Single Brain Metastasis vs Glioblastoma Multiforme: A Voi-Based Multiparametric Analysys for Differential Diagnosis

Abstract PURPOSEThe authors purpose was to evaluate ADC and rCBV values in the enhanced lesion, in the peritumoral area and in distal oedema using a Volume of Interest (VOI) based method and to analysed hemodynamic curves obtained from DSC perfusion MRI, in order to create a valid multiparametric MRI model for the differential diagnosis between Glioblastoma and solitary Brain Metastasis.MATERIALS AND METHODSForty-one patients (twenty glioblastomas and twenty-one single brain metastases) were retrospectively evaluated. MRI images were acquired before surgery, radiotherapy and chemotherapy. MRIs were analysed with Olea Sphere® 3.0 (Olea Medical, La Ciotat, France), in particular with diffusion, perfusion and volume of interest segmentation plug-ins. FLAIR, 3D T1 MP-RAGE images after gadolinium, ADC and rCBV maps for each patient were co-registered by the OleaSphere software; this was followed by visual inspection to ensure adequate alignment. Volumes of interest (VOIs) of the lesions were drawn on enhanced 3D T1 MP-RAGE avoiding cyst or necrotic degeneration, and then projected on ADC and rCBV co-registered maps. Another 2 VOIs were drawn in the region of hyperintense cerebral oedema, surrounding the lesion (GB or BM) visible on FLAIR images. The first VOI was drawn into perilesional oedema within 5mm around the enhancing tumor. The second VOI was drawn into residual oedema. Both VOIs were projected on ADC and rCBV maps. Perfusion curves were obtained for each lesion and the value of signal recovery (SR) was reported. A Two sample T-Test was obtained to compare all parameters of GB and BM groups. Receiver operating characteristics (ROC) analysis was performed to determine the optimal parameter in distinguishing GB from BM. RESULTSComparing all parameters evaluated for patients with GB and BM, the cerebral lesions were distinguishable with the mean ADC VOI- values of solid component, the PSR values and the mean and max rCBV values in the perilesional edema within 5mm around the enhancing tumor. According to ROC analysis, the area under the curve was 88%, 78% and 74% respectively for mean ADC VOI-values of the solid component, the mean and max rCBV values in the perilesional edema and the PSR. The cumulative ROC curve of these parameters reached an area under the curve of 95% .Using perilesional max rCBV>1,37, PSR>75% and mean lesional ADC<1x10-3 mm2 s-1 GB could be differentiated from solitary BM with sensitivity and specificity of 95% and 86%. CONCLUSIONWe can conclude that lower values of ADC in the enhancing tumor volume and a higher percentage of signal recovery in perfusion curves, associated with higher values of rCBV in the peritumoral edema closed to the lesion, are strongly indicative of GB than solitary BM.

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On the Differential Diagnosis of Anxious from Nonanxious Major Depression by means of the Hamilton Scales

The Scientific World JOURNAL ◽

10.1155/2013/294516 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

George Konstantakopoulos ◽

Vasilios G. Masdrakis ◽

Manolis Markianos ◽

Panagiotis Oulis

Keyword(s):

Differential Diagnosis ◽

Sensitivity And Specificity ◽

Gold Standard ◽

Roc Analysis ◽

Operating Characteristics ◽

Middle Aged ◽

Large Effect Size ◽

Major Depressive ◽

Trade Off ◽

Severe Anxiety

Objective.Anxious major depressive disorder (A-MDD) is differentially diagnosed from nonanxious MDD (NA-MDD) as MDD with a cut-off score ≥7 on the HAM-D anxiety-somatization factor (ASF). We investigated whether additional HAM-D items discriminate A-MDD from NA-MDD. Moreover, we tested the validity of ASF criterion against HAM-A, gold standard of anxiety severity assessment.Methods.164 consecutive female middle-aged inpatients, diagnosed as A-MDD () or NA-MDD () by the normative HAM-A score for moderate-to-severe anxiety (≥25), were compared regarding 17-item HAM-D scores. The validity of ASF ≥7 criterion was assessed by receiver-operating characteristics (ROC) analysis.Results.We found medium and large effect size differences between A-MDD and NA-MDD patients in only four out of the six ASF items, as well as in three further HAM-D items, namely, those of agitation, middle insomnia, and delayed insomnia. Furthermore, the ASF cut-off score ≥9 provided the optimal trade-off between sensitivity and specificity for the differential diagnosis between A-MDD and NA-MDD.Conclusion.Additional HAM-D items, beyond those of ASF, discriminate A-MDD from NA-MDD. The ASF ≥7 criterion inflates false positives. A cut-off point ≥9 provides the best trade-off between sensitivity and specificity of the ASF criterion, at least in female middle-aged inpatients.

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Fukuda Stepping Test: Sensitivity and Specificity

Journal of the American Academy of Audiology ◽

10.3766/jaaa.20.5.4 ◽

2009 ◽

Vol 20 (05) ◽

pp. 311-314 ◽

Cited By ~ 31

Author(s):

Julie A. Honaker ◽

Thomas E. Boismier ◽

Nathan P. Shepard ◽

Neil T. Shepard

Keyword(s):

Sensitivity And Specificity ◽

Roc Analysis ◽

Screening Tool ◽

Area Under The Curve ◽

Future Research ◽

Operating Characteristics ◽

Caloric Irrigation ◽

Test Sensitivity ◽

Unilateral Weakness ◽

Vestibular Asymmetry

Background: A vestibulospinal test known as the Fukuda stepping test (FST) has been suggested to be a measure of asymmetrical labyrinthine function. However, an extensive review of the performance of this test to identify a peripheral vestibular lesion has not been reported. Purpose: The purpose of this study was to evaluate the sensitivity and specificity of the standard FST and a head shaking variation for identification of a peripheral vestibular system lesion. Research Design: In this retrospective review, we compared performance on the FST with and without a head shaking component to electronystagmography (ENG) caloric irrigation unilateral weakness results. Study Sample: We studied these factors in 736 chronic dizzy patients. Results: Receiving operating characteristics (ROC) analysis and area under the curve (AUC) indicated no significant benefit to performance from the head shaking variation compared to the standard FST in identifying labyrinthine weakness as classified by caloric unilateral weakness results. Conclusions: These findings suggest that the FST with and without head shake component is not a reliable screening tool for peripheral vestibular asymmetry in chronic dizzy patients; however, future research may hold promise for the FST as a tool for patients with acute unilateral disorders.

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PREDICTING SOFTWARE CHANGE IN AN OPEN SOURCE SOFTWARE USING MACHINE LEARNING ALGORITHMS

International Journal of Reliability Quality and Safety Engineering ◽

10.1142/s0218539313500253 ◽

2013 ◽

Vol 20 (06) ◽

pp. 1350025

Author(s):

RUCHIKA MALHOTRA ◽

ANKITA JAIN BANSAL

Keyword(s):

Machine Learning ◽

Open Source ◽

Open Source Software ◽

Roc Analysis ◽

Area Under The Curve ◽

Machine Learning Algorithms ◽

Operating Characteristics ◽

Preventive Actions ◽

Change Proneness ◽

The Relationship

Due to various reasons such as ever increasing demands of the customer or change in the environment or detection of a bug, changes are incorporated in a software. This results in multiple versions or evolving nature of a software. Identification of parts of a software that are more prone to changes than others is one of the important activities. Identifying change prone classes will help developers to take focused and timely preventive actions on the classes of the software with similar characteristics in the future releases. In this paper, we have studied the relationship between various object oriented (OO) metrics and change proneness. We collected a set of OO metrics and change data of each class that appeared in two versions of an open source dataset, 'Java TreeView', i.e., version 1.1.6 and version 1.0.3. Besides this, we have also predicted various models that can be used to identify change prone classes, using machine learning and statistical techniques and then compared their performance. The results are analyzed using Area Under the Curve (AUC) obtained from Receiver Operating Characteristics (ROC) analysis. The results show that the models predicted using both machine learning and statistical methods demonstrate good performance in terms of predicting change prone classes. Based on the results, it is reasonable to claim that quality models have a significant relevance with OO metrics and hence can be used by researchers for early prediction of change prone classes.

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Case linkage in Australian serial stranger rape

Journal of Criminological Research Policy and Practice ◽

10.1108/jcrpp-01-2020-0016 ◽

2020 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Serena Davidson ◽

Wayne Petherick

Keyword(s):

Roc Analysis ◽

Area Under The Curve ◽

Empirical Support ◽

Theory And Practice ◽

Operating Characteristics ◽

Content Type ◽

Sexual Crimes ◽

Behavioural Consistency ◽

Sexual Assault Case ◽

Serial Rape

Purpose Case linkage theory and practice have received growing empirical support; however, they have yet to be examined fully within Australia. For sexual assault case linkage to be successful, it is assumed that a serial rapist will behave relatively consistently across offences yet distinctively compared to other offenders. The purpose of this paper is to test the underlying principles of case linkage, behavioural consistency and distinctiveness, as well as distinguishing accuracy. Design/methodology/approach In total, 250 solved stranger rapes by 171 offenders (46 serial rapists, 125 one-off rapists) were taken from Queensland Police Service (QPS) crime records. All possible crime pairings were created and cross-crime similarity was assessed using Jaccard’s coefficient. Receiver operating characteristics (ROC) analysis was used to examine the ability to distinguish between linked and unlinked offence pairs. Findings Serial linked pairs had the highest Jaccard’s coefficient (0.456), followed by non-serial unlinked (0.253) and finally, serial unlinked pairs (0.247). Within the ROC analysis, an area under the curve value was found of 0.913, indicating excellent distinguishing accuracy. Both the underlying principles of behavioural consistency and distinctiveness were supported through theoretical and practical methods. This paper provides the first analysis of serial rape case linkage in Australia, adding validity to this practice. Research limitations/implications The authors wish to acknowledge the support and assistance from the QPS in undertaking this research. The views expressed in this publication are not necessarily those of the QPS and any errors of omission or commission are the responsibility of the authors. Practical implications This paper provides validity to the practice of case linkage using a database within Australia. The results of this paper can be used to inform investigators of serial offender behaviours. The theories of offender consistency and distinctiveness are supported, highlighting the importance of behavioural evidence for practitioners. This paper provided a practical increase of the quantity and quality of offences uploaded on the Australian violent and sexual crimes database, which will assist further linkage efforts. Originality/value This paper is the first in Australia to examine consistency, distinctiveness and case linkage of serial stranger rape. Thus is contributes significantly not only to an increased understanding of serial rape and case linkage in Australia but also brings Australia closer to modern research practices in this field.

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Prospective Evaluation of ISTH-BAT As a Predictor of Bleeding Disorder in Adolescent Girls with Heavy Menstrual Bleeding

Blood ◽

10.1182/blood.v128.22.1402.1402 ◽

2016 ◽

Vol 128 (22) ◽

pp. 1402-1402

Author(s):

Shilpa Jain ◽

Ravi Sarode ◽

Janna M. Journeycake ◽

Ayesha Zia

Keyword(s):

Diagnostic Accuracy ◽

Adolescent Girls ◽

Roc Analysis ◽

Assessment Tools ◽

Heavy Menstrual Bleeding ◽

Menstrual Bleeding ◽

Study Cohort ◽

Operating Characteristics ◽

The Mean ◽

Bleeding Score

Background. Heavy menstrual bleeding (HMB) is a frequent complaint in adolescence and is often multifactorial. Of the possible causes, anovulation is likely to be the most common reason but there is mounting evidence that bleeding disorders (BDs) are often an unidentified cause of HMB. Wide ranges of reported prevalence, difficulty in discerning normal from excessive menstrual bleeding and the semi-empiric use of hormonal therapy makes identifying BDs in adolescents challenging. Bleeding assessment tools (BATs) have been developed- primarily in the adults - to improve diagnostic accuracy, predict bleeding phenotype and describe symptoms. The International Society of Haemostasis and Thrombosis (ISTH) BAT was specifically designed to quantify bleeding symptoms that are pediatric specific. An ISTH-BAT score of > 3 for children is considered abnormal. The ISTH BAT has not yet been specifically tested in adolescents presenting with HMB. The objective of this study was to examine the diagnostic utility of ISTH-BAT bleeding score (BS) of > 3 as a predictor of BDs in adolescents with HMB. Methods. We prospectively analyzed clinical data on 70 adolescents without a known BD, referred for HMB, to the Adolescent, Gynecology and multidisciplinary Young Women's Blood Disorders Clinics at University of Texas Southwestern Medical Center from July 2014 to June 2016. This cohort is part of an ongoing prospective study investigating the incidence of BDs in adolescents with HMB (planned n=200). All subjects underwent a standardized comprehensive diagnostic approach, including the ISTH BAT to quantify bleeding symptoms accurately. The ISTH-BAT was applied by two trained investigators and any discrepancy in scores was settled by discussion. As per National Heart, Lung, and Blood Institute guidelines, VWF:Ag and/or VWF:RCo<30 IU/dL were labeled "definite von Willebrand disease (VWD)" while 30-50 IU/dL were labeled as "low VWF levels" which were grouped together to represent vWD. Receiver operating characteristics (ROC) of ISTH-BAT were determined to assess its value for predicting BD in our cohort. Results. The mean age of study participants was 14.4+1.8 years (range: 11-18 years). Twenty-eight out of 70 patients (40%) were found to have a BD; 8 met criteria for VWD, 12 had low VWF levels, 2 were hemophilia A carriers, 5 were diagnosed with inherited platelet dysfunction and 1 had inherited thrombocytopenia. The mean BS was higher in subjects with VWD (N=20) as compared to those without a BD (N=42) (4.5 +1.6, vs. 3.6+ 1.0, p= 0.02). At least one other bleeding symptom was present in 8 (40%) of the 20 girls with vWD. The most commonly reported bleeding symptoms were epistaxis (35%), oral (15%), cutaneous (10%) and post-surgical (5%). There was no difference in patterns of menstrual bleeding (anovulatory vs. ovulatory) between girls with and without a BD (55% ovulatory vs. 41% ovulatory, p-=0.28). ROC analysis of the ISTH-BAT bleeding scores showed that at a BS of > 3, the sensitivity of the ISTH BAT was 100% but specificity was only marginal at 2.4% with an accuracy of 41%, whereas at a BS of > 5, sensitivity, specificity and accuracy were 30%, 88.10% and 69%, respectively. ROC analysis showed area under the curve of 0.66 (CI: 0.52-0.80) indicating poor discrimination for the ISTH-BAT score in determining BD in girls with HMB. Conclusion. Our study is the first attempt to prospectively examine the applicability of using ISTH-BAT score as a screening tool to exclude the presence of BD in adolescent girls presenting with HMB. In this study cohort, ISTH-BAT bleeding score of > 3 demonstrated poor diagnostic accuracy in ruling out vWD. A score of > 5 had high specificity which can decrease false positive diagnosis and repetitive testing. Future data from the ongoing study will help understand how a combination of BATs and a laboratory testing algorithm can unravel hemostatic defects in adolescents with HMB. Disclosures Jain: Bayer: Membership on an entity's Board of Directors or advisory committees; Biogen: Speakers Bureau; Novo Nordisk: Honoraria. Sarode:CSL Behring: Consultancy, Honoraria. Journeycake:CSL: Consultancy; Biogen: Consultancy; Baxalta/Shire: Consultancy. Zia:NHLBI K23: Research Funding.

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Predictive factors for the medical hospitalisation of patients who visited the emergency department with suicide attempt

10.21203/rs.3.rs-51267/v3 ◽

2021 ◽

Author(s):

Hye Jin Kim ◽

Duk Hee Lee

Keyword(s):

Emergency Department ◽

Suicide Attempt ◽

Attempted Suicide ◽

Suicide Attempts ◽

Area Under The Curve ◽

Public Health Problem ◽

Teaching Hospitals ◽

Operating Characteristics ◽

Tertiary Teaching ◽

The Mean

Abstract Background Suicide is a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before suicide. The emergency department (ED) is the first location where individuals are brought after a suicide attempt. This study investigated the factors related to delays in the medical hospitalisation of patients who attempted suicide and aimed to provide criteria for hospitalisation decisions by physicians. Methods This study included patients who had deliberately self-harmed (age ≥19 years) and presented at the EDs of two tertiary teaching hospitals between March 2017 and April 2020. Those for whom relevant demographic and clinical information were unavailable and those admitted to the psychiatric wards were excluded. Results This study included 414 patients in the hospitalisation group and 1,346 in the discharged group. The mean patient age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalised and discharged groups (p <0.001), respectively. The mean ED length of stay (LOS) was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalised and discharged groups, respectively. In the hospitalised group, the odds ratio and confidence interval for aged 35~64 (2.222, 1.343–3.678), aged over 65 (2.788, 1.416-5.492), sex -male (2.041, 1.302–3.119), and consciousness (1.840, 1.253–2.466). The Risk-Rescue Ratio Scale (RRRS) was (1.298, 1.255–1.343). A receiver operating characteristics analysis of RRRS for the decision to hospitalise patients who attempted suicide showed a cut-off value of 42, with sensitivity, specificity, and area under the curve being 85.7%, 85.5%, and 0.924, respectively.Conclusion The level of consciousness and the RRRS of patients who attempted suicide can be the factors to decide medical hospitalisation and reduce ED LOS and crowding.

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Predictive factors for the medical hospitalization of patients who visited to emergency department with suicide attempt

10.21203/rs.3.rs-51267/v2 ◽

2020 ◽

Author(s):

Hye Jin Kim ◽

Duk Hee Lee

Keyword(s):

Emergency Department ◽

Suicide Attempt ◽

Attempted Suicide ◽

Suicide Attempts ◽

Area Under The Curve ◽

Public Health Problem ◽

Teaching Hospitals ◽

Operating Characteristics ◽

Tertiary Teaching ◽

The Mean

Abstract Background Suicide is a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before suicide. The emergency department (ED) is the first location where individuals are brought after a suicide attempt. This study investigated the factors related to delays in the medical hospitalization of patients who attempted suicide and aimed to provide criteria for hospitalization decisions for physicians. Methods This study included who had deliberately self-harmed (age ≥19 years) and who presented at the EDs of two tertiary teaching hospitals between March 2017 and April 2020. Those for whom relevant demographic and clinical information were unavailable and those who were admitted to the psychiatric wards were excluded. Results This study included 414 patients in the hospitalization group and 1,346 in the discharged group. The mean patient age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalized and discharged groups ( p <0.001), respectively. The mean ED length of stay (LOS) was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalized and discharged groups, respectively . In the hospitalized group, the odds ratio and confidence interval for aged 35~64 (2.222, 1.343–3.678), aged over 65 (2.788, 1.416-5.492), sex -male (2.041, 1.302–3.119), and consciousness (1.840, 1.253–2.466). The Risk-Rescue Ratio Scale (RRRS) was (1.298, 1.255–1.343). A receiver operating characteristics analysis of RRRS for the decision to hospitalize patients who attempted suicide showed a cut-off value of 42, with sensitivity, specificity, and area under the curve being 85.7%, 85.5%, and 0.924, respectively. Conclusion The level of consciousness and the RRRS of patients who attempted suicide can be the factors to decide medical hospitalization and reduce ED LOS and crowding.

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Predictive factors for the medical hospitalisation of patients who visited the emergency department with suicide attempt

BMC Psychiatry ◽

10.1186/s12888-021-03089-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hye Jin Kim ◽

Duk Hee Lee

Keyword(s):

Emergency Department ◽

Suicide Attempt ◽

Attempted Suicide ◽

Suicide Attempts ◽

Area Under The Curve ◽

Public Health Problem ◽

Teaching Hospitals ◽

Operating Characteristics ◽

Tertiary Teaching ◽

The Mean

Abstract Background Suicide is a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before suicide. The emergency department (ED) is the first location where individuals are brought after a suicide attempt. This study investigated the factors related to delays in the medical hospitalisation of patients who attempted suicide and aimed to provide criteria for hospitalisation decisions by physicians. Methods This study included patients who had deliberately self-harmed (age ≥ 19 years) and presented at the EDs of two tertiary teaching hospitals between March 2017 and April 2020. Those for whom relevant demographic and clinical information were unavailable and those admitted to the psychiatric wards were excluded. Results This study included 414 patients in the hospitalisation group and 1346 in the discharged group. The mean patient age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalised and discharged groups (p < 0.001), respectively. The mean ED length of stay (LOS) was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalised and discharged groups, respectively. In the hospitalised group, the odds ratio and confidence interval for aged 35 ~ 64 (2.222, 1.343–3.678), aged over 65 (2.788, 1.416–5.492), sex -male (2.041, 1.302–3.119), and consciousness (1.840, 1.253–2.466). The Risk-Rescue Ratio Scale (RRRS) was (1.298, 1.255–1.343). A receiver operating characteristics analysis of RRRS for the decision to hospitalise patients who attempted suicide showed a cut-off value of 42, with sensitivity, specificity, and area under the curve being 85.7, 85.5%, and 0.924, respectively. Conclusion The level of consciousness and the RRRS of patients who attempted suicide can be the factors to decide medical hospitalisation and reduce ED LOS and crowding.

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Drain output volume after pancreaticoduodenectomy is a useful warning sign for postoperative complications

BMC Surgery ◽

10.1186/s12893-021-01285-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Taro Fukui ◽

Hiroshi Noda ◽

Fumiaki Watanabe ◽

Takaharu Kato ◽

Yuhei Endo ◽

...

Keyword(s):

Predictive Value ◽

Roc Analysis ◽

Independent Predictor ◽

Area Under The Curve ◽

Warning Sign ◽

Operating Characteristics ◽

Protein Loss ◽

Chyle Leak ◽

Major Complications ◽

Output Volume

Abstract Introduction The drain output volume (DOV) after pancreaticoduodenectomy (PD) is an easily assessable indicator in clinical settings. We explored the utility of the DOV as a possible warning sign of complications after PD. Methods A total of 404 patients undergoing PD were considered for inclusion. The predictability of the DOV for overall morbidity, major complications, intraabdominal infection (IAI), clinically relevant (CR) postoperative pancreatic fistula (POPF), CR delayed gastric emptying (DGE), CR chyle leak (CL), and CR post-pancreatectomy hemorrhaging (PPH) was evaluated. Results One hundred (24.8%) patients developed major complications, and 131 (32.4%) developed IAI. Regarding CR post-pancreatectomy complications, 75 (18.6%) patients developed CR-POPF, 23 (5.7%) developed CR-DGE, 20 (5.0%) developed CR-CL, and 28 (6.9%) developed CR-PPH. The median DOV on postoperative day (POD) 1 and POD 3 was 266 and 234.5 ml, respectively. A low DOV on POD 1 was an independent predictor of CR-POPF, and a high DOV on POD 3 was an independent predictor of CR-CL. A receiver operating characteristics (ROC) analysis revealed that the DOV on POD 1 had a negative predictive value (area under the curve [AUC] 0.655, sensitivity 65.0%, specificity 65.3%, 95% confidence interval [CI]: 0.587–0.724), with a calculated optimal cut-off value of 227 ml. An ROC analysis also revealed that the DOV on POD 3 had a positive predictive value (AUC 0.753, sensitivity 70.1%, specificity 75.0%, 95% CI: 0.651–0.856), with a calculated optimal cut-off value of 332 ml. Conclusion A low DOV on POD 1 might be a postoperative warning sign for CR-POPF, similar to high drain amylase (DA) on POD 1, high DA on POD 3, and high CRP on POD 3. When the DOV on POD 1 after PD was low, surgeons should evaluate the reasons of a low DOV. A high DOV on POD 3 was a postoperative warning sign CR-CL, and might require an appropriate management of protein loss.

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