Classification of RA Into Active or Inactive With a Modified DAS, for Future Use as a Treat-to-target Tool, With a HandScan Score Replacing Joint Counts

Abstract ObjectivesTo establish the value of a modified DAS (DAS-OST) without joint counts but with a HandScan score (OST), versus that of DAS28, to classify RA as active versus inactive, with as reference standard the rheumatologist's clinical classification.MethodsRA patients with at least one HandScan and DAS28 measurement performed at the same visit were included. Data was extracted from medical records, as was the clinical interpretation as active or inactive RA by the rheumatologist. Logistic regression analyses were performed to calculate areas under the receiver operating characteristics (AU-ROC) curves. The clinical interpretation was used as reference standard in all analyses, and disease activity measures were used as predictor variables. The performance of predictor variables (AU-ROCs) was compared.ResultsData of 1505 unique RA patients were used for analyses. The highest AU-ROC of 0.88 (95%CI 0.85 – 0.90) was shown for DAS28; AU-ROC of DAS-OST was 0.78 (95%CI 0.75 – 0.81), difference 0.10, p<0.01.ConclusionsCompared to DAS28, DAS-OST classified RA statistically significantly less well as active versus inactive, when using the clinical classification as reference standard. However, a DAS-modification without joint scores might have a place in strategies limiting routine outpatients’ visits to the rheumatologist.

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Conduction Disorders during Sinus Rhythm in Relation to Atrial Fibrillation Persistence

Journal of Clinical Medicine ◽

10.3390/jcm10132846 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2846

Author(s):

Willemijn F. B. van der Does ◽

Annejet Heida ◽

Lisette J. M. E. van der Does ◽

Ad J. J. C. Bogers ◽

Natasja M. S. de Groot

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Roc Curves ◽

P Wave ◽

Clinical Classification ◽

Epicardial Mapping ◽

Activation Time ◽

Conduction Disorders ◽

P Wave Duration

Classification of atrial fibrillation (AF) is currently based on clinical characteristics. However, classifying AF using an objective electrophysiological parameter would be more desirable. The aim of this study was to quantify parameters of atrial conduction during sinus rhythm (SR) using an intra-operative high-resolution epicardial mapping approach and to relate these parameters to clinical classifications of AF. Patients were divided according to the standard clinical classification and spontaneous termination of AF episodes. The HATCH score, a score predictive of AF progression, was calculated, and surface ECGs were evaluated for signs of interatrial block. Conduction disorders mainly differed at Bachmann’s bundle (BB). Activation time (AT) at BB was longer in persistent AF patients (AT-BB: 75 (53–92) ms vs. 55 (40–76) ms, p = 0.017), patients without spontaneous termination of AF episodes (AT-BB: 53.5 (39.6–75.8) ms vs. 72.0 (49.6–80.8) ms, p = 0.009) and in patients with a P-wave duration ≥ 120 ms (64.3 (52.3–93.0) ms vs. 50.5 (39.6–56.6) ms, p = 0.014). HATCH scores also correlated positively to AT-BB (rho 0.326, p = 0.029). However, discriminatory values of electrophysiological parameters, as calculated using ROC-curves, were limited. These results may reflect shortcomings of clinical classifications and further research is needed to establish an objective substrate-based classification of AF.

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The acute and long-term prognosis of cerebral infarction on the basis of the clinical classification of the Oxfordshire community stroke project

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/sj.jcbfm.9591524.0151 ◽

2005 ◽

Vol 25 (1_suppl) ◽

pp. S151-S151

Author(s):

Katsunori Isa ◽

Takashi Tokashiki ◽

Koichiro Okumura ◽

Kunitoshi Iseki ◽

Shuichi Takishita

Keyword(s):

Cerebral Infarction ◽

Clinical Classification ◽

Oxfordshire Community Stroke Project ◽

Long Term Prognosis

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Conscious access to fear-relevant information is mediated by threshold

Polish Psychological Bulletin ◽

10.2478/v10059-011-0009-7 ◽

2011 ◽

Vol 42 (2) ◽

pp. 56-64 ◽

Cited By ~ 2

Author(s):

Remigiusz Szczepanowski

Keyword(s):

Present Report ◽

Intrinsic Property ◽

Roc Curves ◽

Relevant Information ◽

Perceptual Processing ◽

High Threshold ◽

Operating Characteristics ◽

Emotional Perception ◽

Fearful Faces ◽

The Subject

Conscious access to fear-relevant information is mediated by thresholdThe present report proposed a model of access consciousness to fear-relevant information according to which there is a threshold for emotional perception beyond that the subject makes hits with no false alarm. The model was examined by having the participants performed a confidence-ratings masking task with fearful faces. Measures of the thresholds for conscious access were taken by looking at the receiver operating characteristics (ROC) curves generated from a three-state low- and high-threshold (3-LHT) model by Krantz. Indeed, the analysis of the masking data revealed that the ROCs had threshold-like-nature (a two-limb shape) rather continuous (a curvilinear shape) challenging in this fashion the classical signal-detection view on perceptual processing. Moreover, the threshold ROC curve exhibited the specific y-intercepts relevant to conscious access performance. The study suggests that the threshold can be an intrinsic property of conscious access, mediating emotional contents between perceptual states and consciousness.

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On the application of the system of machines modular block type in the advanced technology logging activities

Известия СПбЛТА ◽

10.21266/2079-4304.2016.216.135-143 ◽

2016 ◽

Author(s):

С.А. Демидов

Keyword(s):

Advanced Technology ◽

Modular System ◽

Process Equipment ◽

Block Type ◽

Work Efficiency ◽

Operating Characteristics ◽

Promising Direction ◽

Hydrostatic Transmission ◽

Machine Module

Рассматриваются возможности применения системы машин модульно-блочного типа в перспективных технологиях лесосечных работ, а также проблемы машинного парка лесозаготовительных предприятий России. Цель исследования - изучение структуры и особенностей эксплуатации системы лесных машин модульно блочного типа в современных условиях лесозаготовок с перспективой применения на ближайшее будущее. Для улучшения технологии проведения лесосечных работ и повышения экономической эффективности лесопромышленного комплекса предлагается провести ряд важных технических и технологических изменений. Одним из решений проблемы по улучшению эффективности работы является разработка и внедрение комплекса лесных машин, основанного на принципе эксплуатационной модульности. Это будет гарантировать технологическую гибкость производства, предоставит высокую производительность и обеспечит совместимость с окружающей средой. Приведен принцип устройства машин модульно-блочного типа с разделением функций между транспортными и технологическими модулями. Представлены графически классификация модулей по их назначению и концепция компоновки системы машин модульно-блочного типа, а также главный модуль (энергетический) и несколько технологических модулей, способных выполнять различные технологические операции в зависимости от условий и технологии производства. Как показал анализ рынка, наиболее перспективным направлением по улучшению механизации лесного парка машин является создание комплекса модульно-блочных машин на базе колесного трактора, оснащенных гидрообъемными передачами. Это делает конструкцию машины более гибкой и мобильной. Принцип формирования и работы модульной системы машин с многофункциональным технологическим оборудованием рассматривается в качестве перспективного направления по улучшению лесозаготовительного процесса. The article deals with the prospects for the use of machines modular block type in the advanced technology logging activities, as well as the machinery problems of logging enterprises in Russia. The research objective. The study of the structure and operating characteristics of a system of forest modular block type machines in current conditions with the prospect of their application in the nearest future. It is necessary that a number of important technical and technological changes should be made to improve the technology of logging operations and increase the economic efficiency of timber industry complex. One of the solutions to improve work efficiency is the development and introduction of forest machines based on the principle of operational modularity. It will ensure the flexibility of the production process, provide high work efficiency and, what counts, will be environmentally friendly. The article gives the description of the principle of the machine module block type, as well as the functions and how they are divided between the two modules. There are two pictures in the article. The first picture gives the classification of modules according to their application. The second picture shows the principle of arrangement of modular machine-block type. Both the main energetic module and some technological modules capable of performing processing steps depending on the conditions and production technology are presented. According to the market analysis that shows that the most promising direction to improve the mechanization of forest machinery is to create a complex modular block machines on the base of a wheeled tractor equipped with hydrostatic transmission. It will make the machine design more flexible and mobile. The principle of formation and operation of the modular system with multi-function machines process equipment is considered as a promising direction for improvement of the process of logging.

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Clinical Classification of Patellofemoral Pain and Dysfunction

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.1998.28.5.299 ◽

1998 ◽

Vol 28 (5) ◽

pp. 299-306 ◽

Cited By ~ 64

Author(s):

S. Wendell Holmes ◽

William G. Clancy

Keyword(s):

Patellofemoral Pain ◽

Clinical Classification

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Emergency physician’s dispatch by a paramedic-staffed emergency medical communication centre: sensitivity, specificity and search for a reference standard

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00844-y ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Victor Nathan Chappuis ◽

Hélène Deham ◽

Philippe Cottet ◽

Birgit Andrea Gartner ◽

François Pierre Sarasin ◽

...

Keyword(s):

Reference Standard ◽

Medical Systems ◽

Operating Characteristics ◽

First Line ◽

Emergency Calls ◽

Emergency Medical ◽

Dispatch Centre ◽

Second Tier ◽

Low Sensitivity ◽

Level Of Risk

Abstract Background Some emergency medical systems (EMS) use a dispatch centre where nurses or paramedics assess emergency calls and dispatch ambulances. Paramedics may also provide the first tier of care “in the field”, with the second tier being an Emergency Physician (EP). In these systems, the appropriateness of the decision to dispatch an EP to the first line at the same time as the ambulance has not often been measured. The main objective of this study was to compare dispatching an EP as part of the first line emergency service with the severity of the patient’s condition. The secondary objective was to highlight the need for a recognized reference standard to compare performance analyses across EMS. Methods This prospective observational study included all emergency calls received in Geneva’s dispatch centre between January 1st, 2016 and June 30th, 2019. Emergency medical dispatchers (EMD) assigned a level of risk to patients at the time of the initial call. Only the highest level of risk led to the dispatch of an EP. The severity of the patient’s condition observed in the field was measured using the National Advisory Committee for Aeronautics (NACA) scale. Two reference standards were proposed by dichotomizing the NACA scale. The first compared NACA≥4 with other conditions and the second compared NACA≥5 with other conditions. The level of risk identified during the initial call was then compared to the dichotomized NACA scales. Results 97′861 assessments were included. Overall prevalence of sending an EP as first line was 13.11, 95% CI [12.90–13.32], and second line was 2.94, 95% CI [2.84–3.05]. Including NACA≥4, prevalence was 21.41, 95% CI [21.15–21.67], sensitivity was 36.2, 95% CI [35.5–36.9] and specificity 93.2 95% CI [93–93.4]. The Area Under the Receiver-Operating Characteristics curve (AUROC) of 0.7507, 95% CI [0.74734–0.75397] was acceptable. Looking NACA≥5, prevalence was 3.09, 95% CI [2.98–3.20], sensitivity was 64.4, 95% CI [62.7–66.1] and specificity 88.5, 95% CI [88.3–88.7]. We found an excellent AUROC of 0.8229, 95% CI [0.81623–0.82950]. Conclusion The assessment by Geneva’s EMD has good specificity but low sensitivity for sending EPs. The dichotomy between immediate life-threatening and other emergencies could be a valid reference standard for future studies to measure the EP’s dispatching performance.

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Nomogram based on homogeneous and heterogeneous associated factors for predicting distant metastases in patients with colorectal cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02140-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Tianwen Luo ◽

Yutong Wang ◽

Xuefeng Shan ◽

Ye Bai ◽

Chun Huang ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Lung Metastases ◽

Roc Curves ◽

Distant Metastases ◽

Good Prediction ◽

Operating Characteristics ◽

Good Prediction Performance ◽

Different Types ◽

Associated Risk Factors

Abstract Background The identification of the homogeneous and heterogeneous risk factors for different types of metastases in colorectal cancer (CRC) may shed light on the aetiology and help individualize prophylactic treatment. The present study characterized the incidence differences and identified the homogeneous and heterogeneous risk factors associated with distant metastases in CRC. Methods CRC patients registered in the SEER database between 2010 and 2016 were included in this study. Logistic regression was used to analyse homogeneous and heterogeneous risk factors for the occurrence of different types of metastases. Nomograms were constructed to predict the risk for developing metastases, and the performance was quantitatively assessed using the receiver operating characteristics (ROC) curve and calibration curve. Results A total of 204,595 eligible CRC patients were included in our study, and 17.07% of them had distant metastases. The overall incidences of liver metastases, lung metastases, bone metastases, and brain metastases were 15.34%, 5.22%, 1.26%, and 0.29%, respectively. The incidence of distant metastases differed by age, gender, and the original CRC sites. Poorly differentiated grade, more lymphatic metastasis, higher carcinoembryonic antigen (CEA), and different metastatic organs were all positively associated with four patterns of metastases. In contrast, age, sex, race, insurance status, position, and T stage were heterogeneously associated with metastases. The calibration and ROC curves exhibited good performance for predicting distant metastases. Conclusions The incidence of distant metastases in CRC exhibited distinct differences, and the patients had homogeneous and heterogeneous associated risk factors. Although limited risk factors were included in the present study, the established nomogram showed good prediction performance.

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