risk thresholds
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Author(s):  
Sarah F. Moore ◽  
Sarah J. Price ◽  
Sarah Chowienczyk ◽  
Jennifer Bostock ◽  
Willie Hamilton

Abstract Background Expediting cancer diagnosis may be achieved by targeted decreases in referral thresholds to increase numbers of patients referred for urgent investigation. Methods Clinical Practice Research Datalink data from England for 150,921 adults aged ≥40 were used to identify participants with features of possible cancer equating to risk thresholds ≥1%, ≥2% or ≥3% for breast, lung, colorectal, oesophago-gastric, pancreatic, renal, bladder, prostatic, ovarian, endometrial and laryngeal cancers. Results The mean age of participants was 60 (SD 13) years, with 73,643 males (49%). In 2016, 8576 consultation records contained coded features having a positive predictive value (PPV) of ≥3% for any of the 11 cancers. This equates to a rate of 5682/100,000 patients compared with 4601/100,000 Suspected Cancer NHS referrals for these cancers from April 2016–March 2017. Nine thousands two hundred ninety-one patient-consultation records had coded features equating to a ≥2% PPV, 8% more than met PPV ≥ 3%. Similarly, 19,517 had features with a PPV ≥ 1%, 136% higher than for PPV ≥ 3%. Conclusions This study estimated the number of primary-care patients presenting at lower thresholds of cancer risk. The resource implications of liberalising this threshold to 2% are modest and manageable. The details across individual cancer sites should assist planning of English cancer services.


2021 ◽  
Vol 11 (9) ◽  
pp. 916
Author(s):  
Nora Pashayan ◽  
Antonis C. Antoniou ◽  
Andrew Lee ◽  
Michael Wolfson ◽  
Jocelyne Chiquette ◽  
...  

In risk-stratified cancer screening, multiple risk factors are incorporated into the risk assessment. An individual’s estimated absolute cancer risk is linked to risk categories with tailored screening recommendations for each risk category. Absolute risk, expressed as either remaining lifetime risk or shorter-term (five- or ten-year) risk, is estimated from the age at assessment. These risk estimates vary by age; however, some clinical guidelines (e.g., enhanced breast cancer surveillance guidelines) and ongoing personalised breast screening trials, stratify women based on absolute risk thresholds that do not vary by age. We examine an alternative approach in which the risk thresholds used for risk stratification vary by age and consider the implications of using age-independent risk thresholds on risk stratification. We demonstrate that using an age-independent remaining lifetime risk threshold approach could identify high-risk younger women but would miss high-risk older women, whereas an age-independent 5-year or 10-year absolute risk threshold could miss high-risk younger women and classify lower-risk older women as high risk. With risk misclassification, women with an equivalent risk level would be offered a different screening plan. To mitigate these problems, age-dependent absolute risk thresholds should be used to inform risk stratification.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yash S. Huilgol ◽  
Holly Keane ◽  
Yiwey Shieh ◽  
Robert A. Hiatt ◽  
Jeffrey A. Tice ◽  
...  

AbstractRisk-reducing endocrine therapy use, though the benefit is validated, is extremely low. The FDA has approved tamoxifen and raloxifene for a 5-year Breast Cancer Risk Assessment Tool (BCRAT) risk ≥ 1.67%. We examined the threshold at which high-risk women are likely to be using endocrine risk-reducing therapies among Athena Breast Health Network participants from 2011–2018. We identified high-risk women by a 5-year BCRAT risk ≥ 1.67% and those in the top 10% and 2.5% risk thresholds by age. We estimated the odds ratio (OR) of current medication use based on these thresholds using logistic regression. One thousand two hundred and one (1.2%) of 104,223 total participants used medication. Of the 33,082 participants with 5-year BCRAT risk ≥ 1.67%, 772 (2.3%) used medication. Of 2445 in the top 2.5% threshold, 209 (8.6%) used medication. Participants whose 5-year risk exceeded 1.67% were more likely to use medication than those whose risk was below this threshold, OR 3.94 (95% CI = 3.50–4.43). The top 2.5% was most strongly associated with medication usage, OR 9.50 (8.13–11.09) compared to the bottom 97.5%. Women exceeding a 5-year BCRAT ≥ 1.67% had modest medication use. We demonstrate that women in the top 2.5% have higher odds of medication use than those in the bottom 97.5% and compared to a risk of 1.67%. The top 2.5% threshold would more effectively target medication use and is being tested prospectively in a randomized control clinical trial.


2021 ◽  
Author(s):  
William H.B. McAuliffe ◽  
Eric R. Louderback ◽  
Timothy Edson ◽  
Debi LaPlante ◽  
Sarah E Nelson

Online gambling poses novel risks for problem gambling, but also unique opportunities to detect and intervene with at-risk users. A consortium of gambling companies recently committed to using nine behavioral "Markers of Harm'' that can be calculated with online user data to estimate risk for gambling-related harm. The current study evaluates these markers in two independent samples of sports bettors, collected ten years apart. We find over a two-year period that most users never had high enough overall risk scores to indicate that they would have received an intervention. This observation is partly due to characteristics of our samples that are associated with lower risk for gambling-related harm, but might also be due to overly high risk thresholds or flaws in the design of some markers. Users with higher average risk scores had more intraindividual variability in risk scores. Younger age and male gender were not associated with higher average risk scores. The most active users were more likely than other users to have ever exceeded risk thresholds. Several risk scores significantly predicted proxies of gambling-related harm (e.g., account closure). Overall, the current Markers of Harm system has some correctable limitations that future risk detection systems should consider adopting.


Author(s):  
Samuel J. Tu ◽  
Celine Gallagher ◽  
Adrian D. Elliott ◽  
Dominik Linz ◽  
Bradley M. Pitman ◽  
...  

2021 ◽  
Vol 12 (1) ◽  
pp. 18-35
Author(s):  
Rufino López-Ordaz ◽  
Gabriela Pérez-Hernández ◽  
Hugo Alonso Ramírez-Ramírez ◽  
Reyes López-Ordaz ◽  
Germán David Mendoza-Martínez ◽  
...  

The objectives were to study the associations of concentrations of β-hydroxybutyrate acid (BHBA), calcium (Ca2+), and non-esterified fatty acids (NEFA) in blood serum 7 d prepartum with losses in milk yield (MY) and metabolic dysfunctions at seven and 14 d of lactation. Three hundred and thirty-six (336) Holstein-Friesian (780 ± 36 kg BW; which had lactated more than twice) were sampled by coccygeal venipuncture, 7 d before, and 7 and 14 d after parturition. For each sample and metabolite serum concentrations were stratified in thresholds and related to MY. When BHBA levels were high 7 d before parturition and were related to MY at d-7 postpartum, it was observed that 11.00 % of the cows lost 0.370 kg d-1 of milk. In contrast, no relationship was observed between BHBA prepartum and MY on d-14 of lactation. It was not observed any association between high NEFA and low Ca2+ levels prepartum and MY. NEFA concentrations ≥ 0.5 mmol L-1 on d-7 before calving were 7.6 more susceptible for lameness incidence (P≤ 0.01), and when BHBA ≥ 0.8 mmol L-1 cows were 2.4 times more likely to develop ketosis (P≤0.05) in the first 60 d in milk. In brief, data indicate that a high proportion of cows are above the thresholds of β-hydroxybutyrate and non-esterified fatty acids, and are also deficient in calcium, when determined one week before parturition. The risk thresholds for each metabolite were not associated with the amount of milk lost at d-14 after calving.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xia Yu ◽  
Ning Ma ◽  
Tao Yang ◽  
Yawen Zhang ◽  
Qing Miao ◽  
...  

Abstract Background Early alarm of hypoglycemia, detection of asymptomatic hypoglycemia, and effective control of blood glucose fluctuation make a great contribution to diabetic treatment. In this study, we designed a multi-level hypoglycemia early alarm system to mine potential information in Continuous Glucose Monitoring (CGM) time series and improve the overall alarm performance for different clinical situations. Methods Through symbolizing the historical CGM records, the Prefix Span was adopted to obtain the early alarm/non-alarm frequent sequence libraries of hypoglycemia events. The longest common subsequence was used to remove the common frequent sequence for achieving the hypoglycemia early alarm in different clinical situations. Then, the frequent sequence pattern libraries with different risk thresholds were designed as the core module of the proposed multi-level hypoglycemia early alarm system. Results The model was able to predict hypoglycemia events in the clinical dataset of level-I (sensitivity 85.90%, false-positive 23.86%, miss alarm rate 14.10%, average early alarm time 20.61 min), level-II (sensitivity 80.36%, false-positive 17.37%, miss alarm rate 19.63%, average early alarm time 27.66 min), and level-III (sensitivity 78.07%, false-positive 13.59%, miss alarm rate 21.93%, average early alarm time 33.80 min), respectively. Conclusions The proposed approach could effectively predict hypoglycemia events based on different risk thresholds to meet different prevention and treatment requirements. Moreover, the experimental results confirm the practicality and prospects of the proposed early alarm system, which reflects further significance in personalized medicine for hypoglycemia prevention.


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