Three optimal cut-point selection criteria based on sensitivity and specificity with user-defined weights

2018 ◽  
Vol 48 (3) ◽  
pp. 742-754
Author(s):  
Dan-Ling Li ◽  
Jun-Xiang Peng ◽  
Chong-Yang Duan ◽  
Ju-Min Deng
Keyword(s):  
Sensitivity And Specificity ◽  
Selection Criteria ◽  
Point Selection ◽  
Cut Point

scholarly journals Relation of Airway Responsiveness to Methacholine to Parent and Child Reporting of Symptoms Suggecting Asthma

1996 ◽  
Vol 3 (2) ◽  
pp. 115-123 ◽  
Author(s):  
JM FitzGerald ◽  
DE Fester ◽  
MM Morris ◽  
M Schulzer ◽  
FE Hargreave ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Airway Hyperresponsiveness ◽  
Respiratory Symptoms ◽  
Respiratory Illness ◽  
Airway Responsiveness ◽  
Methacholine Challenge ◽  
Cut Point ◽  
The Past ◽  
History Of

BACKGROUND:The lack of a relationship between airway responsiveness and respiratory symptoms in epidemiological studies of children may, in part, reflect inaccuracies in symptom reporting or inadequate knowledge by the parent of the child's symptoms.OBJECTIVE:To relate airway responsiveness to methacholine in children with symptoms of respiratory illness in the child as reported by the parent and as reported by the child.POPULATION:Eight- to 10-year-old (n=290) randomly sampled schoolchildren.SETTING:Seven randomly selected schools in Ontario.METHODS:Parents completed a mailed questionnaire regarding the child's respiratory health. Children completed a similar interview-administered questionnaire at school and underwent methacholine challenge testing by the tidal breathing method.RESULTS:The cumulative prevalence of a history of physician-diagnosed asthma was 9.0%, and of any wheezing it was 25.5%. A further 9% of children reported wheezing not documented by their parent. Of 229 children consenting to methacholine challenge, 78 (34.1%) showed airway responsiveness in the range generally associated with asthma in adults (provocation concentration of methacholine causing a 20% fall [PC20] in forced expired volume in 1 s [FEV1] 8 mg/mL or less); half of these children had no history of respiratory symptoms reported by the parent. The sensitivity of airway hyperresponsiveness defined by a cut-point for PC208 mg/mL or less in relation to any history of recurrent wheezing reported by the parent was 48% and did not improve if only symptoms within the past year were considered (sensitivity 44%); the specificity of the test for parent-reported symptoms ever was 71%, and 68% in those with symptoms in the past year. None of these sensitivities or specificities was increased by using symptoms reported by the child or by combining parent and child reported symptoms. Receiver operating characteristic (ROC) curves for sensitivity and specificity of the methacholine test were constructed for parent and child reports of symptoms. For all symptom strata, the cut-point of PC20producing optimal balance of sensitivity and specificity was between 4 and 8 mg/mL. A parental questionnaire positive for physician-diagnosed asthma was strongly related to methacholine response, producing an ROC curve with an area significantly different from 0.5 (P=0.006), as did all parent-reported wheezing (P=0.009). If the child reported asthma, there was an equally strong relationship, with a positive ROC curve (P=0.001), as there was for all child-reported wheezing (P=0.048).CONCLUSIONS:Airway hyperresponsiveness to methacholine in children relates closely with asthma and wheezing reported by either the parent or the child. In addition, the results confirm that respiratory symptoms and airway hyperresponsiveness are common in Canadian children, and that airway hyperresponsiveness may be found in children with no history of respiratory illness either at present or in the past.

scholarly journals Utility of Glycated Hemoglobin in Diagnosing Type 2 Diabetes Mellitus: A Community-Based Study

2010 ◽  
Vol 95 (6) ◽  
pp. 2832-2835 ◽  
Author(s):  
Padala Ravi Kumar ◽  
Anil Bhansali ◽  
Muthuswamy Ravikiran ◽  
Shobhit Bhansali ◽  
Pinaki Dutta ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diagnostic Test ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Hba1c Level ◽  
Glycated Hemoglobin ◽  
World Health ◽  
Oral Glucose ◽  
Community Based ◽  
Cut Point

Abstract Context: Although glycated hemoglobin (HbA1c) has recently been incorporated as a diagnostic test by the American Diabetes Association, its validity needs to be established in Asian Indians in a community setting. Objective: The objective of the study was to assess the validity of HbA1c as a screening and diagnostic test in individuals with newly detected diabetes mellitus. Design and Setting: Community based randomized cross sectional study in urban Chandigarh, a city in north India, from April 2008 to August 2009. Subjects: Subjects included 1972 subjects aged 20 yr or older. Intervention: Intervention included an oral glucose tolerance test and glycated hemoglobin in all the subjects. Main Outcome Measures: Utility of HbA1c as a diagnostic method in newly detected diabetes mellitus subjects was evaluated. Results: Using World Health Organization criteria for diagnosis of diabetes mellitus, 134 (6.7%) had newly detected diabetes mellitus, 192 (9.7%) known diabetes mellitus, 329 (16.6%) prediabetes, and 1317 (69.4%) were normal of 1972 people screened. Using only the ADA criteria, 38% people were underdiagnosed. An HbA1c level of 6.1% had an optimal sensitivity and specificity of 81% for diagnosing diabetes. A HbA1c level of 6.5% (±2 sd) and 7% (±2.7 sd) had sensitivity and specificity of 65 and 88% and 42 and 92%, respectively, with corresponding positive predictive value and negative predictive value of 75.2 and 96.5% and 90.4and 94.4%, respectively, for diagnosis of newly detected diabetes mellitus. Conclusion: A HbA1c cut point of 6.1% has an optimal sensitivity and specificity of 81% and can be used as a screening test, and a cut point of 6.5% has optimal specificity of 88% for diagnosis of diabetes.

scholarly journals Walking Speed Threshold for Classifying Walking Independence in Hospitalized Older Adults

2010 ◽  
Vol 90 (11) ◽  
pp. 1591-1597 ◽  
Author(s):  
James E. Graham ◽  
Steve R. Fisher ◽  
Ivonne-Marie Bergés ◽  
Yong-Fang Kuo ◽  
Glenn V. Ostir
Keyword(s):  
Older Adults ◽  
Sensitivity And Specificity ◽  
Walking Speed ◽  
Community Dwelling ◽  
Community Based ◽  
Convenience Sample ◽  
Cut Point ◽  
Risk Threshold ◽  
Risk Thresholds ◽  
Hospitalized Older Adults

Background Walking speed norms and several risk thresholds for poor health outcomes have been published for community-dwelling older adults. It is unclear whether these values apply to hospitalized older adults. Objective The purpose of this study was to determine the in-hospital walking speed threshold that best differentiates walking-independent from walking-dependent older adults. Design This was a cross-sectional study. Methods This study recruited a convenience sample of 174 ambulatory adults aged 65 years and older who had been admitted to a medical-surgical unit of a university hospital. The participants' mean (SD) age was 75 (7) years. Fifty-nine percent were women, 66% were white, and more than 40% were hospitalized for cardiovascular problems. Usual-pace walking speed was assessed over 2.4 m. Walking independence was assessed through self-report. Several methods were used to determine the threshold speed that best differentiated walking-independent patients from walking-dependent patients. Approaches included a receiver operating characteristic (ROC) curve, sensitivity and specificity, and frequency distributions. Results The participants' mean (SD) walking speed was 0.43 (0.23) m/s, and 62% reported walking independence. Nearly 75% of the patients walked more slowly than the lowest community-based risk threshold, yet 90% were discharged home. Overall, cut-point analyses suggested that 0.30 to 0.35 m/s may be a meaningful threshold for maintaining in-hospital walking independence. For simplicity of clinical application, 0.35 m/s was chosen as the optimal cut point for the sample. This threshold yielded a balance between sensitivity and specificity (71% for both). Limitations The limitations of this study were the small size of the convenience sample and the single health outcome measure. Conclusions Walking speeds of older adults who are acutely ill are substantially slower than established community-based norms and risk thresholds. The threshold identified, which was approximately 50% lower than the lowest published community-based risk threshold, may serve as an initial risk threshold or target value for maintaining in-hospital walking independence.

scholarly journals Validation of the short Mood and Feelings Questionnaire in young adulthood

2021 ◽  
Author(s):  
Olga Eyre ◽  
Rhys Bevan Jones ◽  
Sharifah Shameem Agha ◽  
Robyn E Wootton ◽  
Ajay K Thapar ◽  
...  
Keyword(s):  
Young Adults ◽  
Sensitivity And Specificity ◽  
Young Adulthood ◽  
Early Adulthood ◽  
Well Being ◽  
The Self ◽  
Depression Symptoms ◽  
Cut Points ◽  
Cut Point ◽  
Dsm 5

AbstractBackgroundDepression often onsets in adolescence and is associated with recurrence in adulthood. There is a need to identify and monitor depression symptoms across adolescence and into young adulthood. The short Mood and Feelings Questionnaire (sMFQ) is commonly used to measure depression symptoms in adolescence but has yet to be validated in young adulthood. This study aimed to (1) examine whether the sMFQ is a valid assessment of depression in young adults, and (2) identify cut-points that best capture a DSM-5 diagnosis of depression at age 25.MethodsThe sample included young people who took part in the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 25 (n=4098). Receiver Operating Characteristic analyses were used to examine how well the self-rated sMFQ discriminates between cases and non-cases of DSM-5 Major Depressive Disorder (MDD) classified using the self-rated Development and Well Being Assessment. Sensitivity and specificity values were used to identify cut-points on the sMFQ.ResultsThe sMFQ had high accuracy for discriminating MDD cases from non-cases at age 25. The commonly used cut-point in adolescence (≥12) performed well at this age, best balancing sensitivity and specificity. However, a lower cut-point (≥10) may be appropriate in some contexts, e.g. for screening, when sensitivity is favoured over specificity.LimitationsALSPAC is a longitudinal population cohort that suffers from non-random attrition.ConclusionsThe sMFQ is a valid measure of depression in young adults in the general population. It can be used to screen for and monitor depression across adolescence and early adulthood.

scholarly journals Cutpoint-free accelerometer metrics to assess children’s physical activity: an example using the school day

2019 ◽  
Author(s):  
Stuart J. Fairclough ◽  
sarah taylor ◽  
Alex Rowlands ◽  
Lynne M. Boddy
Keyword(s):  
Physical Activity ◽  
Sensitivity And Specificity ◽  
Linear Models ◽  
Vigorous Physical Activity ◽  
Health Indicators ◽  
Primary School Children ◽  
Brisk Walking ◽  
Mixed Linear Models ◽  
Cut Point ◽  
School Day

Purpose:The purpose of this study was to use a novel accelerometer metric, the minimum acceleration value above which the most active accumulated x-min are accumulated, and to apply it to data collected in primary school children to explore its utility for reporting the most active 30-min during the school day. The aims were to (i) investigate associations between the most active 30-min during the school day (M30ACC) metric and health indicators, and (ii) demonstrate that applying an equivalent cut-point to the M30ACC metric will give similar, and therefore comparable prevalence results as a traditional moderate-to-vigorous physical activity (MVPA) cut-point approach.Methods:Data were available for 297 children (156 girls; age 10 years) who wore wrist-mounted accelerometers for 7-days. School day MVPA and the minimum acceleration value above which the most active 30-min were accumulated during school (M30ACC) were calculated. Body mass index (BMI), waist-to-height ratio (WHtR), and cardiorespiratory fitness (CRF) (number of 20-m shuttle run test (SRT) laps) were also measured. Mixed linear models investigated associations between M30ACC and health indicators. Agreement between ranked MVPA and M30ACC values was assessed using percent agreement, kappa, sensitivity, and specificity statistics. Results:The mean M30ACC value was 242.7 (99.3) mg, and mean school day MVPA was 34.3 (14.8) min. M30ACC thresholds related to health indicators were 213 mg (BMI), 206 mg (WHtR), and 269 mg (CRF) for girls. The equivalent values for boys were 234mg (BMI), 230 mg (WHtR), and 327 mg (CRF). The 30 min school day MVPA guideline averaged for the week and on every valid day was achieved by 54.9% and 24.9% of the sample, respectively. 63.0% of the participants achieved the equivalent M30ACC threshold averaged for the week, and 20.2% achieved it on every valid day of the week. Less than half of girls and 75% of boys accumulated 30 min of school day MVPA. Just less than 50% of girls and >80% of boys had M30ACC values ≥200 mg, which is equivalent to brisk walking. Agreement between MVPA and M30ACC tertiles was high, reflected by the agreement (89.2% to 94.6%), Kappa scores (0.76 to 0.86), and values for sensitivity and specificity, which exceeded 90%.Conclusions:The results demonstrate the utility of M30ACC as a PA metric that is based on measured accelerations and is not heavily influenced by researcher decisions. M30ACC has potential as an accelerometer-specific metric for generating PA guidelines related to health indicators, and easily understood forms of activity, such as brisk walking.

The utility of DR-70, a novel blood biomarker, in the early detection of lung cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e17521-e17521
Author(s):  
Afsaneh Motamed-Khorasani ◽  
Hooman Etemadi
Keyword(s):  
Lung Cancer ◽  
Early Detection ◽  
Sensitivity And Specificity ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Small Cell Lung ◽  
Lung Cancers ◽  
X Ray ◽  
Cut Point ◽  
Chest X Ray

e17521 Background: Lung cancer accounts for the largest percentage of cancer in adults in North America. Non-small cell lung cancer (NSCLC) accounts for 85-90% of all lung cancers with a death rate of 85%. Early diagnosis is the only chance of a cure when surgery or chemo-radiotherapy can be performed. Chest X-ray is the routine first diagnostic step but is not confirmatory. The purpose of this study was to further validate DR-70 utility in lung cancer early detection considering the relatively high sensitivity of this test. Onko-Sure is a regulatory approved blood test for detection/monitoring of lung cancer treatment/recurrence. It measures the accumulation of fibrin/fibrinogen degradation products in the serum using anti-DR-70 antibody. Methods: A total of 239 serum samples were retrospectively obtained from a serum bank and were tested with DR-70. There were two arms: healthy controls (n= 120) and biopsy-confirmed lung cancers (n= 119) including: small cell lung cancer (SCLC) (n=7) and NSCLC (n=112). The NSCLC included adenocarcinoma (n=65), squamous carcinoma (n=37), large cell lung cancer (n=4) and others (n=6). The data were analyzed to find the optimal cut point, sensitivity and specificity of DR-70. Results: The sensitivity and specificity of 63% and 87.5% were achieved, respectively (cut-point of 1.2 ug/ml). For SCLC, the sensitivity and specificity of 57.1% and 82.5% were achieved (cut-point: 1.1 ug/ml). For NSCLC, the sensitivity and specificity of 65.2% and 87.5% were achieved (cut-point: 1.2 ug/ml). Among the subcategories of NSCLC, DR-70 showed the highest sensitivity for acinar cell carcinoma (81.8%). Furthermore, DR-70 showed sensitivity of 59.5%, 70.4, 66.7 and 70% for stages I, II, III, and IV. Conclusions: Chest X-Ray is the routine first step in lung cancer detection with the sensitivity of 78.3%. It is not confirmatory and it can miss lesions smaller than 1 cm. These findings are promising and highlight DR-70 test as an additional first line diagnostic tool that can potentially replace X-ray to increase the diagnosis sensitivity as early as stage I. An enhanced ability to diagnose NSCLC in an early stage (I/II) should significantly improve prognosis, treatment options and survival rate for patients with lung cancer.

scholarly journals Diagnostic Accuracy of Blood Lactate-to-Pyruvate Molar Ratio in the Differential Diagnosis of Congenital Lactic Acidosis

2007 ◽  
Vol 53 (5) ◽  
pp. 916-921 ◽  
Author(s):  
François-Guillaume Debray ◽  
Grant A Mitchell ◽  
Pierre Allard ◽  
Brian H Robinson ◽  
James A Hanley ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Diagnostic Accuracy ◽  
Blood Lactate ◽  
Sensitivity And Specificity ◽  
Pyruvate Dehydrogenase ◽  
Tertiary Care ◽  
Mitochondrial Diseases ◽  
Positive Association ◽  
Molar Ratio ◽  
Cut Point

Abstract Background: Although the blood lactate-to-pyruvate (L:P) molar ratio is used to distinguish between pyruvate dehydrogenase deficiency (PDH-D) and other causes of congenital lactic acidosis (CLA), its diagnostic accuracy for differentiating between these 2 types of CLA has not been evaluated formally. Methods: We conducted a retrospective study of all patients followed for mitochondrial diseases between 1985 and 2005 in a tertiary care pediatric hospital. Results: At the recommended cut point of ∼25, individual median L:P ratio demonstrated low sensitivity and specificity (77% and 91%, respectively) for differentiating between patients with enzymatically proven PDH-D (n = 11) and those with mitochondrial disease but normal pyruvate dehydrogenase (PDH) activity (non-PDH; n = 35). We observed a strong positive association between L:P ratio and blood lactate in non-PDH CLA, whereas this association was weak in PDH-D CLA. Consequently, patient classification based on median L:P ratio showed improved diagnostic accuracy at higher lactate concentrations: for lactate <2.5 mmol/L the area under the ROC curve was not statistically different from 0.5 (P = 0.3), whereas it was statistically different for lactate >2.5 mmol/L. In the 2.5 to 5.0 mmol/L lactate category, the sensitivity and specificity at an optimal cut point of 18.4 were 93% (95% CI, 77%–99%) and 71% (95% CI, 20%–96%), respectively; for lactate >5.0 mmol/L, with an optimal cut point of 25.8, sensitivity and specificity were 96% (95% CI, 77%–99%) and 100% (95% CI, 59%–100%), respectively. Conclusion: Usefulness of the L:P ratio for differentiating non-PDH and PDH-D types of CLA increases at higher lactate concentrations.

scholarly journals The Utility of the Mini-Addenbrooke’s Cognitive Examination as a Screen for Cognitive Impairment in Elderly Patients with Chronic Kidney Disease and Diabetes

2016 ◽  
Vol 6 (3) ◽  
pp. 541-548 ◽  
Author(s):  
Peter Hobson ◽  
Kamel H. Rohoma ◽  
Stephen P. Wong ◽  
Mick J. Kumwenda
Keyword(s):  
Chronic Kidney Disease ◽  
Cognitive Impairment ◽  
Kidney Disease ◽  
Sensitivity And Specificity ◽  
Receiver Operating Curve ◽  
Case Review ◽  
Cut Point ◽  
Diagnostic And Statistical Manual ◽  
Normal Cognitive Function ◽  
Addenbrooke’S Cognitive Examination

Background/Aims: We tested the utility of the Mini-Addenbrooke’s Cognitive Examination (M-ACE) in a cohort of older adults with chronic kidney disease (CKD) and diabetes. Method: The M-ACE was administered to 112 CKD and diabetes patients attending a nephrology clinic. Cognitive impairment was based upon patient, informant, and case review, neuropsychological assessment, and application of criteria for mild cognitive impairment (MCI) and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition for dementia. The M-ACE was also compared to the Mini-Mental State Examination (MMSE). Results: Upon assessment, 52 patients had normal cognitive function, 33 had MCI, and 27 had dementia. The area under the receiver operating curve for the M-ACE was 0.96 (95% CI 0.95–1.00). The sensitivity and specificity for a dementia diagnosis were 0.96 and 0.84 at the cut point <25 and 0.70 and 1.00 at the cut point <21. Mean M-ACE scores differed significantly between normal, demented, and MCI groups (p < 0.001), and compared to the MMSE, the M-ACE did not suffer from ceiling effects. Conclusion: The M-ACE is an easily administered test with good sensitivity and specificity to capture and assist in the diagnosis of MCI or dementia in patients with CKD and diabetes.

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