Present Classification Systems Research Articles

Intensity of physical activity as a percentage of peak oxygen uptake, heart rate and Borg RPE in motor-complete para- and tetraplegia.

ObjectiveThe aims were to describe VO2peak, explore the potential influence of anthropometrics, demographics and level of physical activity within each cohort; b) to define common, standardized activities as percentages of VO2peak and categorize these as light, moderate and vigorous intensity levels according to present classification systems, and c) to explore how clinically accessible methods such as heart-rate monitoring and Borg rating of perceived exertion (RPE) correlate or can describe light, moderate and vigorous intensity levels.DesignCross sectional.SettingRehabilitation facility and laboratory environment.SubjectsSixty-three individuals, thirty-seven (10 women) with motor-complete paraplegia (MCP), T7-T12, and twenty-six (7 women) with motor-complete tetraplegia (MCT), C5-C8.InterventionsVO2peak was obtained during a graded peak test until exhaustion, and oxygen uptake during eleven different activities was assessed and categorized using indirect calorimetry.Main outcome measuresVO2peak, Absolute and relative oxygen consumption, Borg RPE.ResultsAbsolute VO2peak was significantly higher in men than in women for both groups, with fairly small differences in relative VO2peak. For MCP sex, weight and time spent in vigorous-intensity activity explained 63% of VO2peak variance. For MCT sex and time in vigorous-intensity activity explained 55% of the variance. Moderate intensity corresponds to 61–72% HRpeak and RPE 10–13 for MCP vs. 71–79% HRpeak, RPE 13–14 for MCT.ConclusionUsing current classification systems, eleven commonly performed activities were categorized in relative intensity terms, (light, moderate and vigorous) based on percent of VO2peak, HRpeak and Borg RPE. This categorization enables clinicians to better guide persons with SCI to meet required physical activity levels.

An Incremental Self-Adaptive Wood Species Classification Prototype System

The present wood species classification systems can usually process the limited wood species quantity. We propose a novel incremental self-adaptive wood species classification system to solve the above-mentioned issue. The visible/near-infrared (VIS/NIR) spectrometer is used to pick up the spectral curves of wood samples for the subsequent wood species classification. First, when new wood samples of unknown wood species are added, they are classified as an unknown category by our one-class classifier, Support Vector Data Description (SVDD), while the existent wood species are classified as a known category by the SVDD. Second, the wood samples of known species are sent into the BP neural network for subsequent wood species classification. Third, the new wood samples of unknown species are sent into the Clustering by Fast Search and Find of Density Peaks (CFSFDP) algorithm for the unsupervised clustering, and the clustering result is evaluated by the internal and external norms. Last, if one cluster of one unknown species has an adequate amount of wood samples, these wood samples are removed and identified by human experts or other schemes to ensure to get the correct wood species name. Then, these wood samples are considered as a new known species and are sent into the classifiers, SVDD and BP neural network, to train them again. Experiments on 13 wood species prove the effectiveness of our prototype system with an overall classification accuracy of above 95%.

Update on Neuroendocrine Carcinomas of the Larynx.

Laryngeal neuroendocrine carcinomas are heterogeneous neoplasms characterized by neuroendocrine differentiation. Their prognoses are dependent on tumor type, therefore different classifications have been developed. Moreover, other tumors have overlapping pathologic features posing a range of diagnostic possibilities. A review of the literature was performed to comprehensively understand the classification and diagnosis of these tumors. We review the past and present classification systems, with emphasis to the latest 2017 World Health Organization Classification of Head and Neck Tumors. We highlight salient clinicopathologic features and discuss the presumptive etiologic role of human papilloma virus. We share a practical algorithmic approach to the diagnosis of suspected neuroendocrine neoplasms of the larynx including a novel marker for neuroendocrine differentiation, insulinoma-associated protein 1. Accurate diagnosis and grading of laryngeal neuroendocrine carcinomas is critical for prognostication and therapeutic decision making. The use of an algorithm is instrumental in assuring the exclusion of mimickers.

Classification systems of gingival recession: An update

Gingival recession is defined as “the displacement of marginal tissue apical to the cementoenamel junction (CEJ)”. Various classifications have been proposed to classify gingival recession. Miller's classification of gingival recession is most widely followed. With a wide array of cases in daily clinical practice, it is often difficult to classify numerous gingival recession cases according to defined criteria of the present classification systems. This article outlines the limitations of present classification systems and also the new classifications that have been proposed to classify gingival recession.

RNA Visualization: Relevance and the Current State-of-the-Art Focusing on Pseudoknots.

RNA visualization is crucial in order to understand the relationship that exists between RNA structure and its function, as well as the development of better RNA structure prediction algorithms. However, in the context of RNA visualization, one key structure remains difficult to visualize: Pseudoknots. Pseudoknots occur in RNA folding when two secondary structural components form base-pairs between them. The three-dimensional nature of these components makes them challenging to visualize in two-dimensional media, such as print media or screens. In this review, we focus on the advancements that have been made in the field of RNA visualization in two-dimensional media in the past two decades. The review aims at presenting all relevant aspects of pseudoknot visualization. We start with an overview of several pseudoknotted structures and their relevance in RNA function. Next, we discuss the theoretical basis for RNA structural topology classification and present RNA classification systems for both pseudoknotted and non-pseudoknotted RNAs. Each description of RNA classification system is followed by a discussion of the software tools and algorithms developed to date to visualize RNA, comparing the different tools' strengths and shortcomings.

Proposal for a simple and effective diagrammatic representation of root canal configuration for better communication amongst oral radiologists and clinicians

ObjectivesRoot canal anatomy has been proved to be a complex canal configuration system. The negotiation and cleaning of this system is essential for successful root canal treatment. The present root canal classification systems are unable to transfer the clinically relevant information about the canal system from the oral radiologist to the treating clinician. Thus, a simple and effective diagrammatic representation of the canal system, depicting the major canals, important changes during their course along with other relevant information has been presented. MethodsThe proposed representation consists of five horizontal lines dividing the tooth into four segments from the point of reference to apical foramen. Each line has been designated with different line style. The diagrammatic images, one anterior and one posterior multi-rooted tooth, are given for easy understanding of the orientation of image. The whole image can be saved in portable network graphics format and can be imported to any word processing document. The image can be printed in the reporting sheet. ResultApplying the same proposal, some of the diagrammatic representations have been showed. ConclusionThis proposal for diagrammatic representation of root canal configuration can be helpful in getting an approximate distribution of the canals in a relatively simple manner. This scheme also provides valuable clinical information about the root canal system, which the other classifications fail to represent.

Clinical implications of genomics for cancer risk genetics

The study of human genetics has provided substantial insight into cancer biology. With an increase in sequencing capacity and a reduction in sequencing costs, genomics will probably transform clinical cancer genetics. A heritable basis for many cancers is accepted, but so far less than half the genetic drivers have been identified. Genomics will increasingly be applied to populations irrespective of family history, which will change the framework of phenotype-directed genetic testing. Panel testing and whole genome sequencing will identify novel, polygenic, and de-novo determinants of cancer risk, often with lower penetrance, which will challenge present binary clinical classification systems and management algorithms. In the future, genotype-stratified public screening and prevention programmes could form part of tailored population risk management. The integration of research with clinical practice will result in so-called discovery cohorts that will help identify clinically significant genetic variation.

Tissue Destruction Classification Systems

Assessing the level of tissue destruction in wounds can be a confusing challenge. This important task is frequently accompanied by questions and the need for clarification to accurately classify the level of damage seen in wounds. The purpose of this article was to present several known classification systems to help clarify this issue for the clinician.

Using Treatment Response to Subtype Schizophrenia: Proposal for a New Paradigm in Classification

Phenomenology and Diagnosis The treatment and classification of schizophrenia continue to represent an enormous challenge. Phenomenology and outcome remain the basis of present classification systems although both are heterogeneous and overlap with other psychiatric disorders.1,2 Efforts are in place for change; eg, the Working Group on Classification of Psychotic Disorders for ICD-11 has recommended omitting the traditional subtypes such as paranoid, catatonic, etc., in accordance with DSM-5, the major argument being lack of clinical utility in routine clinical practice.3,4 We believe the changes advocated do not go far enough because classification still relies heavily on symptom clusters. Adding severity and course specifiers, as is the case in the ICD-11 draft, or multiple dimensions (DSM-V) may represent more of a challenge than benefit for clinicians in their busy daily practices. Moreover, the reliability and predictive validity of these specifiers and domains are not well established and, possibly, not substantively better than the subtypes that have been abandoned.

A new classification system for gingival and palatal recession

Various classifications have been proposed to classify gingival recession. Miller's classification of gingival recession is most widely followed. With a wide array of cases in daily clinical practice, it is often difficult to classify numerous gingival recession cases according to defined criteria of the present classification systems. To propose a new classification system that gives a comprehensive depiction of recession defect that can be used to include cases that cannot be classified according to present classifications. A separate classification system for palatal recessions (PR) is also proposed. This article outlines the limitations of present classification systems and also the inability to classify PR. A new comprehensive classification system is proposed to classify recession on the basis of the position of interdental papilla and buccal/lingual/palatal recessions.

Interobserver Reliability and Intraobserver Reproducibility of Three Radiological Classification Systems for Intra-articular Calcaneal Fractures

The management of intra-articular calcaneal fractures is difficult. One aspect for successful management is the use of a reliable and reproducible fracture classification system (FCS). The purpose of this study was to evaluate the interobserver reliability and intraobserver reproducibility of Letournel, Sanders, and Zwipp classification systems on CT scan and the Bohler's angle measurement on plain X-ray. Furthermore, we studied if the addition of a CT scan to the plain X-ray influenced the evaluation of fracture extension to the calcaneocuboid joint. The CT scan and plain X-ray images of 51 intra-articular calcaneal fractures were evaluated two times by three observers (two radiologists and one orthopedic surgeon) within a 5-month interval. The interobserver reliability was measured using the Fleiss kappa while the intraobserver reproducibility was measured using the Cohen's kappa. The mean kappa values for the interobserver reliability and intraobserver reproducibility of the Sanders classification were 0.25 and 0.39, respectively, of Zwipp classification were 0.24 and 0.16, respectively, while those of the Letournel classification were 0.50 and 0.42, respectively. For the Böhler's angle, the mean kappa values for the interobserver reliability and intraobserver reproducibility were 0.34 and 0.32, respectively. The addition of CT scan images to plain X-ray found a higher incidence of calcaneocuboid joint involvement. Clinicians should be aware of the limitation regarding the interobserver reliability and intraobserver reproducibility of the Letournel, Sanders and Zwipp classification systems for calcaneal fractures. Future studies should attempt to improve the present classification systems.

Cycloid Psychosis: Perris Criteria Revisited

Cases presenting with recurrent confusion, alteration of psychomotor activity, and brief psychosis with good inter-episode recovery have many differing etiologies. Only rarely does one diagnose such cases as cycloid psychosis. Even among budding psychiatrists, there seems to be a lack of awareness of this unique disorder. This may be because the present international diagnostic classification systems, ICD10 and DSM IV, do not recognize it as a separate entity. A high index of suspicion is required to diagnose cycloid psychosis. Awareness and recognizing such cases would be helpful clinically as cycloid psychosis entails a distinct prognosis and may require a specific treatment.

Views and Experiences of Family/whanau Carers of Psychiatric Service Users on Diagnosis and Classification

Family (whanau) and other carers can play a central part in the natural history of psychiatric service users. Diagnoses or the classification of mental disorders play a significant role in communications between clinicians, psychiatric service users, and family. Despite that centrality, the views and experiences of family on the utility of the present classification systems have been little studied. This study aimed to document the understanding and opinions of families/whanau on the utility of diagnostic labels as they observed them being applied to their family members. This is a qualitative study. The families of two cultural groups (New Zealand Maori and non-Maori) of psychiatric service users were interviewed using a structured approach. A number of themes on the utility of the diagnostic systems emerged. The single most powerful message being that how the diagnostic labels were communicated, and how they were utilized in the patient management planning, were of paramount importance. There were some cross-cultural differences. From Maori, there was a particular plea for a greater incorporation of culturally syntonic concepts. Family/whanau had positive views of the contributions current diagnostic practices make to patient care. The study elicited the view that more contextual issues, and not just phenomenology, should be taken into account in the development of diagnostic systems.

Update in nonneoplastic lung diseases.

Abstract Context.—Nonneoplastic lung diseases include a wide range of pathologic disorders from asthma to interstitial lung disease to pulmonary hypertension. Recent advances in our understanding of the pathophysiology of many of these disorders may ultimately impact diagnosis, therapy, and prognosis. It is important for the practicing pathologist to be aware of this new information and to understand how it impacts the diagnosis, treatment, and outcome of these diseases. Objective.—To update current progress toward elucidating the pathophysiology of pulmonary alveolar proteinosis, idiopathic pulmonary hemosiderosis, and pulmonary arterial hypertension, as well as to present classification systems for pulmonary hypertension, asthma, and interstitial lung disease and describe how these advances relate to the current practice of pulmonary pathology. Data Sources.—Published literature from PubMed (National Library of Medicine) and primary material from the authors' institution. Conclusions.—Improved understan...

Update in Nonneoplastic Lung Diseases

Nonneoplastic lung diseases include a wide range of pathologic disorders from asthma to interstitial lung disease to pulmonary hypertension. Recent advances in our understanding of the pathophysiology of many of these disorders may ultimately impact diagnosis, therapy, and prognosis. It is important for the practicing pathologist to be aware of this new information and to understand how it impacts the diagnosis, treatment, and outcome of these diseases. To update current progress toward elucidating the pathophysiology of pulmonary alveolar proteinosis, idiopathic pulmonary hemosiderosis, and pulmonary arterial hypertension, as well as to present classification systems for pulmonary hypertension, asthma, and interstitial lung disease and describe how these advances relate to the current practice of pulmonary pathology. Published literature from PubMed (National Library of Medicine) and primary material from the authors' institution. Improved understanding of the pathophysiology of pulmonary alveolar proteinosis, pulmonary hypertension, and idiopathic hemosiderosis may impact the role of the surgical pathologist. New markers of disease may need to be assessed by immunohistochemistry or molecular techniques. The classification systems for interstitial lung disease, asthma, and pulmonary hypertension are evolving, and surgical pathologists should consider the clinicopathologic context of their diagnoses of these entities.

P03-117 A bedside schizophrenia thought disorder scale

Present classification systems for thought disorder lack consistency and require one to remember long-winded definitions limiting their use to research settings. as an extension of recent work in this area (World Congress, 2008), we classify the characteristic thought disorder patterns seen in schizophrenia according to the location of the lesion in notional "threads" of mental computational processes that string speech together. These threads must take both semantics and syntax into consideration in performing their function. When we speak - just as when we write - there is a natural hierarchy topic thread (the topic of the ‘essay’) and multiples of paragraph threads, sentence threads, clause threads, word threads and phoneme threads. Intuitively, we grade the severity of thought disorder depending upon whether a particular thread gets stuck (S), reconnects abnormally (R) or is absent altogether:I.paragraph thread R: Disjointed sentences S: Circumstantiality;II.topic threadR: Tangentiality S: Preoccupatory thinking;III.sentence threads R: Knight's move thinking S: Clause perseveration;IV.clause threads R: Word salad S: Word perseveration, fusion;V.word threads R: Incoherent sounds/ neologisms/ paraphasias S: Phoneme/syllable perseveration;VI.phoneme threads - Failure of production: Mutism.Of course, one must record all the lesions that are present at any given time. This scale incorporates a intuitive progression from mild to severe thought disorder in Schizophrenia. Using the STDS would allow the straightforward ‘bedside’ quantification of the severity of thought disorder and enforce discipline into the thought assessment section of the Mental State Examination.

The mental health of children in out-of-home care

To review the scale, symptomatology and determinants of mental health problems of children in alternate care, and to consider the need for specialized knowledge and clinical competence for assessment and treatment of these problems. The scale of mental health problems among children in care is exceptional for a nonclinical population, approaching that of clinic-referred children. Children in residential care have more mental health problems than those in family-type foster care, while those in kinship care have fewer problems. Children manifest complex psychopathology, characterized by attachment difficulties, relationship insecurity, sexual behaviour, trauma-related anxiety, conduct problems, defiance, inattention/hyperactivity, and less common problems such as self-injury and food maintenance behaviours. Children in care have complex symptomatology that is not well represented in present classification systems. There is a need for research into the characteristics and meaning of these complex presentations, and some re-appraisal of present taxonomies. Clinicians should consider these difficulties in their entirety, rather than as discrete disorders. It is recommended that assessment and intervention are provided by clinical teams that have specialist knowledge of children in care, and that use an ecological approach to assessment.

Characteristics of children with hip displacement in cerebral palsy

BackgroundHip dislocation in children with cerebral palsy (CP) is a common and severe problem. The dislocation can be avoided, by screening and preventive treatment of children with hips at risk. The aim of this study was to analyse the characteristics of children with CP who develop hip displacement, in order to optimise a hip surveillance programme.MethodsIn a total population of children with CP a standardised clinical and radiological follow-up of the hips was carried out as a part of a hip prevention programme. The present study is based on 212 children followed until 9–16 years of age.ResultsOf the 212 children, 38 (18%) developed displacement with Migration Percentage (MP) >40% and further 19 (9%) MP between 33 and 39%. Mean age at first registration of hip displacement was 4 years, but some hips showed MP > 40% already at two years of age. The passive range of hip motion at the time of first registration of hip displacement did not differ significantly from the findings in hips without displacement.The risk of hip displacement varied according to CP-subtype, from 0% in children with pure ataxia to 79% in children with spastic tetraplegia. The risk of displacement (MP > 40%) was directly related to the level of gross motor function, classified according to the gross motor function classification system, GMFCS, from 0% in children in GMFCS level I to 64% in GMFCS level V.ConclusionHip displacement in CP often occurs already at 2–3 years of age. Range of motion is a poor indicator of hips at risk. Thus early identification and early radiographic examination of children at risk is of great importance. The risk of hip displacement varies according to both CP-subtype and GMFCS. It is sometimes not possible to determine subtype before 4 years of age, and at present several definitions and classification systems are used. GMFCS is valid and reliable from 2 years of age, and it is internationally accepted.We recommend a hip surveillance programme for children with CP with radiographic examinations based on the child's age and GMFCS level.

Classification in Psychiatry: Does it deliver in schizophrenia and depression?

BackgroundIn the context of ongoing work to develop the next iteration of psychiatric classification systems, we briefly review the performance of current systems against their own stated objectives, for two major diagnostic groupings.DiscussionIn the major groupings of schizophrenia and depression, experience over the last 50 years has highlighted particular inadequacies in the utility and validity of available classifications.SummaryAdvances in psychiatric knowledge and practice notwithstanding, present classification systems would be enhanced by the incorporation of dimensional components. Minor tinkering with current systems will reflect only a missed opportunity. Improving classification will facilitate quality improvement of mental health systems.

Unusual Combination of Femoral Head Dislocation Associated Acetabular Fracture With Ipsilateral Neck and Shaft Fractures: A Case Report

Traumatic posterior hip dislocation associated with a fracture of the femoral neck is a rare injury. The combination of an acetabular fracture and a fracture of the femoral neck and shaft with posterior dislocation of the femoral head is even more rare. No case similar to ours was found in the literature available. We report a case of ipsilateral femoral neck and shaft fracture with associated fracture of acetabulum and dislocation of femoral head in addition to the diastasis of symphysis pubis and fracture of the right side radius distal end fracture in a car driver. The case was an unusual femur and hip injury that could not be classified with the present classification systems.