Multiple Scoring Systems Research Articles

Improving Data and Prediction Quality of High-Throughput Perovskite Synthesis with Model Fusion.

Combinatorial fusion analysis (CFA) is an approach for combining multiple scoring systems using the rank-score characteristic function and cognitive diversity measure. One example is to combine diverse machine learning models to achieve better prediction quality. In this work, we apply CFA to the synthesis of metal halide perovskites containing organic ammonium cations via inverse temperature crystallization. Using a data set generated by high-throughput experimentation, four individual models (support vector machines, random forests, weighted logistic classifier, and gradient boosted trees) were developed. We characterize each of these scoring systems and explore 66 possible combinations of the models. When measured by the precision on predicting crystal formation, the majority of the combination models improves the individual model results. The best combination models outperform the best individual models by 3.9 percentage points in precision. In addition to improving prediction quality, we demonstrate how the fusion models can be used to identify mislabeled input data and address issues of data quality. In particular, we identify example cases where all single models and all fusion models do not give the correct prediction. Experimental replication of these syntheses reveals that these compositions are sensitive to modest temperature variations across the different locations of the heating element that can hinder or enhance the crystallization process. In summary, we demonstrate that model fusion using CFA can not only identify a previously unconsidered influence on reaction outcome but also be used as a form of quality control for high-throughput experimentation.

Multi-Layer Combinatorial Fusion Using Cognitive Diversity

Multiple scoring systems (including rank and score functions; MSS) have been widely used in multiple regression, intelligent biometric systems, multiple artificial neural nets, combining pattern classifiers, ensemble methods, machine learning and artificial intelligence (AI), data and information fusion, preference ranking, and deep learning. Combining MSS has achieved numerous successful results in a variety of domain applications. However, the reasons why this happens remains an active area of investigation. Combinatorial fusion analysis (CFA) combines MSS using the rank-score characteristic (RSC) function and cognitive diversity (CD). The RSC function was proposed to characterise the predictive behaviour of a scoring system. It was subsequently used to define the notion of “cognitive diversity”, which measures the dissimilarity in the representation of information between two scoring systems. In this article, we first examine characterizations of and diversity between scoring systems. Then, we review combinatorial fusion analysis with a variety of domain applications, including biometric systems in cognitive neuroscience, and joint decision making with visual cognitive systems. Finally, we demonstrate that multi-layer combinatorial fusion (MCF) on the Kemeny rank space is a viable machine learning and AI framework for preference ranking and reinforcement learning. This work provides a scientific foundation and technological insights for the use of Combinatorial Fusion in ensemble methods, data and information fusion, preference ranking, and deep reinforcement learning with applications to a variety of domains in data science and informatics for secure and sustainable societies.

A Novel Clinical Scoring System for Perioperative Morbidity in Metastatic Spinal Tumor Surgery: The Spine Oncology Morbidity Assessment Score.

Retrospective cohort study. To evaluate a scoring system to predict morbidity for patients undergoing metastatic spinal tumor surgery (MSTS). Multiple scoring systems exist to predict survival for patients with spinal metastasis. The potential benefits and risks of surgery need to be evaluated for patients with disseminated cancer and limited life expectancy. Few scoring systems exist to predict perioperative morbidity after MSTS. We reviewed records of patients who underwent MSTS at our institution between 2013 and 2019. All perioperative complications occurring within 30 days were recorded. A clinical scoring system consisting of five variables (age ≥ 70 yr, hypoalbuminemia, poor preoperative functional status [Karnofsky ≤ 40], Frankel Grade A-C, and multilevel disease ≥2 continuous vertebral bodies) was evaluated as a predictive tool for morbidity; every parameter was assigned a value of 0 if absent or 1 if present (total possible score = 5). The effect of the scoring system on morbidity was evaluated using stepwise multiple logistic regression. Model accuracy was calculated by receiver operating characteristic analysis. One hundred and five patients were identified, with a male prevalence of 58.1% and average age at surgery of 61 years. The overall 30-day complication rate was 36.2%. The perioperative morbidity was 4.6%, 30.0%, 53.9%, and 64.7% for patients with scores of 0, 1, 2, and ≥3 points, respectively (P < 0.001). On multiple logistic regression analysis controlling for covariates not present in the model, the scoring system was significantly associated with 30-day morbidity (OR 3.11; 95% CI, 1.72-5.59; P < 0.001). The model's accuracy was estimated at 0.75. Our proposed model was found to accurately predict perioperative morbidity after MSTS. The Spine Oncology Morbidity Assessment (SOMA) score may prove useful for risk stratification and possibly decision-making, though further validation is needed.Level of Evidence: 4.

Rapid Emergency Medicine Score as a Predictive Value for 30-day Outcome of Nonsurgical Patients Referred to the Emergency Department.

ABSTRACTBackground and aimsMultiple scoring systems are designed and prepared nowadays that can be used to determine and predict the severity, morbidity, and mortality rate of patients. Among them, the rapid emergency medicine score (REMS) system has been designed to predict the motility of nonsurgical patients admitted to the emergency department (ED). This study was performed with the aim of evaluating the predictive value of REMS in the mortality rate of nonsurgical patients.Materials and methodsThis study was carried out in 2017 among 300 nonsurgical patients referred to the ED. Data were collected using a checklist containing two parts of demographic information and REMS scale.ResultsBased on the results, we found a significant correlation between the duration of hospitalization and other parameters of the study. The results of this study indicated that the REMS of patients increased by 11%, 3%, and 5%, per each unit rise in patient’s age, heart rate, and respiratory rate, respectively. On the contrary, 12% and 22% decrements for every unit increase in SPO2 and GCS levels were observed, respectively. All the reported findings were statistically significant.ConclusionIn sum, the outcomes of the present study corroborate the REMS system as a successful scale in predicting mortality and the duration of hospitalization in nonsurgical ED patients.How to cite this articleAla A, Vahdati SS, Jalali M, Parsay S. Rapid Emergency Medicine Score as a Predictive Value for 30-day Outcome of Nonsurgical Patients Referred to the Emergency Department. Indian J Crit Care Med 2020;24(6):418–422.

Neutrophil-to-lymphocyte ratio for predictor of in-hospital mortality in ST-segment elevation myocardial infarction: a meta-analysis

BACKGROUND ST-segment elevation myocardial infarction (STEMI) is the most life-threatening condition of acute coronary syndrome that carries a poor prognosis of in-hospital mortality. Multiple scoring systems have been developed to predict in-hospital mortality and other cardiovascular events. Neutrophil-to-lymphocyte ratio (NLR) is hardly used as a predictor of in-hospital mortality. This study was aimed to determine the predictive value of NLR concerning in-hospital mortality in STEMI patients.&#x0D; METHODS Literature search and pooled analysis related to studies on MEDLINE/PubMed, EBSCO, Science Direct, Cochrane, and ProQuest were retrieved. Inclusion criteria were met if they were cohort studies, the subjects were STEMI patient, contained pretreatment NLR cut-off, and considered in-hospital mortality, which is defined as cardiac or all-cause mortality. Quality assessment was conducted using Newcastle-Ottawa scale. Review Manager version 5.3 (The Nordic Cochrane Centre, Copenhagen) was used for meta-analysis.&#x0D; RESULTS We found 12 studies with a total of 7,251 STEMI subjects with median NLR cut-off value of 5.6. Elevated NLR on admission carries a high risk of in-hospital mortality (odds ratio [OR] = 3.00, 95% confidence interval [CI] = 2.46–3.67). A slightly higher risk of all-cause mortality (OR = 2.74, 95% CI = 1.99–3.77) was observed compared with cardiac-related mortality (OR = 3.20, 95% CI = 2.47–4.14). No significant heterogeneity was observed between these studies (p = 0.46, I2 = 0%).&#x0D; CONCLUSIONS Elevated NLR predicts a higher in-hospital mortality rate of STEMI patients.

Diagnostic Accuracy of Sentence Repetition and Nonword Repetition for Developmental Language Disorder in Vietnamese.

Purpose Sentence repetition and nonword repetition assess different aspects of the linguistic system, but both have been proposed as potential tools to identify children with developmental language disorder (DLD). Cross-linguistic investigation of diagnostic tools for DLD contributes to an understanding of the core features of the disorder. This study evaluated the effectiveness of these tools for the Vietnamese language. Method A total of 104 kindergartners (aged 5;2-6;2 [years;months]) living in Vietnam participated, of which 94 were classified as typically developing and 10 with DLD. Vietnamese sentence repetition and nonword repetition tasks were administered and scored using multiple scoring systems. Sensitivity, specificity, and likelihood ratios were calculated to assess the ability of these tasks to identify DLD. Results All scoring systems on both tasks achieved adequate to excellent sensitivity or specificity, but not both. Binary scoring of sentence repetition achieved a perfect negative likelihood ratio, and binary scoring of nonword repetition approached a highly informative positive likelihood ratio. More detailed scoring systems for both tasks achieved moderately informative values for both negative and positive likelihood ratios. Conclusions Both sentence repetition and nonword repetition are valuable tools for identifying DLD in monolingual speakers of Vietnamese. Scoring systems that consider number of errors and are relatively simple (i.e., error scoring of sentence repetition and syllables scoring of nonword repetition) may be the most efficient and effective for identifying DLD. Further work to develop and refine these tasks can contribute to cross-linguistic knowledge of DLD as well as to clinical practice.

ACUTE APPENDICITIS: A COMPARISON OF ROLE OF RIPASA AND MODIFIED ALVARADO SCORE IN ACCURATE DIAGNOSIS

Background: Acute appendicitis is the most common surgical emergency traditionally diagnosed clinically with laboratory and imaging methods with a negative appendicectomy rate of 15-20%.These facts lead to the development of multiple scoring systems of them two commonly used RIPASA and Modified Alvarado score are being compared in the present study. Methods: In a hospital based longitudinal study, clinically suspected cases of acute appendicitis that underwent appendicectomy were included as cases. Pre-operative assessment Modified Alvarado score and RIPASA score were study factors. And Histopathology of the appendix was the outcome factor. Apart from descriptive statistic, diagnostic accuracy was calculated for both scores with validation of cut off score were carried out by plotting of ROC curve. Results: Total 129 patients with a mean age of 31±9.71, male to female ratio of 1.8:1 were enrolled. Negative appendicectomy rate was 6.2% and accuracy of the RIPASA score was 80.5% and Modified Alvarado score was 50.39%. The validated cut off for both scores was >7.5. Conclusions: RIPASA scoring system has higher sensitivity and specificity compared to Modified Alvarado score. It also has higher diagnostic accuracy and a better scoring system for accurate diagnosis of acute Appendicitis in the local population.

Metabolic Health Index (MHI): Assessment of Comorbidity in Bariatric Patients Based on Biomarkers.

The focus of bariatric surgery is reduction of weight, reflected in body mass index (BMI). However, the resolution of comorbidity is a second important outcome indicator. The degree of comorbidity is hard to quantify objectively as comorbidities develop gradually and are interdependent. Multiple scoring systems quantifying comorbidity exist but they lack continuity and objectivity. In analogy with BMI as index for weight, the Metabolic Health Index (MHI) is developed as objective quantification of metabolic health status. Laboratory data were used as comorbidities affect biomarkers. Conversely, laboratory data can be used as objectively obtained variables to describe comorbidity. Laboratory data were collected and crosschecked by national quality registry entries. Machine learning was applied to develop an ordinal logistic regression model, using 4 clinical and 32 laboratory input variables. The output was mathematically transformed into a continuous score for intuitive interpretation, ranging from 1 to 6 (MHI). In total, 4778 data records of 1595 patients were used. The degree of comorbidity is best described by age at phlebotomy, estimated Glomerular Filtration Rate (eGFR), and concentrations of glycated hemoglobin (HbA1c), triglycerides, and potassium. The model is independent of day of sampling and type of surgery. Mean MHI was significantly different between patient subgroups with increasing number of comorbidities. The MHI reflects severity of comorbidity, enabling objective assessment of a bariatric patient's metabolic health state, regardless day of sampling and surgery type. Next to weight-focused outcome measures like %TWL, the MHI can serve as outcome measure for metabolic health.

Impact of Hematopoeitic Cell Transplantation-Co-Morbidity Index (HCT-CI) and Its Individual Components on Allogeneic Transplant Outcomes

Background Allogeneic Stem Cell Transplantation (SCT) is potentially curative for many hematological diseases, however carries a high risk of mortality and morbidity. Multiple scoring systems has been developed to predict SCT outcomes and one of the more popular one id the Hematopoeitic Cell Transplantation - Co-Morbidity Index (HCT-CI). This study evaluates the value of HCT-CI score in predicting the outcomes of patients undergoing SCT at Princess Margaret Cancer Centre (PMCC). We also looked at the impact of the individual elements of HCT-CI in predicting SCT outcomes. Methods Two experienced physicians prospectively calculated the HCT-CI score for all patients transplanted at our center. Prospective calculation was performed during the patient's pre-transplant assessment before transplant admission using a pre-prepared form. All other patient and transplant characteristics were retrospectively collected from the EPR. Non-Relapse Mortality (NRM) and Overall survival (OS) were calculated to assess the prognostic power of the scores. This was correlated with the major SCT outcomes of Non-relapse mortality (NRM) and Overall survival (OS). Separately the impact of each components of HCT-CI was assessed in Univariate and multivariable analysis for NRM and OS. Results From August 2014 to April 2017, 299 patients underwent allogeneic HCT at the Princess Margaret Cancer Centre (PMCC), Toronto. Base line characteristics of the patients are shown in Table 1. HCT-CI scores were grouped as 0-2 as group 1 and ≥3 as group 2. Nearly two thirds belonged to group 1. (Table 1) The 2 year OS for the whole cohort was 51% (45%-56%) and NRM at 2 years was 25.1% (20%-31%). For the HCT-CI scores 0-2 vs ≥3, 2-year OS was 53% vs 46% respectively (p=0.29). The NRM at 2 years was 34% (29%-39%) for the whole cohort. For the HCT-CI scores 0-2 vs ≥3, 2-year NRM was 33% vs 35% respectively (p=0.75). (Figure 1) Univariate analysis of the impact of the independent components of HCT-CI score on OS and NRM was done. A p value of 0.2 was taken as cut off for selection for multivariable analysis. For NRM, cardiac co-morbidity, Diabetes and cerebrovascular accident were considered for multivariable analysis, where as cardiac co-morbidity, diabetes, severe pulmonary comorbidity, arrythmia and cerebrovascular accident were considered for OS multivariable analysis. On multivariable analysis, diabetes was the only factor found independently impacting both NRM [HR 2.2 (95%CI 1.4-3.4), p=0.0005] and OS [HR 1.6 (95%CI 1.1-2.4), p=0.025]. Conclusion HCT-CI was not found to predict OS or NRM accurately in our cohort of patients. Among the components of HCT-CI, diabetes was the only co-morbidity that significantly impacted both OS and NRM. Future prognostic scorings should incorporate only significant elements of comorbidities along with other transplant and disease related elements while developing prognostic scores. Disclosures Mattsson: Therakos: Honoraria; Celgene: Honoraria; Gilead: Honoraria. Michelis:CSL Behring: Other: Financial Support.

Sepsis patient evaluation emergency department (SPEED) score & mortality in emergency department sepsis (MEDS) score in predicting 28-day mortality of emergency sepsis patients

PurposeSepsis is a common acute life-threatening condition that emergency physicians routinely face. Diagnostic options within the Emergency Department (ED) are limited due to lack of infrastructure, consequently limiting the use of invasive hemodynamic monitoring or imaging tests. The mortality rate due to sepsis can be assessed via multiple scoring systems, for example, mortality in emergency department sepsis (MEDS) score and sepsis patient evaluation in the emergency department (SPEED) score, both of which quantify the variation of mortality rates according to clinical findings, laboratory data, or therapeutic interventions. This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis. MethodsThe study is a cross-sectional, prospective study including 61 sepsis patients in ED in Suez Canal University Hospital, Egypt, from August 2017 to June 2018. Patients were selected by two steps: (1) suspected septic patients presenting with at least one of the following abnormal clinical findings: (a) body temperature higher than 38°C or lower than 36°C, (b) heart rate higher than 90 beats/min, (c) hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg, and (d) white blood cell count higher than 12,000/μL or lower than 4000/μL; (2) confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment (SOFA) score following infection. Other inclusion criteria included adult patients with an age ≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection. Patients were shortly follow-up for the 28-day mortality. Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome. The receiver operating characteristic curves were also done for MEDS and SPEED scores. ResultsAmong the 61 patients, 41 died with the mortality rate of 67.2%. The mortality rate increased with a higher SPEED and MEDS scores. Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors (p = 0.004 and p < 0.001, respectively), indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients. Thereafter, the receiver operating characteristic curves were plotted, which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87 (0.788–0.963) as compared with 0.75 (0.634–0.876) for MEDS. Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system. For every one unit increase in SPEED score, the odds of 28-day mortality increased by 37%. ConclusionSPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients. Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.

The Performances of Multiple Scoring Systems to Predict Patients Required Immediate Life-Saving Intervention in Emergency Department

Background: Crowding in emergency room is the major problem especially in the resuscitation room. Many patients require immediate life-saving interventions (LSI). Whereas, many different scoring systems such as national early warning score (NEWS), worthing physiological scoring system (WPS), modified early warning score (MEWS), and rapid emergency medicine score (REMS) have been developed for assessing patients at risk.&#x0D; Objective: To evaluate the effectiveness of 4 scoring systems performance in predicting LSI use in emergency room and reenter to the resuscitation room within 48 hours.&#x0D; Methods: Data were collected by a retrospective cross-sectional study of patients treated in the resuscitation room for 2 months period, at Ramathibodi Hospital. The number of patients who received LSI and reentry to resuscitation room were studied, compared by selected scoring systems.&#x0D; Results: Total 839 patients entered resuscitation room, while 331 (39.45%) patients received LSI. The first three groups at risk were metabolic diseases, gastrointestinal systems, and infections, respectively. The most effective scoring system in predicting patients required LSI was MEWS, the discrimination of this system was significantly better than NEWS (AUC, 0.69 vs 0.65; 95% CI, 0.65 - 0.72; P = .01). Eighty-six patients (13.89%) from 619 patients reentered to the resuscitation room. Moreover, NEWS was the most effective in predicting patients who had a risk of reenter (AUC, 0.72; 95% CI, 0.66 - 0.78; P &lt; .001).&#x0D; Conclusions: MEWS is the most effective scoring system for patient assessment of LSI utilization. However, NEWS is the one suitable for predicting reenter tendency.

Comparison of the Subjective Elbow Value with the DASH, MEPS und Morrey Score after Olecranon Fractures.

Olecranon fractures are common injuries that can occur in patients of any age. To assess the postoperative outcome, multiple scoring systems like the DASH, MEPS und Morrey Score have been described. The goal of this paper is to compare the subjective elbow value (SEV) to these commonly used scoring systems. We hypothesized that the SEV would have a high correlation and practicability for the evaluation of elbow function after isolated olecranon injury. Clinical data of 40 patients were collected and retrospectively analysed. All patients suffered an isolated olecranon fracture and were surgically treated by tension band wiring or plate fixation. In the follow-up examinations the Mayo Score, DASH Score, Morrey Score and SEV were measured for correlation purposes. The mean follow-up time was 70.5 ± 45.6 months. The median DASH Score was 9.9 (4.1 - 20.4) and 100 (85 - 100) for the MEPS. The median Morrey Score was 98 (92 - 100). The median SEV was 90% (80 - 95%). The Pearson correlation between the DASH and SEV was -0.85 and 0.80 between the MEPS and the SEV. The SEV shows a high correlation to the most commonly used scoring systems for outcome evaluation after elbow injury. It is easy to use and can be seen as a valuable tool to assess patients after olecranon fractures.

Treatment of superior vena cava syndrome using AngioJet\u2122 thrombectomy system

BackgroundSuperior vena cava syndrome is a relatively rare presentation in which diminished venous return to the heart produces congestion of the neck, face and upper extremities. Typically, a mediastinal mass produces external compression on the superior vena cava and reduces venous return. However, superior vena cava syndrome can present acutely in the setting of vena cava thrombosis. Multiple scoring systems are available to assist clinicians with appropriate timing of interventions for SVC syndrome. When specific criteria are met, endovascular intervention can be beneficial to patients to prevent rapid deterioration.Case presentationA 75-year-old female with no significant past medical history presented to the emergency department with increased facial swelling, nausea and vomiting which began the night prior to presentation. The patient underwent a CT chest which revealed a 3.2 × 3.0 × 3.8 cm spiculated mass compressing the right main bronchus and right pulmonary artery. The patient was intubated and interventional radiology was consulted. The patient underwent venography which showed extensive thrombosis of the innominate veins. Rheolytic thrombectomy with AngioJet™ was performed to alleviate clot burden and minimize risk of secondary pulmonary embolism. Kissing stents were placed in the bilateral innominate veins to maintain patency after thrombectomy. After the procedure, the patient was successfully extubated and had near complete resolution of facial swelling approximately 12 h post procedure. A follow up venogram performed on post procedure day 4 showed patent bilateral subclavian, innominate, and internal jugular veins as well as a patent superior vena cava.ConclusionsAcute occlusion of superior vena cava can present with life threatening symptoms such as loss of airway. AngioJet™ thrombectomy is another tool available to interventional radiologists when a patient’s clinical condition necessitates treatment.

Review of Current Evidence in Acute Pancreatitis

Acute pancreatitis (AP) is an inflammatory condition of the pancreas and is one of the most common ailments of the gastrointestinal system that results in significant morbidity and mortality. The main etiologic causes of AP are alcohol consumption, gallstones, hypertriglyceridemia, and biliary stones. The clinical signs and symptoms, and diagnostic criteria of AP are well established in the literature and multiple studies. Multiple scoring systems have been used to predict the severity, prognosis, and mortality associated with AP. The present review of the literature brings to light the significant and recent contributions in the etiology, risk factors, epidemiology, diagnosis, complications, prognosis and newest modalities in treatment that could be beneficial in the management of AP.

The modified Frailty Index does not correlate with survival in surgically-treated patients with metastatic spine disease

With the increasing burden of metastatic spinal disease there is ever-more pressure on the health system to provide optimal management. Multiple treatment modalities, including surgical intervention, are available. Multiple prognostic scoring systems have been developed to aid both clinician and patient in making the best decision for each individual. The modified Frailty Index (mFI) has not been assessed for its correlation with survival in patients treated for metastatic spine disease. A retrospective review of a patients undergoing surgery for metastatic spine disease at a tertiary referral centre was performed and a comparison was made between the mFI and previously established disease-specific prognostic scores (revised Tokuhashi, modified Bauer and Tomita scores and the Oswestry Spine Risk Index). 41 patients were included over a 5-year period. 38 deceased by the end of the study period with a 30-day mortality of 14.6% and a 1-year mortality of 73.2%. The mFI poorly correlated with survival. Out of the four established scoring system, the OSRI had the best correlation. The mFI did not correlate with survival in this cohort of surgically treated patients with metastatic spinal disease and is best used as a selection tool for surgery. Dedicated prognostic tools can be selected appropriate to the institution experience and set-up.

Cognitive Diversity: A Measurement of Dissimilarity Between Multiple Scoring Systems

In the context of computing and informatics, Cognitive Diversity (CD) has been proposed to characterize the degree of dissimilarity between multiple scoring systems (MSS). As such, CD serves a role in informatics analogous to that of Pearson’s Correlation in classical statistics. Here we review MSS and explore CD’s utility in relation to the notions of correlation and distance in machine learning, ensemble methods, rank aggregation, and combinatorial fusion in both parametric score space and non-parametric rank space. Finally, we survey applications of CD in combining MSS in a variety of domains in science, technology, society, business, and management. Our study provides a new data science framework for discovery in data-rich environments.

Anew scoring system for increasing the sensitivity of the MMSE.

The mini mental state examination (MMSE) has been criticized for its lack of sensitivity, especially in mild cases of dementia. There have been several attempts to increase the sensitivity by adding or deleting items, which never became accepted in clinical practice. In the current study anew scoring system for improving the sensitivity of the MMSE is proposed, which preserves the original items and the total score of 30points. Instead of changing the number of items or the total score of 30points, the weighting of the different items in the total score of 30points was changed. Neuropsychological test data of 765 patients were retrospectively included in the study to determine the difficulty of each MMSE item. Multiple scoring systems for the MMSE were developed by inclusion of the item difficulty and clinical relevance. The sensitivity of the new scoring system was compared to the original scoring system by using the DemTect as an established measure. The results showed that an increase of 24.3% in sensitivity was statistically significant. Within the mild cognitive impairment subgroup, the sensitivity of the new scoring system was twice as high in comparison to the original MMSE and within the dementia group the sensitivity was increased by 8.2%. Anew scoring system with ahigher sensitivity than the original MMSE was developed, which can easily be administered in clinical practice because it preserves all items and the total score of 30points.

CALR and CD47: An Insight into Their Roles in the Disease Progression of MDS and MPN

Myelodysplastic syndrome and myeloproliferative neoplasms are clonal myeloid disorders arising from haematopoietic stem cells that have the tendency to progress into acute myeloid leukaemia. Multiple prognostic scoring systems have been proposed and utilised in clinical practice to predict disease evolution, however none of them can predict treatment response. In solid tumours, the relationship between the pro-phagocytic calreticulin and the anti-phagocytic CD47 is repeatedly investigated. Overexpression of calreticulin has been documented to produce a pro-phagocytic signal in solid tumour and it is often counteracted by a concomitant expression of the anti-phagocytic CD47 as they act in response to one another, reflecting an apoptosis vs survival mechanism in response to chemotherapy. The role of both calreticulin and CD47 are currently poorly understood in myeloid malignancies including myelodysplastic syndrome and myeloproliferative neoplasms. The aim of this review is to elaborate on the current understanding round the roles and implications of calreticulin and CD47 signalling with in solid and haematological cancers, discuss potential roles for calreticulin and CD47 expression in transformation of myeloid cells in patients with MDS or MPN into AML and how these advances are starting to be used to design new therapeutic strategies to determine disease progression and treatment response in both solid cancer and myeloid malignancies.

UTRme: A Scoring-Based Tool to Annotate Untranslated Regions in Trypanosomatid Genomes.

Most signals involved in post-transcriptional regulatory networks are located in the untranslated regions (UTRs) of the mRNAs. Therefore, to deepen our understanding of gene expression regulation, delimitation of these regions with high accuracy is needed. The trypanosomatid lineage includes a variety of parasitic protozoans causing a significant worldwide burden on human health. Given their peculiar mechanisms of gene expression, these organisms depend on post-transcriptional regulation as the main level of gene expression control. In this context, the definition of the UTR regions becomes of key importance. We have developed UTR-mini-exon (UTRme), a graphical user interface (GUI) stand-alone application to identify and annotate 5′ and 3′ UTR regions in a highly accurate way. UTRme implements a multiple scoring system tailored to address the issue of false positive UTR assignment that frequently arise because of the characteristics of the intergenic regions. Even though it was developed for trypanosomatids, the tool can be used to predict 3′ sites in any eukaryote and 5′ UTRs in any organism where trans-splicing occurs (such as the model organism C. elegans). UTRme offers a way for non-bioinformaticians to precisely determine UTRs from transcriptomic data. The tool is freely available via the conda and github repositories.

A characterization of gestational carriers using the thematic apperception test

Objective personality tests (such as the MMPI-2 and PAI) used to screen gestational carriers (GCs) often show defensiveness. This study investigates the utility of incorporating a projective assessment measure such as the Thematic Apperception Test (TAT) into the psychological screening process to better understand personality functioning of potential GCs. GC candidates' TAT protocols were scored using 3 validated scoring systems. These were compared both within the sample (accepted vs. not accepted) and against norms published for women matched for demographic characteristics. 4 cards of the TAT (1, 2, 3GF, & 13MF) were administered as part of the psychological evaluation process for 39 GC candidates. TAT protocols were then scored using multiple scoring systems as a way of quantifying the responses. Scoring systems included the Scoring Scheme for the TAT, the Rating Scales for Emotional Tone and Outcome, and Apperceptive Norms. Scores of accepted GCs (n=31) were then compared to norms published for women using both t-test and chi-square analyses. Comparisons were also made within the sample between women accepted as GCs (n=31) and those not cleared psychologically (n=8). Card 1 typically elicits themes about self-image, relationships with authority figures, and achievement. When compared to norms on Emotional Tone, women accepted as GCs were significantly more likely to report themes of sadness (p<.001). On cards that typically elicit themes of loss and depression (3GF & 13MF), accepted GCs' mean scores were significantly more positive in tone (p<.05). Comparisons on Apperceptive Norms revealed significant differences across multiple cards. When compared to norms on card 1, accepted GCs endorsed items suggesting compliance in response to authority at a significantly higher rate (p<.001). On card 2, accepted GCs were significantly more likely to endorse themes of pregnancy (p<.001) as well as themes of improving one's educational status and maintaining traditional family values (p<.05). Card 13MF typically elicits themes of sexual conflicts. Accepted GCs were significantly less likely to report negative themes of illicit sexual activity or wrongdoing and more likely to interpret images as more wholesome (p<.05). When comparisons were made within the study sample (accepted vs. not accepted), women not accepted based on their psychological evaluation showed a restricted range of emotion on all cards and a tendency towards describing outcomes that were less favorable and more indeterminate than women who had been accepted as GCs. This study shows there are unique qualities in the TAT profiles of GC candidates that distinguish them from the general population. Incorporating projective measures designed to bypass psychological defenses often present on objective tests can provide a more comprehensive profile of personality functioning and aid mental health professionals in determining the psychological appropriateness of potential GC candidates.