Simple Screening Procedure Research Articles

Salivary Oxidative Stress Assessment in Tobacco Users with and without Potentially Malignant Disorders and Micronuclei Estimation using Fluorescent Microscopy

Abstract Background: Consumption of tobacco in either smoking or nonsmoking form produces free radicals, contributing to an increased risk of oral cancer as a result of oxidative stress. Biochemical changes in antioxidant enzymes are responsible for tobacco-associated oral carcinogenesis. Due to the production of reactive oxygen species and oxidative stress, the promotion of carcinogenesis occurs in the cells. Oral potentially malignant disorders (OPMDs) is an assembly of benign lesions with morphologically altered clinical or histopathological tissue that has a greater than normal risk of transforming into malignant lesions after diagnosis at a later date. Micronuclei are the goal site for early genotoxic events and are involved in carcinogenic events. Micronuclei in exfoliated cells are useful biomarkers in assessing cytogenetic damage. Early detection will help to devise appropriate treatment plans, thereby improving patient survival rates. Aim and Objectives: To estimate the salivary superoxide dismutase (SOD) levels and the expression of micronuclei in exfoliated buccal cells of tobacco users before the onset of tobacco-induced oral lesions and correlating the same with patients with OPMDs to determine if this can be useful in predicting early malignant potential in subjects with habitual tobacco usage. Materials and Methods: The study included three groups. Group I – Tobacco users with OPMD (n = 50), Group II – Tobacco users without OPMD (n = 50), and Group III – Healthy controls (n = 50). Sandwich enzyme-linked immunosorbent assay was done for saliva samples for quantification of salivary SOD. Exfoliated buccal cells were smeared and stained with acridine orange stain and viewed under a fluorescent microscope for micronuclei estimation. Results: The study showed a significant difference in salivary SOD levels and increased micronuclei expression among tobacco users than healthy controls. Conclusion: Our study results revealed a gradual and steady decrease of SOD levels and increased micronuclei expression from healthy control to tobacco users without lesions and tobacco users with lesion, and this can be used as an effective noninvasive early diagnostic biomarker in assessing malignant progression in tobacco users. Furthermore, the evaluation of micronuclei estimation can serve as a simple, quick, and noninvasive chair-side procedure for regular oral cancer screening in patients with tobacco usage.

Change Point Detection in Dynamic Networks via Regularized Tensor Decomposition

Dynamic network captures time-varying interactions among multiple entities at different time points, and detecting its structural change points is of central interest. This article proposes a novel method for detecting change points in dynamic networks by fully exploiting the latent network structure. The proposed method builds upon a tensor-based embedding model, which models the time-varying network heterogeneity through an embedding matrix. A fused lasso penalty is equipped with the tensor decomposition formulation to estimate the embedding matrix and a power update algorithm is developed to tackle the resultant optimization task. The error bound of the obtained estimated embedding matrices is established without incurring the computational-statistical gap. The proposed method also produces a set of estimated change points, which, coupled with a simple screening procedure, assures asymptotic consistency in change point detection under much milder assumptions. Various numerical experiments on both synthetic and real datasets also support its advantage. Supplementary materials for this article are available online.

Breast self-examination practices among young rural women and its associated knowledge and attitudes in Tirunelveli District, Tamil Nadu.

Breast self-examination (BSE) is a simple and cost-effective screening procedure in downstaging breast tumors. To assess the BSE practices and its associated knowledge and attitudes of rural women from Tirunelveli District, Tamil Nadu during the COVID-19 pandemic. A descriptive cross-sectional survey design was employed, and snowball sampling was used to recruit the sample of rural women from Tirunelveli. Women ages 18-60 willing to take part were included. Data were collected online through a self-developed questionnaire. Responses were analyzed using SPSS Version 20. Descriptive statistical analysis was used to present the general details and responses of the rural women through percentages. Using the appropriate tests, the mean differences of the BSE attitudes based on the personal variables were computed using one-way ANOVA. A total of 433 rural women (Mean age: 29.20 ± 9.35 years) from Tirunelveli responded to the online Knowledge, Attitude and Practice (KAP) questionnaire. Regular health checkups were undergone by 27.48% of women and 9.24% underwent breast cancer (BC) screening in the past. While 68.36% had heard of BC, 61% knew it could be detected in the early stages. Insufficient knowledge regarding BSE techniques was evident among the women. Knowledge about BC was highest among those earning more than 20,001 INR, women aged 36-45, widowed/separated/divorced women, and diploma graduates. Overall, BSE and BC knowledge score was low, with correspondingly low attitudes and practices. Findings showed the KAP among rural Tirunelveli women to be low.

Using a computationally driven screening to enhance magnetocaloric effect of metal monoborides

In most cases, substitution studies that aim to optimize magnetic properties are performed at the magnetic atomic site. However, in the case of MnB, magnetic substitutions at the Mn site significantly decrease the once promising magnetocaloric and magnetic properties. This study employs computationally directed search to optimize the magnetocaloric properties of MnB where partial substitutions of boron atoms (Mn50B50− x Si x and Mn50B50− x Ge x where x = 3.125, 6.25, and 12.5) reveal new compounds with a greater magnetocaloric effect than pure MnB at the same Curie temperature. These new compounds were obtained by arc melting the pure elements and further characterized. The computationally driven screening process is based on density functional theory calculations that do not require large databases of known compounds. This work demonstrates that using simple computational screening procedures to search for new magnetocaloric materials with improved properties can be done quickly, cost-effectively, and while maintaining reliability.

Accuracy of Cervical Intraepithelial Lesion Diagnosis by Visual Cervical Examination with Acetic Acid

Introduction: Using acetic acid to inspect the vaginal canal is a simple screening procedure done with the naked eye. During a speculum examination, the cervical transformation zone is painted with acetic acid 3% to 5% or vinegar. It is a simple, cost-effective screening tool that can be used in poor developing countries with high rates of invasive cervical cancer mortality because acetic acid coagulates nuclear proteins, resulting in white discoloration of the transformation zone in CIN and early invasive cancer. Objective: This study aims to measure the effectiveness of a simple and economical screening test, visual inspection with acetic acid (VIA), for diagnosing cervical intraepithelial lesions in comparison to the gold standard of histopathology using a study population of women attending a gynecology outpatient department. Study Design: The study used a cross-sectional design to validate the findings. Study Area: This study was conducted in the Obstetrics & Gynecology Department, Women and Children Teaching Hospital, Dera Ismail Khan. Study Duration: This study took place between November 2018 and April 2019. Materials and Methods: The study included 414 women with abnormal vaginal bleeding. Under a good light source, a lubricated Cusco's speculum was introduced into the vagina to evaluate the cervix for gross abnormalities. A cotton swab was used to apply 3% acetic acid to the cervix and acetowhite changes were observed for one minute. Positive results were considered when distinct acetowhite areas were detected, while negative results were considered when light, faint, or doubtful aceto-white areas were detected. Results: There was a range of age from 18 to 40 years in this study with a mean age of 30.772 years and a mean weight of 71.644 kilograms. For diagnosis of cervical intraepithelial lesions, acetic acid visual examination has shown a sensitivity of 84.38%, specificity of 97.11%, diagnostic accuracy of 95%, PPV of 84.38%, and NPV of 97.11% (p=0.000). Practical implication: The purpose of this study is to compare the efficacy of a simple and inexpensive screening test, visual inspection with acetic acid (VIA), to the gold standard of histopathology in a study group of women attending a gynecological outpatient service. Cervical cancer is a leading cause of death among women in developing countries, where access to advanced diagnostic tools is limited. If VIA proves to be an effective screening tool, it could be widely implemented in low-resource settings to improve early detection and treatment of cervical cancer. Conclusion: VIA is considered an appropriate screening alternative for a large population. In contrast to cytology-based programs, it is highly sensitive, low-cost, and yields immediate results. Keywords: Cervical Cancer; Visual Inspection with Acetic Acid; Screening

Debris-flow risk-to-life: Upper-bound preliminary screening

Where the potential for future debris-flow occurrence is unrecognised, developments can be unknowingly exposed to debris-flow impact, with corresponding risks to lives. Debris-flow modelling is unsuited to routine local office use, so a simple screening procedure is proposed to enable local officials to identify locations where debris flow risk-to-life may be unacceptable, and prioritise where expert modelling and risk analysis are most urgently required for risk-management decision-making . This procedure calculates catchment Melton ratio R from topographic data, uses a linear upper bound of field data relating R to the annual probability of debris-flow occurrence, and matches a model-based debris-flow risk-to-life analysis for Matata, New Zealand. Our data suggest that any development exposed to debris flows will require a detailed risk assessment to ensure that risk-to-life does not exceed acceptable levels.

Correlation Filters in Machine Learning Algorithms to Select Demographic and Individual Features for Autism Spectrum Disorder Diagnosis

Autism spectrum disorder is currently considered one of the main neurodevelopmental disorders with predominant characteristics of difficulty in social communication and cognitive skills, and limited and repetitive patterns. This disorder has no cure and has different levels of severity that vary according to the appearance of symptoms in each patient. Generally, the waiting time for the diagnosis of autism spectrum disorder is slow, having as one of the reasons for this situation the lack of development of simple screening procedures to be implemented and which have efficient results. The objective of this work is to analyze a public database in order to find patterns of the autism spectrum, that is, to isolate the attributes that together with behavioral characteristics can bring greater reliability to the precursor model. The preliminary results showed that the probabilistic neural network algorithm performed well in this classification. In addition, the application of correlation filters demonstrated greater efficiency in accuracy. By applying eight data mining algorithms and aggregating the demographic, individual, and behavioral attributes, and excluding some attributes, we obtained an accuracy of 100% through the support vector machine. Finally, the results with machine learning have shown that the patient's ethnicity, continent, and the presence of jaundice tend to reveal more likely that the patient will be diagnosed with autism spectrum disorder.

A Study of Fine Needle Aspiration Cytology of Breast Lump With The Use of National Health Service Breast Screening Program (NHSBSP) - Study Of 500 Cases

Background: FNAC is rapid, simple, safe, cost effective and good screening procedure with high sensitivity and specificity. Clinically, the diseases of breast mainly present as palpable breast lump, pain and nipple discharge. Most of the breast lumps are benign but pose a significant anxiety to the patient, which can be allayed by giving assurance that, usually it is benign. So it is necessary to distinguish benign from malignant conditions
 Methods: The present study on was carried out during June 2017 to May 2019. We categorized the patients into C1 (Inadequate), C2 (Benign), C3 (Atypia, probably benign), C4 (Suspicious of malignancy) and C5 (Malignant) category according to NHSBSP and correlated histopathologically whenever available.
 Result: Total 500 cases examined. Majority of the cases were in the 3rd decade of the life. Benign category comprised of 368 cases (73.6%), followed by malignant disease 61 (12.2%). Fibroadenoma was most common comprising of 230 cases (62.3%) among benign cases. Out of 230 cases of Fibroadenoma, most (89) cases were in 21-30 years age group, followed by 11-20 years age group. Breast carcinoma was most common (31.1%) in 41-50 years age group and 61-70 (27.9%) years age group followed by 51-60 (19.7%) years age group.
 Conclusion: FNAC of breast lesions is advantageous for both clinicians and patients because of its immediate results, economy, and accuracy. FNAC has got significant diagnostic value in differentiating benign from malignant lesions providing us valuable information for planning of subsequent therapeutic management and avoiding unwanted surgeries.

Are We Modelling Spatially Varying Processes or Non‐linear Relationships?

Studies of spatially varying parameter estimates obtained in the calibration of various types of local statistical models are commonplace. The variation in such estimates is typically explained in terms of spatially varying processes. This paper highlights that an alternative explanation for spatially varying parameter estimates, in terms of non‐linearity, should be examined prior to relating such variation to spatially varying processes. This can be achieved by a simple screening procedure which is described and demonstrated and which can easily be applied to the results of any local model. The problem is highlighted, and the solution demonstrated, with a set of simulated data and then with a real‐world data set. The paper also highlights the obverse situation whereby the inappropriate application of a GAM produces spurious nonlinear results when the real relationships are linear but spatially varying.

EVALUATING THE UTILITY OF FINE-NEEDLE ASPIRATION CYTOLOGY(FNAC) IN LYMPH NODE PATHOLOGIES- A FOLLOW-UP STUDY

Background: Lymphadenopathy or adenopathy is an often encountered clinical problem with many causes ranging from inammatory to malignant process. The present study was conducted to assess the cases of lymphadenopathy using FNAC. Materials & Methods: This study comprised of 140 patients of male and female with neck masses. All patients underwent to FNA and subsequently surgical excision of their neck masses. Smears were then prepared and marked with Pap method. Results: Out of 140 cases, males were 80 and females were 60. The difference was non- remarkable (P- 0.1). Out of 140 cases, 105 were benign and 35 were malignant. In begin lesions, 70 were in males and 40 were in females and in malignant cases, 15 were in males and 15 were in females. The difference was signicant (P- 0.01). Metastatic neoplasm was seen in 11 males and 9 females, hodgkin's lymphoma in 5 males and 4 females, and non- hodgkin's lymphoma in 4 males and 2 females. The difference was nonsignicant (P> 0.05). Conclusion: FNAC is the simple, safe, reliable, and cost-effective procedure for initial screening of various lymph node pathologies.

A simple screening procedure could identify Indian patients with early cognitive impairment and its implications for the management of geriatric hip fracture

Background: Dementia is one of the most common and cognitive impairments growing over the globe. It encompasses a wide range of other neurodegenerative disorders with the symptoms such as loss of memory, inability in carrying out everyday activities, a decline in the brain function activities, and perplexity. However, it has been identified that there is an absolute lack of treatment modalities for dementia, but the early diagnosis plays an important role in identifying the cognitive impairment in the asymptomatic phase itself. It helps in preventing the disease from reaching a further complicated stage. Aim: To assess the impact of cognitive impairment screening on the management of geriatric hip fractures. Methods: It was an observational study carried out at the Shree Krishna Hospital, Karamsad for a period of June, 2018 to May, 2020. Two hundred sixty patients were included in the study. The patients were divided into three groups, namely hemiarthroplasty (HA), Total Hip Arthroplasty (THA), hemiarthroplasty in patients with known dementia (HAd). Result: The study showed male preponderance in the study, and the majority of the patients were above 80 years of age. There was a significant difference in the patients who can perform their grocery or medication independently and not independently with respect to MMSE. However, there was no statistically significant difference in Hip Harris Score. There was a statistically significant difference among the three groups regarding the intraoperative blood, operation duration, hospital stay, ICU postoperative, in-hospital details. Conclusion: In light of the above literature, it was found that hip fractures and cognitive impairment were closely related. There are many risk factors of hip fracture, which are aggravated due to the late diagnosis of cognitive impairment. The incidence of hip fracture among patients suffering from dementia was much higher as compared to normal patients.

Differential diagnosis of thalassemia and iron deficiency anemia using the CellaVision Advanced Red Blood Cell software

Red blood cells (RBCs) in patients with thalassemia and iron deficiency anemia (IDA) exhibit different patterns of morphological changes. However, manual quantitative analysis of the morphological changes in the RBCs is time-consuming and subjective, limiting its use in differential diagnosis. The aim of this study was to evaluate the CellaVision Advanced RBC software as a prescreening tool for differential diagnosis of thalassemia and IDA. The study cohort consisted of 54 thalassemia and 46 IDA cases in the training group and 36 thalassemia and 31 IDA patients in the validation group. The CellaVision DM96 Advanced RBC software was used to analyze the RBC morphology. Specific patterns of quantitative changes in RBC shapes were found in thalassemia and IDA patients. As a single parameter, target cell was the best morphological cell type to distinguish thalassemia from IDA, with an area under the curve (AUC) of 0.79, followed by hypochromatic cells with an AUC of 0.70. Combination of target and hypochromatic cells expressed as a ratio of the percentage of target cells to percentage of hypochromatic cells (T/H ratio) presented better differential diagnostic ability with an AUC of 0.88. A cutoff value of 1.755 for T/H ratio showed a sensitivity and specificity of 80.43% and 81.48% in the training group and 88.89% and 80.65% in the validation group, respectively. Assessment of the T/H ratio using the CellaVision Advanced RBC software represents a relatively simple and economical screening procedure for diagnostic testing of thalassemia and IDA.

The validity of 5-aminorevrinic acid as a biomarker for risk screening and supportive diagnostic parameters in lung cancer patients.

e21027 Background: Early detection and treatment of cancer is an important issue that affect the prognosis of cancer patients. Photodynamic screening with 5-aminorevrinic acid (ALA-PDS) is simple and non-invasive procedure for risk screening of cancer, and it is gradually recognized as the predictable biomarkers for cancer in Japan. In this study, we examined the predictability of lung cancer by ALA-PDS and its usefulness as a supportive parameter for preoperative diagnosis. Methods: Eighty-five lung cancer patients (48 males and 37 females) just before lung resection were enrolled. 5-aminolevulinic acid phosphate 150mg was taken at night and urine samples were collected in the next morning. The porphyrin metabolites in the urine samples were detected by solid phase extraction method, previously reported from our group. Afterwards, the data was adjusted depending renal function. The data was compared with that from healthy volunteer without any abnormal symptom and physical disorder. Results: The average age of 85 patients was 70 years (46-85). The number of patients in each pathological stage was 2 in Stage 0, 58 in Stage IA and IB, 15 in Stage IIA and IIB, 8 in Stage IIIA and IIIB, and 2 in Stage IV, respectively. The diagnosis was 61 cases of adenocarcinoma and 22 cases of squamous cell carcinoma. Urinary porphyrin metabolites in lung cancer patients increased significantly as compared to those of healthy volunteers (2,847nM/gCRE vs 1,668nM/gCRE, p < 0.001). Increase of urinary porphyrin metabolites was observed even in stage 0 or I patients, but the correlation with stage progression was not clear (Stage 0 and I vs Stage II vs Stage III and IV: 2,757nM/gCRE vs 3,099nM/gCRE vs 3,010nM/gCRE). Furthermore, urinary porphyrin metabolites were confirmed to be significantly increased even in PET-negative cancer patients, compared to healthy volunteers (p < 0.001). Conclusions: ALA-PDS was able to predict lung cancer in our cohort. Moreover, it was also suggested that it may be useful as a supportive parameter for diagnosis of early stage lung cancer or PET negative lung cancer.

Mechanical sap transmission of Tomato leaf curl New Delhi virus infecting ridge gourd [Luffa acutangula (L.) Roxb.] in south India

Ridge gourd (Luffa acutangula L.) is an important cucurbitaceous crop cultivated throughout India. The crop is severely affected by yellow mosaic disease caused by Tomato Leaf Curl New Delhi Virus (ToLCNDV). The symptoms of ToLCNDV consists of yellow mosaic spots on young leaves, reduction in leaf area, leaf thickening flower abortion and severe stunting of the plants. High disease dissemination under epiphytotic conditions also affects the chemical control measures and leads to heavy crop losses. Identification of resistant sources is most important tool to reduce the economic loss and maximize quality and quantity of output. Efficient and simple screening procedures are very crucial in disease resistant breeding program. In this experiment, mechanical sap inoculation of ToLCNDV has been studied in twelve ridge gourd genotypes. All the inoculated plants developed characteristics ToLCNDV symptoms and severe infection after three-week post inoculation. In all the assays ToLCNDV transmission was confirmed by PCR amplification using virus specific primer followed by sequencing of random samples. Mechanical sap transmission is easy and simple screening method which will facilitate the development of ToLCNDV resistant breeding cultivars.

Development of an analytical method for multi-residue quantification of 18 anthelmintics in various animal-based food products using liquid chromatography-tandem mass spectrometry

In this study, we developed a simple screening procedure for the determination of 18 anthelmintics (including benzimidazoles, macrocyclic lactones, salicylanilides, substituted phenols, tetrahydropyrimidines, and imidazothiazoles) in five animal-derived food matrices (chicken muscle, pork, beef, milk, and egg) using liquid chromatography-tandem mass spectrometry. Analytes were extracted using acetonitrile/1% acetic acid (milk and egg) and acetonitrile/1% acetic acid with 0.5 mL of distilled water (chicken muscle, pork, and beef), and purified using saturated n-hexane/acetonitrile. A reversed-phase analytical column and a mobile phase consisting of (A) 10 mM ammonium formate in distilled water and (B) methanol were used to achieve optimal chromatographic separation. Matrix-matched standard calibration curves (R2≥0.9752) were obtained for concentration equivalent to ×1/2, ×1, ×2, ×3, ×4, and ×5 fold the maximum residue limit (MRL) stipulated by the Korean Ministry of Food and Drug Safety. Recoveries of 61.2–118.4%, with relative standard deviations (RSDs) of ≤19.9% (intraday and interday), were obtained for each sample at three spiking concentrations (×1/2, ×1, and ×2 the MRL values). Limits of detection, limits of quantification, and matrix effects were 0.02–5.5 μg/kg, 0.06–10 μg/kg, and −98.8 to 13.9% (at 20 μg/kg), respectively. In five samples of each food matrix (chicken muscle, pork, beef, milk, and egg) purchased from large retailers in Seoul that were tested, none of the target analytes were detected. It has therefore been shown that this protocol is adaptable, accurate, and precise for the quantification of anthelmintic residues in foods of animal origin.

Tracking forest biophysical properties with automated digital repeat photography: A fisheye perspective using digital hemispherical photography from below the canopy

In recent years, digital repeat photography has received increasing attention as an inexpensive means by which seasonal changes in vegetation canopies can be monitored. Offering automation and an increased measurement frequency, colour indices derived from above-canopy digital repeat photography have proven a popular alternative to traditional observations of forest phenology. Nevertheless, previous work has demonstrated several features in time-series of colour indices that are unrelated to canopy structure, limiting their utility to track specific biophysical properties such as leaf area index (LAI). Whilst techniques such as digital cover photography and the use of radiometric sensors are better suited to this task, they are restricted by the need for careful calibration of above- and below-canopy reference sensors, ancillary information on canopy leaf angle distribution, and smaller measurement footprints. Using data collected at a deciduous broadleaf forest site in Southern England, we investigated a new method to derive continuous measurements of LAI, making use of automated digital hemispherical photography (DHP) from below the canopy. After applying simple data screening procedures, the LAI observations derived from our automated DHP system demonstrated very close agreement with those obtained from manually acquired DHP images, which were collected under optimal illumination conditions over the surrounding forest plot (r2 = 0.99, RMSE = 0.20, NRMSE = 13%). By combining our automated DHP system with an above-canopy time-lapse digital camera, we then investigated the relationship between the green chromatic coordinate (GCC) and LAI. Distinct hysteresis effects were observed, as were substantial differences between phenological transition dates derived from the GCC and LAI, particularly in the case of the onset of senescence. Our results indicate that phenological transition dates derived from colour indices cannot easily be linked to any one biophysical property. We recommend further investigation of the automated DHP approach, which provides time-series of LAI whose physical interpretation is straightforward, as an alternative to above-canopy digital repeat photography.

Ultra-high dimensional variable screening via Gram–Schmidt orthogonalization

Independence screening procedure plays a vital role in variable selection when the number of variables is massive. However, high dimensionality of the data may bring in many challenges, such as multicollinearity or high correlation (possibly spurious) between the covariates, which results in marginal correlation being unreliable as a measure of association between the covariates and the response. We propose a novel and simple screening procedure called Gram–Schmidt screening (GSS) by integrating the classical Gram–Schmidt orthogonalization and the sure independence screening technique, which takes into account high correlations between the covariates in a data-driven way. GSS could successfully discriminate between the relevant and the irrelevant variables to achieve a high true positive rate without including many irrelevant and redundant variables, which offers a new perspective for screening method when the covariates are highly correlated. The practical performance of GSS was shown by comparative simulation studies and analysis of two real datasets.

Papanicolaou smear: A diagnostic aid in sexually transmitted infections.

Background:Sexually transmitted infections (STIs) are a major public health problem in developing countries, and treatment with the right medicine at the right time is necessary to reduce transmission and improve sexual and reproductive health. Laboratory diagnosis has undergone changes in the recent years. The new generation tests are not cost-effective in resource-poor settings. Papanicolaou smear (Pap smear) of the cervix is a simple, quick, and inexpensive screening procedure for cervical cancer that can also give a clue to the presence of STIs.Methods:A hospital-based cross-sectional design with fifty patients was conducted studied. The initial diagnosis based on clinical findings and routine laboratory results was compared with the final diagnosis incorporating Pap smear results.Results:The Pap smear was abnormal in 96%, and the abnormalities were koilocytosis (30%), endocervicitis (24%), Trichomonas vaginalis (16%), multinucleated giant cells (10%), low-grade squamous intraepithelial lesion (10%), and clue cells (8%). Pap smear could diagnose an infection in 64%, of which 38% were asymptomatic. Clinical and Pap smear correlation was found only in 26% of the patients.Conclusion:Along with the conventional methods, Pap smear can be a valuable tool in diagnosing STIs. This can detect asymptomatic infections, not detected by conventional methods, thus preventing complications and further spread in the community. Asymptomatic human papillomavirus (HPV) infection and trichomoniasis are the two STIs that can be easily detected by Pap smear. By detecting asymptomatic cervical HPV infection, the patients at risk for carcinoma of the cervix can be identified and referred to gynecology department for further management.

Could a Simple Screening Procedure Identify Patients With Early Cognitive Impairment? Implications for the Treatment of Geriatric Femoral Neck Fractures

BackgroundCurrent evidence suggests that cognitive capacities in patients who sustain a femoral neck fracture (FNF) correlate to patient outcome. We hypothesized that a simple selection procedure with 2 questions: “Can you perform your groceries independently?” and “Can you prepare your daily medications unassisted?”, which imply a certain level of physical and cognitive function, could identify patients with early cognitive impairment and as a result influence the outcome of hip arthroplasty following an FNF. MethodsAt our clinic, the selection procedure was introduced in 2012 to simplify decision-making in geriatric FNF. At the time of surgery, patients received a total hip arthroplasty (THA) when able to perform their grocery shopping and prepare their daily medications unassisted (n = 100); otherwise, a hemiarthroplasty (HA) was performed (n = 100). Postoperative complications and mortality were assessed retrospectively. Second, we prospectively investigated whether patients’ inability to perform groceries or prepare medications was associated with the presence of early cognitive impairment, tested with the Consortium to Establish a Registry for Alzheimer’s Disease-Neuropsychological Assessment Battery. ResultsThe screening questions showed almost perfect agreement (k = 0.8; sensitivity/specificity: 82%/95%) to early cognitive impairment. The 30-day mortality for THA and HA patients was 2% and 4%, respectively. The 1-year and 5-year survivorship for the THA group was 95% and 87% and for the HA group 63% and 8%, respectively. Complication rates were comparable. ConclusionThe results might suggest that 2 simple screening questions could help in the decision-making of the appropriate surgical treatment in elderly patients suffering from a displaced FNF.

A parsimonious approach for screening moderate-to-profound hearing loss in a community-dwelling geriatric population based on a decision tree analysis

BackgroundHearing loss is one of the most common modifiable factors associated with cognitive and functional decline in geriatric populations. An accurate, easy-to-apply, and inexpensive hearing screening method is needed to detect hearing loss in community-dwelling elderly people, intervene early and reduce the negative consequences and burden of untreated hearing loss on individuals, families and society. However, available hearing screening tools do not adequately meet the need for large-scale geriatric hearing detection due to several barriers, including time, personnel training and equipment costs. This study aimed to propose an efficient method that could potentially satisfy this need.MethodsIn total, 1793 participants (≥60 years) were recruited to undertake a standard audiometric air conduction pure tone test at 4 frequencies (0.5–4 kHz). Audiometric data from one community were used to train the decision tree model and generate a pure tone screening rule to classify people with or without moderate or more serious hearing impairment. Audiometric data from another community were used to validate the tree model.ResultsIn the decision tree analysis, 2 kHz and 0.5 kHz were found to be the most important frequencies for hearing severity classification. The tree model suggested a simple two-step screening procedure in which a 42 dB HL tone at 2 kHz is presented first, followed by a 47 dB HL tone at 0.5 kHz, depending on the individual’s response to the first tone. This approach achieved an accuracy of 91.20% (91.92%), a sensitivity of 95.35% (93.50%) and a specificity of 86.85% (90.56%) in the training dataset (testing dataset).ConclusionsA simple two-step screening procedure using the two tones (2 kHz and 0.5 kHz) selected by the decision tree analysis can be applied to screen moderate-to-profound hearing loss in a community-based geriatric population in Shanghai. The decision tree analysis is useful in determining the optimal hearing screening criteria for local elderly populations. Implanting the pair of tones into a well-calibrated sound generator may create a simple, practical and time-efficient screening tool with high accuracy that is readily available at healthcare centers of all levels, thereby facilitating the initiation of extensive nationwide hearing screening in older adults.