Use Of Cutoffs Research Articles

Effect of United States Medical Licensing Examination Score Cutoffs on Recruitment of Underrepresented Applicants in the Urology Match

To determine how the use of United States Medical Licensing Examination (USMLE) score cutoffs during the screening process of the Urology Residency Match Program may affect recruitment of applicants who are underrepresented in medicine (URM). Deidentified data from the Association of American Medical Colleges' (AAMC) Electronic Residency Application Service (ERAS) system was reviewed, representing all applicants to our institution's urology residency program from 2018 to 2022. We analyzed self-reported demographic variables including race/ethnicity, age, sex/gender, as well as USMLE Step 1 and Step 2 scores. Chi-square tests and ANOVA were used to determine the association between race/ethnicity and other sociodemographic factors and academic metrics. Applicants were stratified according to USMLE Step 1 cutoff scores and the distribution of applicants by race/ethnicity was assessed using a Gaussian nonlinear regression fit. A total of 1258 applicants submitted applications to our program during the 5-year period, including 872 males (69.3%) and 386 females (30.7%). Most applicants were White (43.5%), followed by Asian (28.3%), Hispanic/Latino (11.7%), and Black (7.0%). There was an association between race/ethnicity and USMLE scores. Median USMLE Step 1 scores for White, Asian, Hispanic/Latino, and Black applicants were 242, 242, 237, and 232, respectively (P<.001). As cutoff score increases, percentage of URM applicants decreases. The use of cutoffs based on USMLE scores disproportionately affects URM applicants. Transitioning from numeric scores to pass/fail may enhance holistic review processes and increase the representation of URM applicants offered interviews at urology residency programs.

The Presence of Bulky Disease and/or Very High LDH Defines a High-Risk Subset of IPI 1-2 for Eligibility in Clinical Trials of Newly Diagnosed Aggressive B-Cell Lymphoma

Background: The goal of clinical trial eligibility criteria is to identify a population of patients that have high risk disease or have unmet needs with standard of care therapy. Frontline trials of diffuse large B-cell lymphoma (DLBCL) include patients with International Prognostic Index (IPI) scores of 3-5 as a way to identify a high risk population. Trials typically include patients with IPI score=2, and sometimes IPI score=1, to expand the eligible patient population. However, broader patient populations must be balanced by the potential inclusion of low-risk patients with excellent outcomes to standard of care therapy, leading to potentially underpowered trials. IPI is a sum of dichotomous variables which makes implementation easy but can result in heterogeneity in outcomes within IPI scores. This heterogeneity may be caused by unequal prognostic information across IPI variables, loss of information within IPI variables due to the use of cutoffs, as well as information captured by variables that are not included in the IPI. In prior modeling of outcomes in DLBCL (Maurer et al, AJH 2016), we identified that: i) LDH has a strong prognostic ability beyond the upper limit of normal (ULN) and ii) bulky disease is an independent variable for prognosis. Here we evaluate if the presence of either of these two variables, easily captured at diagnosis within the current standard clinical work-up, can identify a high-risk subset of patients within the population of those with IPI scores of 1-2. Methods: Patients with newly diagnosed lymphoma were enrolled within 6 months of diagnosis in the LEO Cohort at 8 academic medical centers from 2015-2020 and prospectively followed. Inclusion criteria for this analysis was aggressive B-cell lymphoma typically included in frontline trials (e.g. DLBCL, high grade B-cell lymphoma, FL3B), IPI 1-5, frontline therapy with rituximab and anthracycline-based chemotherapy, stage II-IV disease and ages 18-80 years. Event-free survival (EFS) was defined as the time from diagnosis until progression, initiation of 2 nd line therapy, or death due to any cause; EFS was evaluated at 24 months (EFS24). Very high LDH was defined as LDH&amp;gt;1.3xULN based on prior modeling (Maurer et al, AJH 2016) and bulky disease was defined as maximum tumor diameter (MTD) of 7cm or greater. IPI 1 and 2 were first evaluated separately and then combined due to similar outcomes in patients with very high LDH and/or bulky disease. High risk IPI1-2 was defined as the presence of either bulky disease and/or very high LDH within an IPI score of 1-2. Confirmation was performed in a similar cohort of patients enrolled in the Iowa/Mayo SPORE Molecular Epidemiology Resource (MER) from 2002-2015; bulky disease was defined using a 10cm cutoff per availability in MER data collection forms. Results: 1560 patients from LEO were analyzed; median age was 64 years (IQR: 54-71), 42% were female and 83% had stage III/IV disease; subtype was DLBCL, NOS in 1335 (86%). IPI was 1-2 in 766 patients, 3 in 496 patients and 4-5 in 298 patients ( table). 391 (51%) with IPI1-2 had either bulky disease and/or very high LDH (high risk IPI1-2) and 375 had low-risk IPI1-2. EFS24 in high risk IPI1-2 (71.6%, 95% CI: 67.2-76.3) was significantly inferior to IPI1-2 without bulky disease or very high LDH (85.2, 95% CI: 81.7-88.9 logrank p=0.0035, figure) and similar to patients with IPI3 (70.7%, 95% CI: 66.8-74.9). Consistent results were observed in 1014 patients analyzed in the MER using a higher cutoff for bulky disease (10cm) due to data availability ( table). Patients with high risk IPI1-2 had significantly shorter diagnosis to treatment interval (DTI) in both the LEO (per-week OR=0.83, 95% CI: 0.77-0.88) and MER (per-week OR=0.77, 95% CI: 0.68-0.87) cohorts compared to low risk IPI1-2, both p&amp;lt;0.0001). In sensitivity analysis, LEO results were similar when performed in the subset of patients with DLBCL, NOS. Conclusion: The presence of either bulky disease and/or very high LDH at presentation identifies a high-risk subset of patients with IPI 1-2 that have similar outcomes to patients with IPI 3 disease. These simple criteria can be easily implemented within existing clinical trial diagnostic work-ups. Future trial designs in frontline aggressive B-cell lymphoma should include patients with IPI 3-5 and patients with IPI 1-2 with either bulky disease and/or very high LDH to better define a high-risk population of patients for clinical trial eligibility.

USMLE Step 2 CK Scores and Radiology Residency Applications: Does it Affect Diversity in Selection of Trainees?

As residency programs in diagnostic radiology aspire to broaden trainee diversity, reliance on certain criteria may affect the selection of candidates from underrepresented groups. With the conversion of reporting of the United States Medical Licensing Examination (USMLE) Step 1 scores to pass/fail, programs may rely more on numerical USMLE Step 2 Clinical Knowledge (CK) scores. The purpose of our investigation is to assess the effects of Step 2 CK scores on the selection of underrepresented minority (URM) and female candidates. Applications from United States senior allopathic medical students to a radiology residency program from the 2021-2023 National Residency Matching Program cycles were analyzed. Subjects were classified as male or female and URM or non-URM by self-identification. Step 2 CK scores were compared and the use of cutoff scores was examined for disparate effects. 1017 subjects fulfilled the entry criteria. There were 721 males and 296 females, with 164 URM and 853 non-URM candidates. Comparing males to females, there was no significant difference in the mean score (p=0.21) and no disparate effects of cutoff scores. There was a significant difference between the mean score of URM versus non-URM candidates of eight points (p<0.00011). The use of cutoffs showed a disparate effect on URM candidates with a cutoff score of 250 (average score for 2022 matched applicants) excluding 71% of URM candidates while excluding only 46% of non-URM candidates. Reliance on USMLE Step 2 CK scores to screen applications for radiology residency can disadvantage URM candidates. Females are not adversely affected.

Self-reported health literacy and medication adherence in older adults: a systematic review

ObjectivesTo give an overview over the associations between self-reported health literacy and medication adherence in older adults.DesignA systematic literature review of quantitative studies published in English and German.Data sourcesMEDLINE via...

AGREE II appraisals of clinical practice guidelines in rehabilitation showed poor reporting and moderate variability in quality ratings when users apply different cuff-offs: a methodological study

ObjectivesTo analyze the reporting characteristics of Appraisal of Guidelines Research and Evaluation (AGREE) II appraisals in rehabilitation and explore how much quality ratings of Clinical Practice Guidelines (CPGs) vary applying different cut-offs. Study Design and SettingWe conducted a methodological study re-analyzing data of an overview of AGREE II CPG appraisals in rehabilitation. Reporting characteristics of appraisals and methods used for quality rating were abstracted. We applied the most frequent cut-offs retrieved on all CPG sample to explore changes in quality ratings (i.e., high/low). ResultsWe included 40 appraisals (n = 544 CPGs).The AGREE II overall assessment 1 (overall CPG quality) was reported in 26 appraisals (65%) and the overall assessment 2 (recommendation for use) in 17 (42.5%). Twenty-five appraisals (62.5%) reported the use of cut-offs based on domains and/or overall assessments. Application of the most reported cut-offs led to variability in quality ratings in 26% of the CPGs, of which 92% CPGs shifted their rating from low to high-quality and 8% shifted from high to low-quality. ConclusionRehabilitation stakeholders should take care to select the highest quality CPG in view of the poor reporting of AGREE II overall assessment 1 and 2 and moderate variability of quality ratings.

Cosmological constant and the use of cutoffs

Of the contributions to the cosmological constant, zero-point energy contributions scale as ${\ensuremath{\delta}}^{4}(0)\ensuremath{\sim}{\mathrm{\ensuremath{\Lambda}}}^{4}$ where $\mathrm{\ensuremath{\Lambda}}$ is an ultraviolet cutoff used to regulate the calculations. I show that such contributions vanish when calculated in perturbation theory. This demonstration uses a little-known modification to perturbation theory found by Honerkamp and Meetz and by Gerstein, Jackiw, Lee, and Weinberg which comes into play when using cutoffs and interactions with multiple derivatives, as found in chiral theories and gravity. In a path integral treatment, the new interaction arises from the path integral measure and cancels the ${\ensuremath{\delta}}^{4}(0)$ contributions. This reduces the sensitivity of the cosmological constant to the high energy cutoff, although it does not resolve the cosmological constant problem. The feature removes one of the common motivations for supersymmetry. It also calls into question some of the results of the asymptotic safety program. Covariance and quadratic cutoff dependence are also briefly discussed.

Quantifying landscape externalities of renewable energy development: Implications of attribute cut-offs in choice experiments

Renewable energy is worldwide seen as a key element necessary to address climate change. However, finding socially acceptable locations for renewable energy facilities and the accompanying infrastructure increasingly often faces fierce opposition. This paper quantifies the landscape externalities of renewable energies employing a choice experiment. In addition, it is investigated how accounting for non-compensatory choice behavior, i.e. attribute cut-offs, affects welfare measures and subsequently policy recommendations. The empirical application is Germany where we conducted a nationwide survey on the development of renewable energies. We first show that cut-off elicitation questions prior to the choice experiment at least partially influence preferences. We further find that most participants state cut-off levels for attributes. Many are, however, at the same time willing to violate the self-imposed thresholds when choosing among the alternatives. To account for this effect, stated cut-offs are incorporated into a mixed logit model following the soft cut-off approach. Model results indicate substantial taste heterogeneity in preferences and in the use of cutoffs. Also, welfare estimates are substantially affected. We conclude that welfare changes from renewable energy development could be strongly underestimated when cut-offs are ignored.

Antimicrobial resistance in ovine bacteria: A sheep in wolf's clothing?

BackgroundTo monitor the prevalence of antimicrobial resistance (AMR), methods for interpretation of susceptibility phenotypes of bacteria are needed. Reference limits to declare resistance are generally based on or dominated by data from human bacterial isolates and may not reflect clinical relevance or wild type (WT) populations in livestock or other hosts.MethodsWe compared the observed prevalence of AMR using standard and bespoke interpretations based on clinical breakpoints or epidemiological cut-offs (ECOFF) using gram positive (Staphylococcus aureus) and gram negative (Escherichia coli) bacteria from sheep as exemplars. Isolates were obtained from a cross-sectional study in three lowland sheep flocks in Scotland, and from a longitudinal study in one flock in Norway. S. aureus (n = 101) was predominantly isolated from milk or mammary glands whilst E. coli (n = 103) was mostly isolated from faecal samples. Disc diffusion testing was used to determine inhibition zone diameters, which were interpreted using either clinical breakpoints or ECOFF, which distinguish the bacterial wild type population from bacteria with acquired or mutational resistance to the compound of interest (non-wild type). Standard ECOFF values were considered as well as sheep-specific values calculated from the data using Normalized Resistance Interpretation (NRI) methodology.ResultsThe prevalence of AMR as measured based on clinical breakpoints was low, e.g. 4.0% for penicillin resistance in S. aureus. Estimation of AMR prevalence based on standard ECOFFs was hampered by lack of relevant reference values. In addition, standard ECOFFS, which are predominantly based on human data, bisected the normal distribution of inhibition zone diameters for several compounds in our analysis of sheep isolates. This contravenes recommendations for ECOFF setting based on NRI methodology and may lead to high apparent AMR prevalence. Using bespoke ECOFF values based on NRI, S. aureus showed non-wild type for less than 4% of isolates across 13 compounds, and ca. 13% non-wild type for amoxicillin and ampicillin, while E. coli showed non-wild type for less than 3% of isolates across 12 compounds, and ca. 13% non-wild type for tetracyclines and sulfamethoxazole-trimethoprim.ConclusionThe apparent prevalence of AMR in bacteria isolated from sheep is highly dependent on interpretation criteria. The sheep industry may want to establish bespoke cut-off values for AMR monitoring to avoid the use of cut-offs developed for other host species. The latter could lead to high apparent prevalence of resistance, including to critically important antimicrobial classes such as 4th generation cephalosporins and carbapenems, suggesting an AMR problem that may not actually exist.

Comparability of PD-L1 immunohistochemistry assays for non-small-cell lung cancer: a systematic review.

Programmed cell death ligand 1 (PD‐L1) immunohistochemistry is used to determine which patients with advanced non‐small‐cell lung cancer (NSCLC) respond best to treatment with PD‐L1 inhibitors. For each inhibitor, a unique immunohistochemical assay was developed. This systematic review gives an up‐to‐date insight into the comparability of standardised immunohistochemical assays and laboratory‐developed tests (LDTs), focusing specifically on tumour cell (TC) staining and scoring. A systematic search was performed identifying publications that assessed interassay, interobserver and/or interlaboratory concordance of PD‐L1 assays and LDTs in tissue of NSCLC patients. Of 4294 publications identified through the systematic search, 27 fulfilled the inclusion criteria and were of sufficient methodological quality. Studies assessing interassay concordance found high agreement between assays 22C3, 28‐8 and SP263 and properly validated LDTs, and lower concordance for comparisons involving SP142. A decrease in concordance, however, is seen with use of cut‐offs, which hampers interchangeability of PD‐L1 immunohistochemistry assays and LDTs. Studies assessing interobserver concordance found high agreement for all assays and LDTs, but lower agreement with use of a 1% cut‐off. This may be problematic in clinical practice, as discordance between pathologists at this cut‐off may result in some patients being denied valuable treatment options. Finally, five studies assessed interlaboratory concordance and found moderate to high agreement levels for various assays and LDTs. However, to assess the actual existence of interlaboratory variation in PD‐L1 testing and PD‐L1 positivity in clinical practice, studies using real‐world clinical pathology data are needed.

Utilization of the Caprini score in conjunction with thrombodynamic testing reduces the number of unpredicted postoperative venous thromboembolism events in patients with colorectal cancer

BackgroundThe thrombodynamic test (TD) is a novel global test of hemostasis that allows to study the spatial-temporal characteristics of a clot formation in real time under conditions close to natural ones and demonstrates high sensitivity to detect the state of hypercoagulation. The main paraments of the test are the velocity of clot growth, clot's size, and clot density. The objective of this study was to compare the classic Caprini 2005 score and its modified version in association with the results of TD. The goal is to predict postoperative venous thromboembolism (VTE) in surgical patients undergoing surgery for colorectal cancer. MethodsThis was a prospective observational clinical study involving 80 patients (33 men and 47 women; mean age, 73.9 ± 7.2 years) who underwent major (79 cases) or minor (1 case) surgery for colorectal cancer. Patients were at high risk for postoperative VTE (ie, a mean Caprini score of 9.9 ± 2.0) and received combined prophylaxis (ie, antiembolic compression stockings and enoxaparin 40 mg once daily) until discharge. Enoxaparin was administered at a fixed time of blood sampling for the TD test. Duplex ultrasound scan was performed to detect postoperative vein thrombosis before and 5 to 7 days after surgery. ResultsPostoperative vein thrombosis was found in 21 of 80 patients (26.3%; 95% confidence interval, 17.9%-36.8%). Regression analysis and receiver operating characteristic (ROC) curve showed that Caprini scores significantly predicted VTE (P < .0001; area under the curve [AUC] = 0.839 ± 0.045). Analysis of ROC curve coordinates showed that a cutoff point of 11 scores had a sensitivity of 76.2% and a specificity of 74.6%. The results of the TD test showed significant hypercoagulation despite enoxaparin administration in patients with VTE. Regression analysis and ROC curves demonstrated that the following TD parameters had the greatest predictability for postoperative DVT: initial velocity of clot growth (Vin) and clot size (CS) measured at 12 hours after enoxaparin administration (AUC, 0.697 ± 0.063 and AUC, 0.790 ± 0.059, respectively), as well as Vin and CS measured 24 hours after the enoxaparin injection (S = 0.847 ± 0.059 and S = 0.803 ± 0.069, respectively). The cutoff points for VTE prediction at 12 and 24 hours seemed to be a Vin of greater than 62.5 and greater than 64.5 μm/minute (normal range, 35-56 μm/minute) as well as a CS of greater than 1351.5 and greater than 1333.5 μm (normal range, 800-1200 μm), respectively. Identified thresholds for TD parameters have been integrated into Caprini scores under the item “other congenital or acquired thrombophilia.” The total Caprini scores were recalculated in patients where one or all TD parameters had exceeded the cutoff followed by reanalysis of the ROC curves. The best predictability was found for Caprini scores considering the elevation of all four TD parameters (AUC, 0.924 ± 0.029) with increased cutoff to a score of 12 with a sensitivity of 85.7% and a specificity of 81.4%. The use of cutoffs for the original and modified scores could be used to calculate the number of patients that were under cutoff but developed with VTE: 10.2% and 5.9%, respectively. ConclusionsIntegrating TD parameters into the Caprini score increases the ability to predict postoperative VTE.

The Effect of Cutoffs on the Uplift Pressure Beneath the Hydraulic Structures Floor

The use of cutoffs underneath the hydraulic structures is considered a safe solution to ensure the stability of hydraulic structure against uplift pressure and piping phenomenon in addition to the sliding and overturning forces of the water. These cutoffs are used at critical sections underneath the floor of hydraulic structure to substitute with their depths the horizontal lengths of the creep line of the hydraulic structure base. In this paper, the experimental method- by using electrical analogue model- was carried out to plot the flow net and study the efficiency of the front and rear faces of the cutoffs for dissipating the potential energy of the percolating water underneath the floor of hydraulic structure. An electrical analogue model which was used in this study consists of twenty five models with different depths of upstream and downstream cutoffs. After plotting the flow net for all models, it is concluded that the efficiency of the inner sides are less than that of the outer sides which were investigated before in this topic of this work that both faces reduction values in the uplift pressure are considered the same, where the efficiency of the outer face of upstream cutoff is (70.35) % and for the inner face is (29.64)%, while for the downstream cutoff the efficiency for the outer face is (76.21)% and for the inner face is (23.79)% .

Serum human epididymis protein 4 vs. carbohydrate antigen 125 in ovarian cancer follow-up

BackgroundThe addition of human epididymis protein 4 (HE4) to carbohydrate antigen 125 (CA125) in ovarian cancer (OC) assessment has been proposed. We compared the clinical value of biomarker changes in a prospective series of patients undergoing OC monitoring. MethodsWe studied 43 patients (79% post-menopausal), followed for 3.5 ± 3.1 years. Serous OC was prevalent (53.5%), with 81.4% of patients diagnosed at late stages. Both cut-offs and reference change values (RCV) were used for assessing significant marker changes. ResultsThe use of cut-offs for CA125 and HE4 interpretation appeared equally fitting the evaluation of disease progression defined according to running guidelines, performing better than RCV criterion. However, both markers were simultaneously over cut-offs only in 46% of samples and changed in agreement in 35% of cases. The inspection of individual longitudinal trends indicated as main causes of disagreement the influence of renal impairment on HE4 concentrations and the more significant rate of decrease of CA125 vs. HE4 concentrations early after treatment. CA125 and HE4 changes according to RCV were not predictive of OC progression. ConclusionsCA125 appears the most reliable biomarker for OC monitoring, whereas HE4 contributes additional information only in a minority of cases.

Retrospective cytological evaluation of indeterminate thyroid nodules according to the British Thyroid Association 2014 classification and comparison of clinical evaluation and outcomes.

The cytology of 130 indeterminate nodules (Thy 3) was retrospectively reviewed according to the British Thyroid Association 2014 classification. Nodules were divided into Thy 3a (atypical features) and Thy 3f (follicular lesion) categories. Histology was available as a reference for 97 nodules. Pre-surgical evaluations comprised biochemical tests, color-Doppler ultrasonography (US), semi-quantitative elastography-US (USE), contrast-enhanced US (CEUS), and mutation analysis from cytological slides. Thyroid malignancy was the final diagnosis for 19% of surgically-treated nodules. No statistically significant difference in the risk of malignancy was found between Thy 3a (26%) and Thy 3f (14%) nodules. Histology of the Thy 3a and Thy 3f nodules showed a higher incidence of Hurtle cell adenomas in Thy 3f (29%) than in Thy 3a (3%) nodules (P=0.01). The only pre-surgical difference concerned the BRAF V600E mutation, which was positive in some Thy 3a but not in any Thy 3f nodules (P=0.04). Receiver-operating characteristic (ROC) analysis was used to obtain cut-off values from US (score), USE (ELX 2/1 strain index), and CEUS (time-to-peak index and peak index) data. The cut-off values were similar for Thy 3a and Thy 3f nodules. Data showed that malignancy can be suspected if the US score is >2, ELX 1/2 strain index >1, time-to-peak index >1, and peak index <1. In a sub-group of 24 revised nodules (12 Thy 3a and 12 Thy 3f) with histology as a reference, the diagnostic power of cumulative pre-surgical analysis by means of US, USE, and CEUS showed high positive and negative predictive values (83% and 100%, respectively) for the presence of malignancy in Thy 3a and Thy 3f nodules. In conclusion, in our series of revised Thy 3 nodules, malignancy was low and displayed no significant differences between Thy 3a and Thy 3f categories. The use of cut-offs based on histology as a reference could reduce surgery. Our data support the conviction that, in mutation-negative Thy 3a and Thy 3f nodules, observation should be the first choice when not all instrumental results are suspect.

Electrochemical Battery Testing Methods Designed for Safety and Efficiency in a Research Laboratory

Electrochemical battery testing is performed under either potentiostatic or galvanostatic control and often results in the need to manage potentials on the order of tens of volts and currents higher than one ampere. The specifications of commercial potentiostat / galvanostat instruments (PGSTATS) vary according to the intended application. Some instruments are specifically designed for battery testing and handle high-power applications routinely. Other instrumentations are designed for broad application within an electrochemical research laboratory setting and may have standard specifications that just meet, or even fall short of, the needs for electrochemical battery testing. This contribution outlines some strategies to carry out popular electrochemical battery testing experiments safely and efficiently with an instrument intended for general laboratory purposes, such as the Metrohm Autolab PGSTAT302N, by using a few additional accessories and the Nova 2 electrochemical software package. Characterization of lithium-ion (Li-ion) batteries typically involves galvanostatic charge and discharge over multiple cycles. A current booster is used to extend the usable current range of the PGSTAT from 2 amperes to 20 amperes. Nickel metal hydride batteries (NiMH) are also routinely characterized via charge and discharge cycling. Although a single NiMH battery may have a nominal voltage of 1.2 volts, these batteries are usually available in packs with multiple single cells. When characterizing a pack of batteries the total voltage can reach values greater than 10 volts, however the measureable potential range for the PGSTAT302N is ± 10 V. This contribution demonstrates how the potential range may be extended to ± 30 volt using a voltage multiplier, so that the instrument can be used for potentiostatic charge and discharge measurements on NiMH battery packs. The galvanostatic and potentiostatic intermittent titration techniques (GITT and PITT) are popular methods applied to the characterization of Li-ion battery systems to determine the diffusion coefficient of lithium ions in the electrode active material. Herein, the GITT and PITT methods are demonstrated as applied to the characterization of a Li-ion battery with a nominal voltage of 3.75 volts. In this example, the current booster and voltage multiplier are not necessary. Since battery testing applications may take a general purpose PGSTAT to the upper limit of its intended specifications, the safety of the researcher and the instrument must be considered in the experiment design. The potential and current limitations of the instrument are related to its power management capabilities. Exceeding the specifications can lead to permanent damage of the equipment, or subtle drifts in the measurement that result in unreliable data, depending on the magnitude of the overload. In addition, working outside of the battery’s own specifications could lead to heating, expansion, and possible explosion of the specimen, this being an unacceptable risk for the researcher. To this end, it is recommended to implement cutoffs on the maximum current, potential, and / or power associated with the electrochemical measurement. Such cutoffs are simple to program in the Nova 2 software. In this contribution, the use of cutoffs for safety and convenience is highlighted for the above-mentioned examples (charge / discharge, GITT, and PITT).

A Model-Based Approach to Identify Classes and Respective Cutoffs of the Brazilian Household Food Insecurity Measurement Scale

Background: The Brazilian Household Food Insecurity Measurement Scale (EBIA) is the main tool for assessing household food insecurity (FI) in Brazil, assisting in monitoring and improving national public policies to promote food security. Based on the sum of item scores, households have been classified into 4 levels of FI, with the use of cutoffs arising from expert discussions informed by psychometric analyses and policy considerations.Objectives: This study aimed to identify homogeneous latent groups corresponding to levels of FI, examine whether such subgroups could be defined from discriminant cutoffs applied to the overall EBIA raw score, and compare these cutoffs against those currently used.Methods: A cross-sectional population-based study with a representative sample of 1105 households from a low-income metropolitan area of Rio de Janeiro was conducted. Latent class factor analysis (LCFA) models were applied to the answers to EBIA’s items to identify homogeneous groups, obtaining the number of latent classes for FI measured by the scale. Based on this and a thorough classification agreement evaluation, optimal cutoffs for discriminating between different severity levels of FI were ascertained. Model-based grouping and the official EBIA classification cutoffs were also contrasted.Results: LCFA identified 4 homogeneous groups with a very high degree of class separation (entropy = 0.906), endorsing the classification of EBIA as a 4-level measure of FI. Two sets of cutoffs were identified to separate such groups according to household type: 1/2, 5/6, and 10/11 in households with children and adolescents (score range: 0–14); and 1/2, 3/4, and 5/6 in adult-only households (score range: 0–7).Conclusion: Although roughly classifying EBIA as in previous studies, the current approach suggests that, in terms of raw score, households endorsing only one item of the scale would be better classified by being placed in the same stratum as those remaining negative on all items.

Contemporary celiac disease diagnosis: is a biopsy avoidable?

The duodenal biopsy is the gold standard for the diagnosis of celiac disease. However, given improvements in the performance of serological testing, the possibility of accurately diagnosing celiac disease without the need of a biopsy has attracted interest. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition has revised its recommendations to include a diagnostic algorithm that includes sequential serological testing and human leukocyte antigen genotyping for symptomatic children which would enable a diagnosis of celiac disease to be made in the absence of a confirmatory intestinal biopsy. Recent studies have evaluated the ESPGHAN guidelines and have mostly corroborated that celiac disease can be accurately diagnosed in specific pediatric patient populations without the need of a biopsy. However, two cautionary points have been raised that warrant further consideration - the success of this approach is highly dependent targeting a population with a high pretest probability of celiac disease, as well, the performance of serology assays must be established and the appropriate use of cutoffs is essential. The duodenal biopsy will remain the gold standard for diagnosing celiac disease in a majority of patients. However, as serology assays evolve and as a greater understanding of the genetic risk factors of celiac disease is achieved, more patients may be accurately diagnosed without the need for a biopsy.

Attenuating type 2 diabetes with postpartum interventions following gestational diabetes mellitus.

Women with a history of gestational diabetes should be screened during and after the postpartum period because of a high risk for developing type 2 diabetes mellitus. Although differences exist between guidelines practiced throughout various parts of the world, all recommend the use of cutoffs for fasting and/or post-load plasma glucose to diagnose diabetes or pre-diabetes. The use of these glycemic parameters could be optimized when a trend is observed, rather than considering them as isolated values at various time points. As the presence of insulin resistance and beta-cell dysfunction start before glycemic changes are evident, the estimation of insulin sensitivity and beta-cell function by Homeostatic Model Assessment is suggested for women who have additional risk factors for diabetes, such as obesity. Disease-modifying lifestyle intervention should be the first-line strategy to prevent or delay the onset of diabetes in women with a history of gestational diabetes mellitus. Intensive lifestyle interventions are designed to decrease caloric intake and increase physical activity in order to reduce body weight and fat, which will in turn reduce insulin resistance. This article also reviews unique problems of postpartum women, which should be considered when designing and implementing an intervention. Innovative "out of the box" thinking is appreciated, as continued adherence to a program is a challenge to both the women and the health care personnel who deal with them.

Measurements of plasma metanephrines by immunoassay vs liquid chromatography with tandem mass spectrometry for diagnosis of pheochromocytoma.

Reports conflict concerning measurements of plasma metanephrines (MNs) for diagnosis of pheochromocytomas/paragangliomas (PPGLs) by immunoassays compared with other methods. We aimed to compare the performance of a commercially available enzyme-linked immunoassay (EIA) kit with liquid chromatography-tandem mass spectrometric (LC-MS/MS) measurements of MNs to diagnose PPGLs. In a substudy of a prospective, multicenter trial to study the biochemical profiles of monoamine-producing tumors, we included 341 patients (174 males and 167 females) with suspected PPGLs (median age 54 years), of whom 54 had confirmed PPGLs. Plasma MNs were measured by EIA and LC-MS/MS, each in a specialized laboratory. Plasma normetanephrine (NMN) and MN were measured 60 and 39% lower by EIA than by LC-MS/MS. Using upper cut-offs stipulated for the EIA, diagnostic sensitivity was only 74.1% at a specificity of 99.3%. In contrast, use of similar cut-offs for MN and overall lower age-adjusted cut-offs for NMN measured by LC-MS/MS returned a diagnostic sensitivity and specificity of 98.1 and 99.7%. Areas under receiver-operating characteristic curves, nevertheless, indicated comparable diagnostic performance of the EIA (0.993) and LC-MS/MS (0.985). Diagnostic sensitivity for the EIA increased to 96.2% with a minimal loss in specificity (95.1%) following use of cut-offs for the EIA adapted to correct for the negative bias. The EIA underestimates plasma MNs and diagnostic sensitivity is poor using commonly stipulated cut-offs, resulting in a high risk for missing patients with PPGLs. Correction of this shortcoming can be achieved by appropriately determined cut-offs resulting in comparable diagnostic performance of EIA and LC-MS/MS assays.

Thin Beds and Cutoffs: Improved Assessment and Modeling of Net Porous Volume

This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 166045, ’Thin Beds and Cutoffs: A Probabilistic Approach for an Improved Assessment and Modeling of the Net Porous Volume,’ by J. Clavel and P. Ruelland, Total, prepared for the 2013 SPE Reservoir Characterisation and Simulation Conference and Exhibition, Abu Dhabi, 16-18 September. The paper has not been peer reviewed. Applying a cutoff consists of defining a threshold value on one or more logs to separate the reservoir intervals in which hydrocarbons are mobile from the gross rock thickness. In a thin-bed context, this deterministic approach is insufficient because of the resolution of the logs and a limited number of data. The probabilistic approach proposed in this paper considers that the relationship between the cutoff value on the selected log and hydrocarbon mobility in the sandy laminae is a statistical function. Introduction Cutoffs in petrophysics are frequently applied in the oil and gas industry. Previous work has shown the benefits that result from their use, in particular the decrease in the biases related to the upscaling of petrophysical properties, as well as the usual disadvantages of using cutoffs (i.e., the possible decrease of volume-in-place calculations and connectivity). The overall increase in computer power and cellsize reduction in cellular models, as well as the improvement in upscaling methodologies, render the use of cutoffs less crucial for massive sandstone facies. The objective of this paper is to propose a probabilistic approach to cutoffs in order to improve the coherency and quality of 3D cellular models. Thin Beds and Cutoffs Thin beds are a common occurrence in turbiditic, deltaic, and tidal series. They consist of alternating sand and clay layers that have a thickness of less than 50 cm. Outside these layer thickness, sand and clay are well-distinguished on classic logs and are not considered to be thin beds. Thin-bed facies are heterogeneous, and sampling by wells is insufficient to obtain a representative set of calibration and data; thin beds are undersampled. At the scale of the core, the variability of sand proportion and of lamina thickness in thin beds is clearly observed. The usual work flow to carry information from core to log and then to gridcell size includes two scale jumps. The synthesis of sedimentological core characterization and image logs into a high-resolution petrophysical log is used to calibrate the quantitative interpretation of wireline/logging-while-drilling logs. Petrophysical data that result from this interpretation then need to be upscaled per facies (or rock type) to the cell size of the 3D reservoir model. Applying a cutoff consists of defining a threshold value on permeability or other logs that will define reservoir intervals in which hydrocarbons are mobile. Byproducts of a cutoff include net height and net-to-gross (NTG) ratio, the ratio of net height to total height. The examples in this paper are all extracted from turbidite environments with a shallow burial where cutoffs on the log of volume of clay (VCL) are the best indicator. Cutoffs are applied at log scale on one or more petrophysical parameters in order to take a phenomenon into account: fluid mobility at the scale of the lamination. The relationship between VCL and fluid mobility is statistical. The cutoff is then consolidated at the scale of one or more fields, taking into account fluid types and production mechanism; this operation also relies on statistics. Well sampling in the laminated facies is often insufficient to capture heterogeneity at these different scales. Net height, computed through cutoffs, is very sensitive to small variations in parameters such as cutoff value and VCL-log and lithology variations at small scale. This explains the limitations of a deterministic cutoff in thin beds. When considering a cellular model and the way the log information is upscaled to the cell size, the limitations of a deterministic cutoff are even greater.

Effects of neck coordination exercise on sensorimotor function in chronic neck pain: a randomized controlled trial.

To evaluate the effect of neck coordination exercise on sensorimotor function in women with neck pain compared with best-available treatment and sham treatment. Observer-blinded randomized controlled trial with short-term and 6-month follow-ups. Women with chronic non-specific neck pain were randomized to 3 groups: neck coordination exercise with a novel training device; strength training for the neck and shoulders; or massage. Each group had 36 participants. The intervention period was 11 weeks with 22 individually supervised sessions. Primary outcomes were postural sway measures and precision of goal-directed arm movements. Secondary outcomes were range of motion for the neck, peak speed of axial rotation, and neck pain. A repeated measures multivariate analysis of variance (MANOVA) was conducted separately on the primary outcomes for the short-term and 6-month evaluations and on the sensorimotor secondary outcomes for the 6-month effect. The 6-month effect on pain was analysed with a repeated measures analysis of variance (ANOVA). No significant treatment effects in favour of neck coordination exercise were found for short-term or 6-month evaluations. Neck coordination exercise is no better than strength training and massage in improving sensorimotor function. Further research should investigate the use of cut-offs for sensorimotor dysfunctions prior to proprioceptive or coordinative training.