Method For Assessment Of Severity Research Articles

Gait assessment in dairy cattle

Lameness is one of the most important dairy cow welfare issues and has inspired a growing body of literature on gait assessment. Validation studies have shown that several methods of gait assessment are able to successfully distinguish cows with and without painful pathologies. While subjective methods provide an immediate, on-site assessment and require no technical equipment, they show variation in observer reliability. On the other hand, objective methods of gait assessment provide accurate and reliable data, but typically require sophisticated technology, limiting their use on farms. In this critical review, we evaluate gait assessment methods, discuss the reliability and validity of measures used to date, and point to areas where new research is needed. We show how gait can be affected by hoof and leg pathologies, treatment of these ailments and the pain associated with lameness. We also discuss how cow (e.g. conformation, size and udder fill) and environmental features (e.g. flooring) contribute to variation in the way cows walk. An understanding of all these factors is important to avoid misclassifying of cows and confounding comparisons between herds.

Reproducibility and sensitivity to change of a new method of computer measurement of joint space width in hip osteoarthritis. Performance of three radiographic views obtained at a 3-year interval

Measurement of radiographic joint space width (JSW) and of joint space narrowing (JSN) is the currently recommended method for assessment of anatomical severity and structural progression of osteoarthritis (OA), respectively. A standard radiographic view of the pelvis is commonly used for measurement of hip OA but other views are available. To evaluate the inter-intra reader reproducibility and the sensitivity to change of a new automated method of measurement of the hip JSW and to assess which radiographic view [pelvis anteroposterior (AP) view, hip AP view, hip oblique view] provides the greatest accuracy for JSW and JSN measurements. An AP pelvis radiograph, an AP radiograph centered on the target hip (AP hip) and an oblique view were performed at baseline (M0) and 3 years later (M36) in 50 hip OA patients. Two readers, blinded to each other's results and time sequence, measured twice, at a minimum 15 day interval, the six radiographs of each patient, using a novel version of a previously validated software program whose edge-based algorithm automatically detects the joint space contours. Inter-observer cross-sectional (M0+M36) and longitudinal (M0-M36) reproducibility of JSW measurement was assessed by the intra-class correlation coefficient (ICC) and the Bland-Altman method. Sensitivity to change was estimated by the standardized response mean (SRM). An ANOVA was used to analyze differences related to the observer and the view. Intra-observer reproducibility: For JSW measurement, the ICC value, for observers 1 and 2 respectively, were 0.92 and 0.83 for the pelvic view, 0.96 and 0.88 for the hip AP view, and 0.90 and 0.86 for the oblique view. For JSN, ICC was 0.94 and 0.82 for the pelvic view, 0.97 and 0.78 for the hip AP view, and 0.95 and 0.86 for the oblique view. Inter-observer reproducibility: For JSW measurement, ICC was 0.87 for the pelvic view, 0.98 for the hip AP view, and 0.87 for the oblique view. The mean inter-observer difference (SD) was 0.0 (0.31), -0.01 (0.15) and -0.04 (0.4)mm for pelvic, AP and oblique views respectively. For JSN, ICC was 0.91 for the pelvic view, 0.93 for the hip AP view, and 0.90 for the oblique view. Sensitivity to change: SRM values were 0.61 (observer 1) and 0.65 (observer 2) for the pelvic view, 0.68 and 0.75, respectively, for the hip AP view, 0.64 and 0.66, respectively, for the oblique view. JSN did not vary significantly with the observer and the view. In 27% of cases intervention by the observer was necessary to correct the computer's identification of the acetabular edge in the area of interest. Computer measurement of the radiographic hip joint space provided good intra- and inter-observer reproducibility and good sensitivity to change. However, it was necessary for the observer to intervene frequently to select the area of interest and adjust detection of the bone edge. The hip AP view performed better than the pelvis and oblique views, but not significantly so.

Effectiveness of Early-season, Single Applications of Azoxystrobin for the Control of Potato Black Dot as Evaluated by Three Assessment Methods

Timing of azoxystrobin application for control of potato black dot was evaluated at two to four discrete times during early growth stages of potato from planting to just before row closure in trials from 2003 through 2006. Application timings consisted of a single application of azoxystrobin made either at planting, 34, 43, or 60–62 days after planting. Black dot severity was evaluated on above- and below-ground stems using three assessment methods. Incidence of infected progeny tubers and yield were also determined. Application at 60–62 days after planting was the most efficacious timing when black dot was evaluated as frequency of detecting Colletotrichum coccodes from 0.5 cm stem sections taken from near the plant crown in 2 of 3 years, as distance of sclerotium expansion on stems in 1 of 2 years, and as sclerotium density on stems 2 of 3 years. Black dot severity was not reduced as evaluated by any of the assessment methods when application of azoxystrobin was made at planting. Below-ground stems had more disease than the above-ground stems as measured by frequency of detection of C. coccodes near the crown 2 of 4 years, distance of sclerotium expansion on stems 2 of 2 years and sclerotium density on stems 3 of 3 years. Disease severity between above- and below-ground stem segments were highly correlated for all disease assessment methods and years except for frequency of detection of C. coccodes from crown tissue in 2005. There were no statistical interactions for any of the disease severity assessment methods between above- and below-ground stem segments with azoxystrobin timing. The sclerotia assessment on above-ground stem segments at end of season was an efficient measure of black dot. Incidence of infected progeny tubers was significantly reduced compared to the non-treated control when application was made at 62 days after planting in 1 of 3 years and at 34 and 43 days after planting in 2 of 4 years. There was not a significant difference in yield between any of the application times and the non-treated control in any year.

A simple method for measuring colour in wild animals: validation and use on chest patch colour in geladas (Theropithecus gelada)

Adaptive hypotheses about colour variation are widespread in behavioural ecology, and several methods of objective colour assessment have been proposed and validated for use in a wide variety of taxa. However, to date, the most objective and reliable methods of assessing colour are not readily applied to wild animals. In the present study, we present a simple method for assessing colour in unrestrained, wild subjects using digital photography. The method we describe uses a digital camera, a colour standard, and colour analysis software, and can be used to measure any part of the visible colour spectrum. We demonstrate that the method: (1) is accurate and precise across different light conditions; (2) satisfies previous criteria regarding linearity and red, green, and blue equality; and (3) can be independently validated visually. In contrast with previous digital methods, this method can be used under natural light conditions and can be readily applied to subjects in their natural habitat. To illustrate this, we use the method to measure chest colour in wild geladas (Theropithecus gelada). Unique among primates, geladas have a red patch of skin on their chest and neck, which, for males, is thought to be a sexually selected signal. Offering some support to this hypothesis, we found differences in chest ‘redness’ for males across different age groups, with males in their reproductive prime exhibiting the reddest chests. © 2008 The Linnean Society of London, Biological Journal of the Linnean Society, 2008, 94, 231–240.

The BPAQ: a bone-specific physical activity assessment instrument

A newly developed bone-specific physical activity questionnaire (BPAQ) was compared with other common measures of physical activity for its ability to predict parameters of bone strength in healthy, young adults. The BPAQ predicted indices of bone strength at clinically relevant sites in both men and women, while other measures did not. Only certain types of physical activity (PA) are notably osteogenic. Most methods to quantify levels of PA fail to account for bone relevant loading. Our aim was to examine the ability of several methods of PA assessment and a new bone-specific measure to predict parameters of bone strength in healthy adults. We recruited 40 men and women (mean age 24.5). Subjects completed the modifiable activity questionnaire, Bouchard 3-day activity record, a recently published bone loading history questionnaire (BLHQ), and wore a pedometer for 14 days. We also administered our bone-specific physical activity questionnaire (BPAQ). Calcaneal broadband ultrasound attenuation (BUA) (QUS-2, Quidel) and densitometric measures (XR-36, Norland) were examined. Multiple regression and correlation analyses were performed on the data. The current activity component of BPAQ was a significant predictor of variance in femoral neck bone mineral density (BMD), lumbar spine BMD, and whole body BMD (R(2) = 0.36-0.68, p < 0.01) for men, while the past activity component of BPAQ predicted calcaneal BUA (R(2) = 0.48, p = 0.001) for women. The BPAQ predicted indices of bone strength at skeletal sites at risk of osteoporotic fracture while other PA measurement tools did not.

Vibration-based damage detection and evaluation of sheet materials using a remote acoustic excitation

A simple method of damage severity assessment on sheet materials is suggested and proved by theory and experiment. The investigated defect types are in forms of added mass and crack. The method is based on the frequency shift measurement of a material vibrating as a membrane subjected to static tension and irradiated by an acoustic wave. It is shown both theoretically and experimentally that the natural frequency of the damaged membrane is shifted relative to its position in the ideal material. A local increase in thickness (or addition of mass) shifts the natural frequency down, while a crack shifts the frequency up. The method can be considered as acoustic weighting through the frequency shift. The sensitivity of this method can be high because frequency measurement is one of the most accurate measurements in physics and metrology.

Comparison of biotic indices for water quality diagnosis in the Duero Basin (Spain)

Several methods for water quality assessment have been proposed for European rivers. The EU Water Framework Directive requires the use of ecological indicators for stream monitoring networks and has encouraged research on biological indices. However, there is a lack of integrative studies comparing the efficiency of such methods in the determination of the ecological status in rivers. The present work, carried out in the Spanish side of the Duero Basin, the largest in the Iberian Peninsula, aimed at comparing different water quality indices. The survey was conducted during autumn 2003 and summer 2004 in 95 sites covering the entire basin. Epilithic diatoms and benthic macroinvertebrates were sampled and analysed following standard methods for the calculation of the macroinvertebrate index IBMWP and 18 different diatom indices. Additionally, water physical and chemical variables were measured and Habitat (IHF) and Riparian (RQI) indices were determined in situ. In general, both diatom and macroinvertebrate indices were strongly correlated with each other and with abiotic factors. The highest correlation coefficients between water physical and chemical data (especially with the concentrations of phosphates and N-derived compounds) were obtained for the diatom index SPI and the IBMWP, though no biotic method detected changes in the concentrations of toxicants (Zn 2+ , Cr III). The use of diversity metrics as monitoring indices is not recommended. The results indicated that several different biotic indices, based on a wide range of biotic communities, must be integrated in water quality surveillance protocols, in order to reflect complementary aspects of the ecological status in river ecosystems.

CON: Proximal Isovelocity Surface Area Should Not Be Measured Routinely in All Patients with Mitral Regurgitation

Long-standing moderate and severe mitral regurgitation (MR) lead to remodeling of the left atrium, left ventricle, and, ultimately, the right ventricle. These changes are associated with increased morbidity and mortality. Because of the importance of the MR severity in a patient's long-term outcome, the American Society of Echocardiography has recommended that the evaluation of MR severity take the time to “integrate multiple parameters of severity assessment rather than rely on a single measurement (1).” In taking this approach to severity assessment, the inherent theoretical, technical, or measurement errors associated with each method are minimized. Color flow Doppler (CFD) measurements of maximal jet area (MJA) at an aliasing velocity of 50–60 cm/s, the ratio of jet area/left atrial area, and the vena contracta combined with pulsed wave Doppler interrogation of the pulmonary veins, in the absence of proximal isovelocity surface area (PISA), can provide the required multiple techniques. Just because one can do PISA measurements, it does not necessarily follow that they should be done routinely. Though PISA is a recognized means to assess the severity of MR, there are many reasons that its use should not be universal. Even in the most simplified ways, PISA calculations may be time consuming for novices and require focus. Thus, performance of these measurements may lead to distraction from patient care. Another reason not to perform PISA calculations intraoperatively on a routine basis is that in many, if not most, cases there are conditions that invalidate the findings (Table 1). PISA measurements assume perfectly symmetric spherical unconstrained flow acceleration. Unfortunately, in the real world of pathologic mitral valves (MV), the geometry is often irregular and not symmetric (Fig. 1). Another problem is that the measurements vary throughout the cardiac cycle. Several studies evaluated continuous PISA-regurgitant orifice area (ROA) using computational calculations of the PISA-eROA (the effective size of the regurgitant orifice) through the complete systolic period (2–4). These instantaneous calculations were computationally performed using instantaneous MR flow rates and the corresponding simultaneous mitral regurgitant velocity in patients with rheumatic, functional, and myxomatous MR. Patients with rheumatic MR demonstrated parabolic MR flow rates and MR velocities which yielded a relatively a fixed PISA-ROA. Patients with functional MR demonstrated a bifid MR flow rate and parabolic MR velocity spectral envelope yielding a bifid PISA-ROA curve that was largest in early and late systole. The ROA in MV prolapse demonstrated a late peak as a result of a parabolic MR velocity spectral envelope and a mid-to-late increase in the MR flow rate. This study suggests that the maximal instantaneous PISA-ROA may not provide a reliable reflection of the ROA throughout systole or of the average systolic ROA (4).Table 1: Assumptions Involved in Mitral Regurgitation (MR PISA Calculations) and LimitationsFigure 1.: Image of an ischemic Type IIIb restricted mitral valve. Note the irregular shape of the deformity.In patients with Carpentier Type I and III mechanisms of regurgitation, there are often multiple regurgitant sites in addition to the dynamic nature of the ROA. Using PISA in these circumstances would require an independent assessment of each regurgitant orifice. On the other hand, multiple jets do not cause a problem when using CFD MJA color or pulse-wave Doppler pulmonary vein assessment. Just as one would not try to calculate mitral valve area by the pressure half-time method in patients with significant aortic regurgitation; you should not rely on the PISA measurement in all patients. Another key point relates to patients scheduled for MV surgery. The decision regarding the severity of MR has already been made, and the most important role of the prepump transesophageal echocardiography examination is to determine the mechanism of the MR not the severity. In MV repair surgery, the surgeon needs to know exactly why and where the valve is leaking. This determination requires a careful two-dimensional analysis of all views of the valve and then CFD is used to confirm the location and mechanism. Furthermore, as it has been shown in previous work (5), due to variations in loading conditions under anesthesia, intraoperative assessment may underestimate the severity of MR using CFD and pulmonary venous flow analysis. The effects of changes in loading conditions on PISA measurements are not well characterized. In conclusion, PISA is not routinely indicated in all intraoperative TEEs. However, in those circumstances when MR severity is critical in guiding the intraoperative management of our patients, the PISA measurements should be performed. Most importantly, however, PISA findings must be 1) considered in the context of the patient's presentation and 2) integrated with other severity assessment methods in a manor that is weighted by the quantitative ability of the specific method, and the quality of the recorded data (1).

Mitral Leaflet Separation Index: A New Method for the Evaluation of the Severity of Mitral Stenosis? Usefulness Before and After Percutaneous Mitral Commissurotomy

Two-dimensional planimetry (MVA(2D)) is the reference method for the evaluation of the severity of mitral stenosis (MS) but requires experienced operators. The mitral leaflet separation (MLS) index (distance between mitral leaflets) was recently presented as a reliable measure of MS severity. This method has the advantage of simplicity but has not been evaluated in a nonselected series of consecutive patients before and after percutaneous mitral commissurotomy (PMC). Patients referred for MS evaluation in our institution between February and September 2006 were prospectively enrolled in the present study. The only exclusion criterion was nonfeasible planimetry. MLS index was obtained by averaging the maximal leaflet separation distance at the tips in diastole in parasternal long-axis and apical four-chamber views. Planimetry was used as reference. Ninety consecutive patients were enrolled, and 116 examinations were performed: 55 before PMC and 61 after PMC. Overall mean MVA(2D) was 1.48 +/- 0.52 cm(2), MLS index was 1.01 +/- 0.24 cm, and a good correlation between both measurements was observed (r = 0.77, P < .00001). MLS index was significantly different between patients with severe (MVA(2D) >or= 1,5 cm(2)) and nonsevere MS (0.87 +/- 0.17 vs. 1.17 +/- 0.21 cm, P < .0001), but there was an important overlap. No threshold value could predict a nonsevere MS with both a sensitivity and a specificity greater than 80%. A threshold value of 0.97 cm provided the best combination of sensitivity and specificity (86% and 75%, respectively). However, an MLS index of 1.2 cm or more provided a good specificity and positive predictive values for the diagnosis of nonsevere MS (85% and 89%, respectively) and an MLS index of less than 0.8 cm an excellent specificity and positive predictive value for severe MS (98% and 96%, respectively). The MLS index cannot be considered as a substitute for MVA, but it can be used as a semiquantitative and complementary method for the integrative assessment of MS severity.

GI Epidemiology: nutritional epidemiology

Nutritional epidemiology is the assessment of diet and its relationship to disease aetiology in populations. The choice of dietary assessment method depends on the disease pathology. Events such as cancer that are chronic and complicated by exposure time require methods that capture consumption patterns of populations over a period of years. Although several methods of dietary assessment exist for collecting information on groups of individuals, their application to epidemiologic studies requires an understanding of the effect of variability in nutrient intake, sources of measurement error, and statistical issues unique to the study of nutritional epidemiology. This review provides an overview of commonly-used methods of dietary assessments in epidemiologic studies, and identifies their strengths and limitations and application to epidemiologic study designs. It concludes with a brief discussion of assumptions of nutrient databases and objectives of energy-adjustment and measurement error correction models. Nutritional epidemiology has contributed significantly to our understanding of the relationships between diet and disease. Ongoing investigations that further characterize important exposure periods (early life, in utero) and clarify associations within the context of genetic susceptibility will continue to elucidate our understanding of the pathophysiology of complex diseases, and support future recommendations for disease prevention.

Comparative predictive and diagnostic value of flow-mediated vasodilation in the brachial artery and intima media thickness of the carotid artery for assessment of coronary artery disease severity

Background While recent reports suggest that both flow-mediated vasodilation (FMD) in the brachial artery (BA), endothelium-dependent vasodilatation, and intima media thickness (IMT) in the carotid artery correlate with the extent of coronary artery disease (CAD), it is not clear which modality is a better predictor for CAD severity and whether either of these modalities are superior to conventional ST-segment depression in exercise stress electrocardiogram (ECG). Thus, the goal of the present study was to compare the predictive value of FMD and IMT for CAD severity and to evaluate the diagnostic accuracy. Study A total of 103 consecutive patients (62 ± 9 years, 79 men) with clinically suspected CAD underwent FMD and nitroglycerin-induced dilation (NTG-D) in the BA as well as measurement of carotid artery IMT by using high-resolution ultrasound, and exercise treadmill testing. Coronary stenosis index (CSI) was calculated from coronary angiography. Results Seventy-three patients had significant CAD, and 30 patients showed no CAD (NL). FMD was significantly lower and IMT was significantly higher in patients with CAD compared with NL patients (FMD, 3.7 ± 3.0% vs. 7.5 ± 2.9%; IMT, 1.1 ± 0.2 mm vs. 0.7 ± 0.1 mm). FMD and IMT correlated to CSI to a similar degree ( r = − 0.67, r = 0.69, respectively), and there was a significant correlation between FMD and IMT. In contrast, NTG-D did not correlate with CSI or IMT. Further, the diagnostic accuracy of FMD and IMT was comparable or even better than that obtained with conventional ST-segment depression during exercise in this cohort. Conclusions FMD in BA and IMT could represent a surrogate diagnostic method for assessment of CAD severity.

Assessment methods in medical education

Since the 1950s, there has been rapid and extensive change in the way assessment is conducted in medical education. Several new methods of assessment have been developed and implemented over this time and they have focused on clinical skills (taking a history from a patient and performing a physical examination), communication skills, procedural skills, and professionalism. In this paper, we provide examples of performance-based assessments in medical education, detailing the benefits and challenges associated with different approaches. While advances in psychometric theory and technology have been paralleled by the development of assessment instruments that improve the evaluation of these skills, additional research is needed, particularly if the assessment is used to make high stake decisions (e.g., promotion and licensure).

Application of Level-of-Service Methods for Evaluation of Operations at Pedestrian Facilities

Several methods for assessment of the quality of operations of pedestrian facilities on the basis of pedestrian level of service (LOS) have been proposed. Some of these methods use the principles of vehicular traffic to evaluate pedestrian traffic operations. Other methods are more concerned with the facility design and walking environment than with the actual pedestrian flows. To draw a complete picture of LOS determination methods for pedestrian facilities, it is necessary to review, compare, and contrast the various methods in the literature that assess quality of service for pedestrian facilities. This paper compares some of the more common and widely accepted methods for determination of the pedestrian LOS at sidewalks. These include the Highway Capacity Manual 2000 method, the Australian method, the Trip Quality method, the Landis model, and the conjoint analysis approach. After the methods and their associated measured criteria are described, a total of 13 sidewalks at two study sites were evaluated. The study sites are located in the downtown area of Birmingham, Alabama, and represent pedestrian operations at urban sidewalks. The comparison provides useful information on the consistency of the outcomes from the various methods and identifies needs for modifications and improvements. This is particularly useful in determining possible improvements to the existing Highway Capacity Manual 2000 method in the upcoming version of the Highway Capacity Manual.

1053 Long-term prognostic value of right ventricular contractile reserve by dobutamine stress echocardiography in patients with mitral stenosis: A tissue Doppler study

Eur J Echocardiography Abstracts Supplement, December 2006 leaflet separation index to predict a good valve opening was 0.87. Using a threshold value of 0.98 cm, sensitivity, specificity, positive predicted value and negative predicted value were 85%, 77%, 82% and 80% respectively. Conclusion: In this large study group of patients with a wide range of MS severity, mitral leaflet separation index was well correlated to the planimetry and a threshold value of 0.98 cm could predict a good PMC result with high sensitivity and specificity. Thus this new index, as a semi-quantitative method, seems to be a useful and complimentary method for MS severity assessment in the setting of PMC.

Estimating nutrient intake in comparative studies of animals: an example using dietary carotenoid content in birds

Many different methods of reporting animal diets have been used in ecological research. These vary greatly in level of accuracy and precision and therefore complicate attempts to measure and compare diets, and quantitites of nutrients in those diets, across a wide range of taxa. For most birds, the carotenoid content of the diet has not been directly measured. Here, therefore, I use an avian example to show how different methods of measuring the quantities of various foods in the diet affect the relative rankings of higher taxa (families, subfamilies, and tribes), and species within these taxa, with regard to the carotenoid contents of their diets. This is a timely example, as much recent avian literature has focused on the way dietary carotenoids may be traded off among aspects of survival, fitness and signalling. I assessed the mean dietary carotenoid contents of representatives of thirty higher taxa of birds using four different carotenoid intake indices varying in precision, including trophic levels, a coarse‐scale and a fine‐scale categorical index, and quantitative estimates of dietary carotenoids. This last method was used as the benchmark. For comparisons among taxa, all but the trophic level index were significantly correlated with each other. However, for comparisons of species within taxa, the fine‐scale index outperformed the coarse‐scale index, which in turn outperformed the trophic level index. In addition, each method has advantages and disadvantages, as well as underlying assumptions that must be considered. Examination and comparison of several possible methods of diet assessment appears to highlight these so that the best possible index is used given available data, and it is recommended that such a step be taken prior to the inclusion of estimated nutrient intake in any statistical analysis. Although applied to avian carotenoids here, this method could readily be applied to other taxa and types of nutrients.

Comparison of Severity Assessment Methods for Predicting Yield Loss to Rhizoctonia Foliar Blight in Soybean.

Rhizoctonia foliar blight, caused by Rhizoctonia solani Kühn anastomosis group 1, causes rapid and severe destruction of soybean foliage and pods during hot, wet weather. The objectives of this study were to determine the yield components affected by this disease and whether rating pod damage or foliar damage provides a more reliable method of assessing disease severity relative to impact on yield. Disease severity in the moderately resistant cv. NK S57-11 and the susceptible cv. Buckshot 723 was assessed in field plots in 1996 and 1997 using foliar and pod ratings (0-to-10 scale corresponding to 0 to 100% of tissue affected). Based on results from regression analysis, pod number, seed number, and seed weight per plot decreased as disease severity increased, whereas the proportion of partially filled pods and the weight of 100 seed were not affected. Yield loss appeared to be due primarily to loss of entire pods. Foliar and pod assessments of disease severity correlated positively in 1996 (r = 0.8343) and 1997 (r = 0.5958) for both cultivars, which suggests that either method can be used to identify relative differences among cultivars. However, pod assessments accounted for more variability than foliar assessments under low-disease conditions. Plants exhibiting moderate to severe symptoms of Rhizoctonia foliar blight also retained green stems and pods at harvest, which was evidence of delayed maturity.

An exploratory study of the efficacy of a Cognitive–Behavioral Treatment for hypochondriasis using different measures of change

The authors analyzed the efficacy of a cognitive–behavioral treatment applied to 12 patients diagnosed as suffering from hypochondriasis. The therapeutic procedure used was an adaptation of the program developed by Salkovskis and Warwick (Salkovskis, 1989; Salkovskis & Warwick, 1986; Warwick, 1989; Warwick & Salkovskis, 19891990). Several methods of assessment (statistical significance and clinical significance) were used to evaluate changes. As a group, the patients in the posttreatment phase showed significant improvement both statistically and clinically, and this was maintained at 2- and 6-month follow-up. Likewise, normalization of the scores was achieved in several of the measures. At an individual level and according to the Reliable Change Index (Jacobson & Truax, 1991), 75% of the patients showed noticeable improvements in hypochondriacal attitudes. Future lines of investigation in the evaluation of change in hypochondriacal preoccupations are suggested.

A Java software for calculating mean breath-by-breath variability in gas exchange parameters: Application in young cardiac patients with exercise-related periodic breathing

Oscillatory changes in parameters of gas exchange have been reported during rest and exercise in cardiac patients with severely depressed left ventricular function. As a result of the growing interest in this oscillatory phenomenon, several methods for assessment of this ventilatory response have been presented in cardiovascular research. Nowadays, objective measurement becomes more important. Therefore, the software reported in this study is based on calculating the mean breath-by-breath variability in respiratory variables and has the advantage that patients can be compared to normal controls. This Java-based software is available for public download under: http://www.perswww.kuleuven.ac.be/Steven_Vangesselen

Algorithm for the Diagnosis and Treatment of Acute Biliary Pancreatitis

Gallstones are the commonest cause of acute pancreatitis in developed countries. There is now a considerable evidence base consolidated by a series of systematic reviews, meta-analyses and guidelines that has established a clear algorithm for diagnosis and management. In the majority of patients the combination of ultrasonography and serum alanine transaminase > or = 60 iu/l < or = 48 hours of symptoms will identify gallstones as the cause. The simplest method of severity assessment is a high level of serum C-reactive protein (> 150 mg/l up to 72 hours after symptoms). In mild disease, all fit patients must undergo laparoscopic cholecystectomy with intraoperative cholangiography or if not fit for surgery then endoscopic sphincterotomy during the same admission to prevent further attacks. All patients with severe disease should undergo endoscopic sphincterotomy in less than 72 hours. Patients with > 30% necrosis should undergo fine needle aspiration for bacteriology. Necrosectomy is indicated for infected necrosis or sterile necrosis if there are persisting clinically significant symptoms. There is increasing evidence for the use of minimally invasive pancreatic necrosectomy. Enteral nutrition should be instituted whenever possible but antibiotics should be reserved for patients with proven sepsis. The presence of fungal infection requires active anti-fungal therapy. Patients with severe disease should undergo cholecystectomy at a later stage. Patients who have undergone necrosectomy require long-term follow-up because of delayed complications.

Multivariate statistical assessment of polluted soils

AbstractThis study deals with the application of several multivariate statistical methods (cluster analysis, principal components analysis, multiple regression on absolute principal components scores) for assessment of soil pollution by heavy metals. The sampling was performed in a heavily polluted region and the chemometric analysis revealed four latent factors, which describe 84.5 % of the total variance of the system, responsible for the data structure. These factors, whose identity was proved also by cluster analysis, were conditionally named “ore specific”, “metal industrial”, “cement industrial”, and “steel production” factors. Further, the contribution of each identified factor to the total pollution of the soil by each metal pollutant in consideration was determined.