fold increase of CRP.On the day of fever onset no significant difference in PCT values was observed between different etiologies of fever (p=0.314), whereas median CRP values were significantly higher in IFD versus all other etiologies (median 98.8 mg/dL vs 28.8 mg/dL, p=0.027). Both PCT and CRP reached their peak at a median of 2 days after onset of febrile neutropenia. Median PCT values on day 2 showed no statistically significant difference when comparing etiologies of fever (Figure 1A). There was a tendency towards higher median PCT values in MDI and IFD where they rose > 0.25 ng/mL, while they did not in CDI or FUO without prior administration of ATG. Median CRP values on day 2 after fever onset were significantly higher in IFD versus all other etiologies (median 172 mg/dL vs 78.4 mg/dL, p=0.002). In MDI median CRP values rose > 100 mg/dL, whereas they did not in CDI or FUO (Figure 1B).The discriminatory power between IFD and FUO of CRP on day 2 after onset of febrile neutropenia was superior to that of PCT. With the cut-off set at 200 mg/dL, CRP has a positive predictive value of 66.7% and a negative predictive value of 97% for the diagnosis of IFD versus FUO, leading to an efficiency of 94.5%.Conclusions: Both CRP and PCT are not able to predict neither etiology nor severity of infection at the onset of fever. When performing reassessment of antibiotic therapy 2 days after onset of febrile neutropenia, CRP has the better discriminatory power between etiologies of fever and shows higher peak values in clinically severe infections. As such we conclude that PCT has no added value over CRP for clinical management of febrile neutropenia. In our study a CRP value above 200 mg/dL has a positive predictive value of 66.7% and a negative predictive value of 97% for the diagnosis of IFD versus FUO (when MDI and CDI were ruled out by diagnostic workup). A high CRP in the absence of a clear focus of infection might prompt earlier investigation for IFD, leading to earlier treatment initiation and lower mortality. In view of the low numbers of IFD in our study it is important to note that this finding should be confirmed in a larger patient population. [Display omitted] DisclosuresVerlinden:MSD - Merck: Research Funding. Gadisseur:Bayer: Research Funding.

Functional Status After Pulmonary Rehabilitation as a Predictor of Weaning Success and Survival in Patients Requiring Prolonged Mechanical Ventilation.

Background: Comprehensive rehabilitation programs are recommended for patients with prolonged mechanical ventilation (PMV) to facilitate functional recovery and ventilator weaning, but whether the functional status after rehabilitation influences outcome has not been clearly evaluated. This study aimed to investigate the association between post-rehabilitation functional status and weaning and survival outcome in PMV patients.Methods: We retrospectively enrolled PMV patients admitted to the respiratory care center (RCC), a post-ICU weaning facility with protocolized rehabilitation program, from January 2016 through December 2017. Functional status was measured by the de Morton Mobility Index (DEMMI), with a cut-off value set at 20 points. The primary outcomes were the weaning status at RCC discharge and hospital survival. The secondary outcomes were overall survival and survival at 3 months after RCC discharge. We followed patients until 3 months after RCC discharge or death. Logistic and Cox regressions were performed to identify significant parameters associated with weaning success and survival.Results: In total, 320 patients were enrolled. The weaning success rate was 71.6%. The survival rate at RCC discharge, hospital discharge, and 3 months after RCC discharge was 89.1, 77.5, and 66.6%, respectively. Post-rehabilitation DEMMI ≥ 20 (odds ratio [OR], 3.514; 95% confidence interval [CI], 1.436–8.598; P = 0.006) was the most significantly associated with weaning success. The weaning success and higher post-rehabilitation DEMMI were the two most significant independent factors associated with both hospital survival (weaning success, OR, 12.272; 95% CI, 5.281–28.517; P < 0.001; post-rehabilitation DEMMI ≥ 20, OR, 6.298; 95% CI, 1.302–30.477; P = 0.022) and survival at 3 months after RCC discharge (weaning success, OR, 38.788; 95% CI, 11.505–130.762; P < 0.001; post-rehabilitation DEMMI ≥ 20, OR, 4.830; 95% CI, 1.072–21.756; P = 0.040). Post-rehabilitation DEMMI ≥ 20 remained significantly association with overall survival at 3 months after RCC discharge (hazard ratio, 0.237; 95% CI, 0.072–0.785; P = 0.018).Conclusions: Post-rehabilitation functional status of PMV patients was independently associated with weaning success, as well as hospital and 3-month overall survival after RCC discharge. Post-rehabilitation, but not pre-rehabilitation, functional status was a significant parameter associated with weaning success and survival in patients requiring PMV.

Right ventricular contractility as a potential independent evaluation parameter in pulmonary hypertension

Pulmonary artery hypertension (PAH) is a common disease with high disability and mortality rates, and can lead to right heart failure. We aimed to evaluate the capability of right ventricular pressure-volume coupling parameters, end-systolic elastance (Ees), right ventricular afterload (Ea), and arterial elastance (Ees/Ea) for assessing right ventricular performance during the chronic development of PAH. Thirty-six PAH patients were enrolled in this study. We reported the cutoff values of the right ventricular pressure-volume coupling parameters in the progression of PAH and their relations with other pressure-volume loop measurements in both the right and left ventricles. Ees and normalised Ees (Ees/Ea) calculated from the pressure method performed better than ones from the volume method in correlation with mean pulmonary arterial pressure and mean right arterial pressure. The cutoff sets of Ees and Ees/Ea were capable of grouping pulmonary hypertension patients which were well supported by their significant correlation with several key right ventricular hemodynamic parameters. Additionally, the normalised Ees was able to reflect the changes in left ventricular function during the deterioration of PAH. Ees and Ees/Ea are promising independent reference parameters for assessing ventricular function in progressing PAH patients.

Negative correlation between PANSS negative subscale score and obesity in a chronic group of patients with schizophrenia, an observational study

Background. Schizophrenia, as a chronic mental disorder with lifelong evolution is associated with low functionality and a high degree of disability. Obesity is an overlapping risk factor that is present in almost half of the patients worldwide and is responsible for increasing the overall mortality by itself or by predisposing to extensive morbidity. Its pathophysiology describes many mechanisms, the central position being occupied by the appetite regulation throughout the lipids and glucose metabolism. It is important to analyze whether the trends of correlation pairs of obesity in schizophrenia in Romanian patients are similar to those described in literature and if they are depicted in smaller groups of patients. Methods. This study paper is an observational cross-sectional study taking into account 110 inpatients with schizophrenia. The study included 110 inpatients diagnosed with schizophrenia admitted in ”Prof. Dr. Alexandru Obregia” Psychiatry Hospital. They were divided into two groups by applying the criterium of BMI with a cut-off point set at 25 and were applied PANSS and GAFs altogether with a structured basic anamnestic interview. Results. The mean age of the patients was 39.15 years in the study group (SG) and 40.95 years in the control group (CG), the sex ratio was similar between the two groups. Regarding previous treatment, 59.3% normal weight patients were priorly medicated and 38.1% of those with BMI&gt;25 received prior treatment. Both groups had a similar mean value of the positive and the general psychopathology subscales, the SG registered a slightly higher mean score on the negative subscale as well as on the total PANSS score. The mean value of Global Assessment of Functioning score was higher for the normal weight group. Discussion. Our findings point out that only PANSS negative subscale score has a negative statistical correlation (p=.005) with obesity in the chronic schizophrenic group we selected. No other statistically significant correlations between sex, age, place of living, education, employment and professional statuses, previous treatment, current antipsychotic medication and obesity were made possible due to reasons such as study design choice or the large number of obese patients related to the entire sample. Conclusion. There is an important number of schizophrenia patients that are overweight or obese. We found no major differences between the two groups on the topic of demographics or clinical variables, resulting in the conclusion that schizophrenia carries an important morbidity load, so that obesity can indiscriminately impact these patients.