Establishment of PIVKA-Ⅱ Reference Intervals From Hospital-stored Data: A Comparison Analysis

Objective The authors aimed to explore methods to establish indirect reference intervals for PIVKA-II from hospital-stored data.Method 7623 patient specimens of the Renmin Hospital of Wuhan University were collected. Indirect reference intervals were established based on the hospital-stored data with four different methods, including the Hoffmann method (HM), revised Hoffmann method (HMCDF), E-M algorithm-based method (EMBCT), and a recent estimator (KOSMIC). According to CLSI C28-A3 guidelines, 369 healthy specimens were collected. The authors tested the difference between reference intervals of gender-specific and age-specific subgroups using Harris and Boyd's test. Finally, the averaging result of estimates was calculated according to how likely each model was.Results The indirect reference intervals of PIVKA-II based on LIS data were 0 to 35.30 mAU/mL (HM), 0 to 31.48 mAU/mL (HMCDF), 0 to 30.78 mAU/mL (EMBCT), 0 to 36.17 mAU/mL (KOSMIC) and 0 to 31.48 mAU/mL (averaging) respectively, and the reference intervals based on healthy group were 0 to 32 mAU/mL. Compared with HM, EMBCT and KOSMIC, HMCDF and the averaging result was closer to those of the health group. Significant difference was detected between gender-partitioned subgroups, and the reference upper limit in the female group was smaller than the male group.Conclusions The authors established the indirect reference intervals of PIVKA-II for the Wuhan population, which could be used to the clinical reference intervals. The framework proposed could help clinical laboratory set their reference intervals of test items.

Quantify each Dendritic Cell Subsets along with Normal Thymus Tissues in Different Ages

BackgroundDendritic cells (DCs) in the thymus are involved in central tolerance formation, but they also play other roles in the thymus. In this study, thymuses of different ages were collected for observation after tissue sectioning and staining. The area of cortex and medulla parts of the thymus in the sections and the density of different subsets of DCs in the thymus were also calculated. ResultsWe found that, along with the increasing age, the thymic cortex atrophies faster, leading to a gradual rise in the medullary's surface area ratio to that of the cortex with an increase in age. The medullary's surface area ratio to cortex can be used as an indirect reference to reflect the thymus hyperplasia. The density of DCs in the thymus showed different changes with the increasing age, and the density of plasmacytoid DCs (pDCs) in the thymus gradually increased with aging, suggesting that pDCs may play an essential role in the thymus in addition to central tolerance.ConclusionsThese findings complement our knowledge about the DCs’ subsets in the thymus along with physical ageing and help us understand the full function of DCs in the thymus beyond central tolerance.

Separating disease and health for indirect reference intervals

The indirect approach to defining reference intervals operates ‘a posteriori’, on stored laboratory data. It relies on being able to separate healthy and diseased populations using one or both of clinical techniques or statistical techniques. These techniques are also fundamental in a priori, direct reference interval approaches. The clinical techniques rely on using clinical data that is stored either in the electronic health record or within the laboratory database, to exclude patients with possible disease. It depends on the investigators understanding of the data and the pathological impacts on tests. The statistical technique relies on identifying a dominant, apparently healthy, typically Gaussian distribution, which is unaffected by the overlapping populations with higher (or lower) results. It depends on having large databases to give confidence in the extrapolation of the narrow portion of overall distribution representing unaffected individuals. The statistical issues involved can be complex, and can result in unintended bias, particularly when the impacts of disease and the physiological variations in the data are under appreciated.

Indirect reference intervals for haematological parameters in capillary blood of pre-school children

Introduction: Indirect estimation of reference intervals (RIs) is straightforward and inexpensive procedure for determination of intra-laboratory RIs. We applied the indirect approach to assess RIs for haematological parameters in capillary blood of pre-school children, using results stored in our laboratory database. Materials and methods: We extracted data from laboratory information system, for the results obtained by automatic haematology analyser in capillary blood of 154 boys and 146 girls during pre-school medical examination. Data distribution was tested, and logarithmic transformation was applied if needed. Reference intervals were calculated by the nonparametric percentile method. Results: Reference intervals were calculated for: RBC count (4.2-5.4 x1012/L), haemoglobin (114-146 g/L), MCH (25.0-29.4 pg), MCHC (321-368 g/L), RDW-SD (36.1-43.5 fL), WBC count (4.5-12.3 x109/L), neutrophils count (1.7-6.9 x109/L) and percentage (29.0-69.0%), lymphocytes count (1.6-4.4 x109/L) and percentage (21.9-60.7%), PLT (165-459 x109/L), MPV (8.1-11.4 fL) and PDW (9.2-14.4%). Gender specific RIs were calculated for monocytes count (male (M): 0.2-1.6 x109/L; female (F): 0.1-1.4 x109/L) and percentage (M: 2.5-18.3%; F: 1.8-16.7%), haematocrit (M: 0.34-0.42 L/L; F: 0.34-0.43 L/L), MCV (M: 73.4-84.6 fL; F: 75.5-84.2 fL) and RDW (M: 12.1-14.3%; F: 11.7-13.9%), due to observed gender differences in these parameters (P = 0.031, 0.028, 0.020, 0.012 and 0.001; respectively). Estimated RIs markedly varied from the literature based RIs that are used in the laboratory. Conclusions: Indirect method employed in this study enables straightforward assessment of RIs in pre-school children. Herein derived RIs differed from the literature-based ones, indicating the need for intra-laboratory determination of RIs for specific populations and sample types.

Application of the TML method to big data analytics and reference interval harmonization

Significant variation in reported reference intervals across healthcare centers and networks for many well-standardized laboratory tests continues to exist, negatively impacting patient outcomes by increasing the risk of inappropriate and inconsistent test result interpretation. Reference interval harmonization has been limited by challenges associated with direct reference interval establishment as well as hesitancies to apply currently available indirect methodologies. The Truncated Maximum Likelihood (TML) method for indirect reference interval establishment developed by the German Society of Clinical Chemistry and Laboratory Medicine (DGKL) presents unique clinical and statistical advantages compared to traditional indirect methods (Hoffmann and Bhattacharya), increasing the feasibility of developing indirect reference intervals that are comparable to those determined using a direct a priori approach based on healthy reference populations. Here, we review the application of indirect methods, particularly the TML method, to reference interval harmonization and discuss their associated advantages and disadvantages. We also describe the CSCC Reference Interval Harmonization Working Group’s experience with the application of the TML method in harmonization of adult reference intervals in Canada.

Intentionality and the Logico-Linguistic Commitment

The aim of this article is to analyze and criticize Roderick Chisholm’s conception of intentionality, which has, historically, served as the point of departure for most accounts of intentionality in analytic philosophy. My goal is to highlight the problematic ‘logico-linguistic commitment’ presupposed by Chisholm, according to which mental concepts should be interpreted by means of semantic concepts. After addressing Chisholm’s differentiation between the ontological thesis (the idea that the intentional object might not exist) and the psychological thesis (the conception that only mental phenomena are intentional), as well as his defining criteria for intentionality (non-existential implication, independency of truth-value, and indirect reference), I focus on the manifold problems presented by his theory. First, the two initial criteria entail a conceptual confusion between the semantic concept of ‘intensionality’ and the mental concept of ‘intentionality’. Second, according to these criteria””and against Chisholm’s explicit intention””perception and other cognitive activities should not be considered intentional. Third, there are no grounds for the artificial conflation of intentionality and the concept of ‘propositional attitudes’””an equation which is an explicit tenet of the logico-linguistic commitment. In general, I argue that an interpretation of intentionality based on this commitment obscures the true meaning of the concept of intentionality, as it is presented, for instance, by phenomenology.

What Has Been Thought and Taught on the Lunar Influence on Plants in Agriculture? Perspective from Physics and Biology

This paper reviews the beliefs which drive some agricultural sectors to consider the lunar influence as either a stress or a beneficial factor when it comes to organizing their tasks. To address the link between lunar phases and agriculture from a scientific perspective, we conducted a review of textbooks and monographs used to teach agronomy, botany, horticulture and plant physiology; we also consider the physics that address the effects of the Moon on our planet. Finally, we review the scientific literature on plant development, specifically searching for any direct or indirect reference to the influence of the Moon on plant physiology. We found that there is no reliable, science-based evidence for any relationship between lunar phases and plant physiology in any plant–science related textbooks or peer-reviewed journal articles justifying agricultural practices conditioned by the Moon. Nor does evidence from the field of physics support a causal relationship between lunar forces and plant responses. Therefore, popular agricultural practices that are tied to lunar phases have no scientific backing. We strongly encourage teachers involved in plant sciences education to objectively address pseudo-scientific ideas and promote critical thinking.

Generic bare plurals in Russian and beyond

This paper focuses on indirect reference to kinds achieved by means of bare plural nominal expressions in Russian, which is a language without articles. These NPs refer to sums of individuals, whose denotation is built on Number. Their default interpretation is indefinite, while generic and definite readings are a result of a pragmatic strengthening, i.e. these readings appear only in certain environments (argument position of k-level predicates, subject position of characterising statements) and depend on the world knowledge of interlocutors. Generically and definitely interpreted expressions are similar to each other, being characterised by maximality, identifiability and presupposition of existence. However, the former ones cannot be spatiotemporally localised or anaphorically anchored. Going beyond Russian, it is suggested that in some languages genericity (along with definiteness) may be encoded semantically by means of a definite article, while in others it is pragmatically inferred on bare NPs; this difference can account for the inter- and intra- linguistic variation in the expression of genericity.