Search

The effect of prolonged intertwin delivery interval (IDI) is not well studied. This work aimed to assess the inflection point for Cesarean delivery (CD) and associated adverse maternal and neonatal outcomes. This was a retrospective cohort study at a single tertiary care center. The study included women with twin pregnancies in 2010–2019 who reached the second stage of labor, and assessed the most predictive cutoff for CD using Youden J statistic and compared adverse maternal and neonatal outcomes between short and prolonged intertwin delivery intervals. A total of 461 gravidas reached the second stage of labor and were included in the study. Using the ROC curve and Youden J statistic, the IDI cutoff was set at 15 min (80% sensitivity, 75% specificity, p < 0.001), with 312 women in the short and 149 in the prolonged IDI groups. Women in the prolonged IDI group were less likely to deliver the second twin vaginally (75.8% vs. 93.3%, p < 0.001). Postpartum hemorrhage (PPH) (39.1% vs. 24.7%, p = 0.01), and placental abruption (4% vs. 1%, p = 0.03) were more likely to occur in the prolonged IDI group. An increased rate of neonatal acidemia and low 5-min Apgar score were also found in the prolonged IDI group (15.7% vs. 4.3%, P = 0.01, 9.7% vs. 3.5%, p = 0.008; respectively). IDIs of more than 15 min are associated with increased risk of adverse maternal and neonatal outcomes. These findings should be used for counseling and managing twin pregnancies attempting vaginal delivery. [ABSTRACT FROM AUTHOR]

Background: Attention-deficit/hyperactivity disorder (ADHD) is diagnosed in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria by using subjective observations and information provided by parents and teachers. However, subjective analysis often leads to overdiagnosis or underdiagnosis. There are two types of motor abnormalities in patients with ADHD. First, hyperactivity with fidgeting and restlessness is the major diagnostic criterium for ADHD. Second, developmental coordination disorder characterized by deficits in the acquisition and execution of coordinated motor skills is not the major criterium for ADHD. In this study, a machine learning-based approach was proposed to evaluate and classify 96 patients into ADHD (48 patients, 26 males and 22 females, with mean age: 7y6m) and non-ADHD (48 patients, 26 males and 22 females, with mean age: 7y8m) objectively and automatically by quantifying their movements and evaluating the restlessness scales. Methods: This approach is mainly based on movement quantization through analysis of variance in patients' skeletons detected in outpatient videos. The patients' skeleton sequence in the video was detected using OpenPose and then characterized using 11 values of feature descriptors. A classification analysis based on six machine learning classifiers was performed to evaluate and compare the discriminating power of different feature combinations. Results: The results revealed that compared with the non-ADHD group, the ADHD group had significantly larger means in all cases of single feature descriptors. The single feature descriptor "thigh angle", with the values of 157.89 ± 32.81 and 15.37 ± 6.62 in ADHD and non-ADHD groups (p < 0.0001), achieved the best result (optimal cutoff, 42.39; accuracy, 91.03%; sensitivity, 90.25%; specificity, 91.86%; and AUC, 94.00%). Conclusions: The proposed approach can be used to evaluate and classify patients into ADHD and non-ADHD objectively and automatically and can assist physicians in diagnosing ADHD. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to evaluate the hypothesis test results after categorizing the scale scores with cut-off points and to assess whether similar results would be obtained in that best represent the categories. Methods: This cross-sectional study was conducted between March 15 and 20, 2023 via the Lime Survey. The questionnaire included questions about the sociodemographic and life characteristics of the participants and the Beck Depression Inventory II (BDI-II). Four groups (minimal, mild, moderate, severe depression) were formed using the cutoff points. Data analysis was performed with all participants and referred to as the conventional analysis group. Then, six subanalysis groups were determined to best represent the groups formed according to the BDI-II. In each BDI-II category, six subanalysis groups were created, including those between Q1–Q3 (IQR group), including those within ± 1 std, including those between 5p–95p (90% of the sample), including those between 2.5p–97.5p (95% of the sample). In addition, 100 different samples were randomly selected containing 50% of each group. Results: Of the 1950 participants, 84.7% (n = 1652) were female and 15.3% (n = 298) were male. In terms of depression, it was observed that the significance varied in the analysis groups for sex (p = 0.039), medication use (p = 0.009) and age (p = 0.010) variables. However, these variables were not significant in some of the subanalysis groups. On the other hand, a p < 0.001 value was obtained for income, physical activity, health perception, body shape perception, life satisfaction, and quality of life variables in terms of depression in the conventional analysis group, and it was seen that the significance continued in all subanalysis groups. Conclusions: Our findings showed that variables with p < 0.001 in the conventional analysis group maintained their significance in the other analysis groups. In addition, as the p value got closer to 0.05, we observed that the significance changed according to different cutoff points in the analysis groups. In addition, 50% randomly selected samples support these results. At the end of our study, we reached results that support the necessity of secondary tests in the evaluation of scales. Although further studies are needed, we anticipate that our study will shed light on other studies. [ABSTRACT FROM AUTHOR]

Hadron spectroscopy is revealed by observing heavy resonances. Among various explanations of the internal structure of these hadronic states, hadronic molecules play a unique role. For hadronic molecules, which are associated with meson–meson or meson–baryon interactions, the Λ cutoff is a significant factor in determining the composite states' binding energies and overall properties. The cutoff becomes important when it comes to the location of hadronic molecules' masses because it influences the predictions. From this perspective, in the light of cutoff dependency, heavy quark spin partners of near-threshold the χ c 0 (3 9 1 5) , χ c 1 (3 8 7 2) , P c (4 4 4 0) , and P c (4 4 5 7) resonances, which are considered as hadronic molecules, are examined. [ABSTRACT FROM AUTHOR]

Multisystem inflammatory syndrome in children (MIS-C or PIMS-TS) is a severe disease. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is used for positive and differential diagnosis, diagnosis of complications and severity, and cardiogenic shock prediction. However, contrasting cut-offs have been suggested. The aims of the present study were to compare NT-proBNP values depending on the time of measurement and to describe the NT-proBNP course during the MIS-C episode. The data from a single-centre cohort observational study on the impact of time to diagnosis, defined as the time from first symptom to diagnosis of MIS-C, were used for the purpose of this study, with an extended period of inclusion from May 2020 to April 2023. The timing and level of all NT-proBNP samples available for each patient were retrospectively collected. Thirty-seven children (18 (49%) females, median age 8.8 years, 14 (38%) with shock) were included. Until diagnosis, NT-proBNP increased with time and was significantly higher at 6 days from first symptoms than at 3 days (median (interquartile range) 32,933 (7773–61,592) versus 1994 (1291–4190) pg/mL, respectively, p = 0.031). From diagnosis, NT-proBNP decreased by at least 50% after 3.0 (2.1–5.3) days (n = 12) when NT-proBNP at diagnosis was low ≤ 11,000 pg/mL versus 1.8 (0.7–3.4) days (n = 16) when NT-proBNP at diagnosis was high (p = 0.040), and after 3.6 (2.4–5.9) days (n = 7) when fever persisted after 48 h versus 1.8 (0.8–3.0) days (n = 21) when fever resolved before 48 h (p = 0.004). Conclusions: During the MIS-C episode, NT-proBNP increased over time until diagnosis and treatment. It dropped faster thereafter in children with high NT-proBNP at diagnosis > 11,000 pg/mL and slower in case of persistent fever. What is Known: • NT-proBNP is useful in MIS-C for positive and differential diagnosis, diagnosis of complications and severity, and cardiogenic shock prediction. • Contrasting cut-offs for differential diagnosis and severity assessment have been suggested. What is New: • Before diagnosis, NT-proBNP increases with time and is significantly higher at 6 days from first symptoms than at 3 days suggesting different cut-offs depending on the timing of measurement. • From diagnosis and treatment initiation, the 50% NT-proBNP drop occurs earlier in children with high NT-proBNP at diagnosis > 11,000 pg/mL and later in children with persistent fever. [ABSTRACT FROM AUTHOR]

Using the 2017–2018 National Health and Nutrition Examination Survey (weighted population size = 35,460,209; 8–18 years old; 52.1% males), we compared the obesity prevalence in children and adolescents between body mass index-based (BMI-based) and total percent body fat-based (BF%-based, measured by the dual-energy x-ray absorptiometry) cutoffs. The BMI-based cutoffs exhibited closer alignments (k,.88–.97) in the childhood obesity prevalence, while the absolute (sex-specific) BF% cutoffs had higher prevalence rates than the relative (age- and sex-specific) BF% cutoffs (k =.43 [95% CI, 0.38–0.49]), overly labeling Non-Hispanic white and Other race/ethnicity females with obesity. The BF%-based cutoffs had higher prevalence rates in most sex, age, and race/ethnicity groups than the BMI-based cutoffs. Furthermore, the absolute BF% cutoffs overly labeled Hispanic and Other race/ethnicity females with obesity. In summary, childhood obesity prevalence varied by sex, age, race/ethnicity across different cutoffs, with the BMI-based cutoffs showing closer alignments than the BF%-based cutoffs. [ABSTRACT FROM AUTHOR]

Background: Testing of bulk tank milk (BTM) for Mycoplasmopsis bovis (previously Mycoplasma bovis) antibodies is increasingly popular. However the performance of some commercially available tests is unknown, and cutoff values possibly need to be adjusted in light of the purpose. Therefore, the aim of this study was to compare the diagnostic performance of three commercially available M. bovis antibody ELISAs on BTM, and to explore optimal cutoff values for screening purposes. A prospective diagnostic test accuracy study was performed on 156 BTM samples from Belgian and Swiss dairy farms using Bayesian Latent Class Analysis. Samples were initially classified using manufacturer cutoff values, followed by generated values. Results: Following the manufacturer's guidelines, sensitivity of 91.4%, 25.6%, 69.2%, and specificity of 67.2%, 96.8%, 85.8% were observed for ID-screen, Bio K432, and Bio K302, respectively. Optimization of cutoffs resulted in a sensitivity of 89.0%, 82.0%, and 85.5%, and a specificity of 83.4%, 75.1%, 77.2%, respectively. Conclusions: The ID-screen showed the highest diagnostic performance after optimization of cutoff values, and could be useful for screening. Both Bio-X tests may be of value for diagnostic or confirmation purposes due to their high specificity. [ABSTRACT FROM AUTHOR]

Aim: The Questionnaire for Medical Checkup of Old‐Old (QMCOO) is a 15‐item dichotomous questionnaire developed for the early detection and intervention of frailty in a nationwide health checkup program targeting the old‐old (i.e. aged ≥75 years). The Kihon Checklist (KCL) is a 25‐item questionnaire widely used for screening and self‐monitoring frailty status in administrative settings. With fewer items than the KCL, the QMCOO might expedite the frailty screening process. This study tested whether the QMCOO shows noninferiority in detecting frailty compared with the KCL. Methods: Overall, 645 participants aged ≥75 years in the Itabashi Longitudinal Study on Aging were assessed for their frailty status according to the revised Japanese version of the Cardiovascular Health Study criteria. They also completed the QMCOO and the KCL simultaneously. We compared the discriminative performance of the two questionnaires using non‐inferiority testing with an operationally defined non‐inferiority margin of 10% of the area under the receiver operating characteristic curve computed from the KCL. Results: The prevalence of frailty was 8.8%. The area under the receiver operating characteristic curve for the QMCOO in determining frailty was 0.76 (95% CI 0.70, 0.82), and the corresponding area under the receiver operating characteristic curve for the KCL was 0.77 (95% CI 0.69, 0.84). The QMCOO was not inferior to the KCL for frailty discrimination (P for non‐inferiority = 0.006). Conclusions: The accuracy of the QMCOO for determining frailty was not inferior to that of the KCL. The QMCOO might be more acceptable and useful, as it can be applied in a shorter time with fewer questions than the KCL. Geriatr Gerontol Int 2024; 24: 176–181. [ABSTRACT FROM AUTHOR]

AbstractWe aimed to verify the capacity of the Dimensional Clinical Personality Inventory 2 (IDCP-2) factors to identify people with high levels of dependent personality disorder (DPD) traits in a Brazilian sample extracted from the general population. Participants were 1469 adults who responded to factors from the IDCP-2, the Personality Inventory for DSM-5 (PID-5), and the Structured Clinical Interview for the DSM-IV—Personality Questionnaire (PQ-SCID-II). We found three profiles via Latent Profile Analysis using PID-5 facets. Based on the discrimination capacity of IDCP-2 factors to identify these profiles, we created a DPD score for screening patients showing high levels of DPD traits. The IDCP-2 factors were discriminative of the profiles, showing large effects, except Perseveration. The DPD score presented a cutoff equal to 23 with good discriminative indicators, prioritizing the ability to produce fewer false negatives, and higher than those observed in the PQ-SCID-II. The DPD score can be clinically employed to indicate patients presenting a profile matching the DPD pattern. Moreover, the DPD score can assist the professional in mapping the patient’s pathological profile into typical DPD traits, as well as helping to plan more personalized interventions. Studies focusing on clinical samples must be conducted to investigate whether our findings replicate. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) studies often involve four different states under consideration, namely, "healthy," "latent infection," "pulmonary active disease," and "extra‐pulmonary active disease." While highly accurate clinical diagnosis tests do exist, they are expensive and generally not accessible in regions where they are most needed; thus, there is an interest in assessing the accuracy of new and easily obtainable biomarkers. For some such biomarkers, the typical stochastic ordering assumption might not be justified for all disease classes under study, and usual ROC methodologies that involve ROC surfaces and hypersurfaces are inadequate. Different types of orderings may be appropriate depending on the setting, and these may involve a number of ambiguously ordered groups that stochastically exhibit larger (or lower) marker scores than the remaining groups. Recently, there has been scientific interest on ROC methods that can accommodate these so‐called "tree" or "umbrella" orderings. However, there is limited work discussing the estimation of cutoffs in such settings. In this article, we discuss the estimation and inference around optimized cutoffs when accounting for such configurations. We explore different cutoff alternatives and provide parametric, flexible parametric, and non‐parametric kernel‐based approaches for estimation and inference. We evaluate our approaches using simulations and illustrate them through a real data set that involves TB patients. [ABSTRACT FROM AUTHOR]

To establish a cutoff level of AMH which could help for the diagnosis of PCOS, to investigate the predictive value of AMH combined with androgens in Chinese women to diagnose PCOS. This is a prospective case control study, 550 women recruited (aged 20–40 years), in which 450 PCOS women recruited according to the Rotterdam criteria and 100 non-PCOS women in the control group were from the women for the pregnancy preparation examination. AMH were measured by the Elecsys AMH Plus immunoassay. Androgens and other sex hormone were measured. The validity of AMH toward the diagnosis of PCOS, or AMH combined with total testosterone, free testosterone, bioavailable testosterone and androstenedione was estimated by receiver operating characteristic (ROC)curves, and correlations between paired variables was estimated by Spearman's rank correlation coefficient. The cutoff value of AMH in Chinese reproductive-age women with PCOS is 4.64 ng/mL, AUC under the curve is 0.938, with 81.6% sensitivity, and 92.0% specificity. Total testosterone, free testosterone, bioactive testosterone, and androstenedione are significantly higher in women with PCOS of reproductive age than in controls. The combination of AMH and free testosterone resulted in a higher AUC of 94.8%, with higher sensitivity (86.1%) and excellent specificity (90.3%) for the prediction of PCOS. The Elecsys AMH Plus immunoassay, with a cutoff of 4.64 ng/mL, is a robust method for identifying PCOM to aid in PCOS diagnosis. The combination of AMH and free testosterone resulted in a higher AUC of 94.8% for the diagnose of PCOS. [ABSTRACT FROM AUTHOR]

Background: Post-stroke cognitive impairment (PSCI) is one of the serious complications of stroke. The Montreal Cognitive Assessment (MoCA), as a brief cognitive impairment screening tool, is widely used in stroke survivors. However, some studies have suggested that the use of the universal cutoff value of 26 may be inappropriate for detecting cognitive impairments in stroke settings. Aim: We conducted this study to identify the optimal cutoff value of the MoCA in screening for PSCI. Methods: PubMed, CINAHL, Embase, the Cochrane Library, and Web of Science were searched for eligible studies until March 23, 2023. All studies were screened by two independent researchers. The quality of each article was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate mixed-effects model was used to pool sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the summary receiver operating characteristic curve. Results: Twenty-four studies with a total of 4231 patients were included in this review. Despite the lack of evidence of publication bias, a high degree of heterogeneity was observed. A meta-analysis revealed that a cutoff value of 21/22 yielded the best diagnostic accuracy. The optimal cutoff varied in different regions, stroke types, and stroke phases as well. Conclusion: The optimal cutoff of MoCA was 21/22 for stroke populations rather than the initially recommended cutoff of 26. A revised (lower) cutoff should be considered for stroke survivors. [ABSTRACT FROM AUTHOR]

Parental burnout (PB) is a chronic stress-related condition resulting from long-lasting exposure to overwhelming parenting stress. Previous studies showing the seriousness of this condition stressed the urgent need to provide researchers and practitioners with effective assessment tools. Validated PB measures are the Parental Burnout Inventory (PBI) and the Parental Burnout Assessment (PBA). The good psychometric properties of these instruments have been replicated across different samples and countries, but thresholds for identifying impairing PB levels (i.e., cutoff scores) have not yet been established. The present study aims to fill this gap by adopting a multi-informant and multimethod approach to a sample of 192 burned-out and control parents. PBI and PBA cutoffs were derived from the combination of several PB indicators, based on a preregistered analysis strategy. Results identified a score of 74.6 (95% confidence interval (CI) = [69.48–79.68]) for the PBI and 86.3 (95% CI = [79.49–93.03]) for the PBA as indicators of the most severe PB levels. [ABSTRACT FROM AUTHOR]

Purpose: Several [18F]Flortaucipir cutoffs have been proposed for tau PET positivity (T+) in Alzheimer's disease (AD), but none were data-driven. The aim of this study was to establish and validate unsupervised T+ cutoffs by applying Gaussian mixture models (GMM). Methods: Amyloid negative (A−) cognitively normal (CN) and amyloid positive (A+) AD-related dementia (ADRD) subjects from ADNI (n=269) were included. ADNI (n=475) and Geneva Memory Clinic (GMC) cohorts (n=98) were used for validation. GMM-based cutoffs were extracted for the temporal meta-ROI, and validated against previously published cutoffs and visual rating. Results: GMM-based cutoffs classified less subjects as T+, mainly in the A− CN (<3.4% vs >28.5%) and A+ CN (<14.5% vs >42.9%) groups and showed higher agreement with visual rating (ICC=0.91 vs ICC<0.62) than published cutoffs. Conclusion: We provided reliable data-driven [18F]Flortaucipir cutoffs for in vivo T+ detection in AD. These cutoffs might be useful to select participants in clinical and research studies. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to define a cutoff serum thyroglobulin (Tg) level associated with either residual or metastasis that may help decide postoperative radioactive iodine (RAI) scan and treatment in differentiated thyroid cancer (DTC) patients residing in low-income countries like Nepal. Methods We prospectively studied a total of 81 patients (female-to-male ratio of 3.0:1; mean age: 37.3 ± 14.0 years, within age range of 14–88 years) who underwent total thyroidectomy with/without neck dissection and were referred for RAI whole-body scan (WBS) ± RAI ablation or adjuvant treatment in the department of Nuclear Medicine, Chitwan Medical College. We calculated the cutoff value of Tg using receiver operating characteristic (ROC) curve analysis. Results Forty-six of 81 patients (56.7%) had remnants in the thyroid bed, 26/81 (32.1%) had regional lymph node metastasis, 9/81 (11.1%) had distant lymph node metastasis, 3/81 (3.7%) had lung metastases, and only 1/81 (1.2%) had bone metastases. RAI WBS was positive in 61/81 (75.3%) patients and negative in 20/81 (24.7%) patients. Seventeen of 81 (20.9%) patients had negative RAI scans with low serum Tg levels; only 3/81 (3.7%) patients had Tg elevated negative RAI scan (TENIS). Although scan was positive in 61/81 (75.3%) patients, 64/81 (79.0%) patients received treatment with RAI, of which 3/81 (3.7%) patients were TENIS patients. There was a significant difference in serum Tg levels between patients who received or did not receive RAI ablation or treatment (p < 0.05). On ROC curve analysis, the cutoff value of Tg levels between patients who received and did not receive treatment was 2.9 ng/mL (sensitivity: 85.9%; specificity: 94.1%; positive predictive value [PPV], 98.2%; negative predictive value [NPV]: 64.0%; AUC: 0.938). Conclusion We identified a cutoff value of 2.9 ng/mL between patients who required or did not require treatment with high sensitivity, specificity, and PPVs. [ABSTRACT FROM AUTHOR]

Background: A clear cutoff value of galactomannan (GM) has not been established for chronic pulmonary aspergillosis (CPA) and is frequently extrapolated from invasive pulmonary aspergillosis. We performed a systematic review and meta-analysis to evaluate the diagnostic performance of serum and bronchoalveolar lavage (BAL) GM, and to propose a cutoff. Methods: We extracted from the studies the cutoff of serum or/and BAL GM associated with true positives, false positives, true negatives, and false negatives. We performed a multi-cutoff model and a non-parametric random effect model. We estimated the optimal cutoff and the area under the curve (AUC) for GM in serum and BAL samples. Results: Nine studies from 1999 to 2021 were included. Overall, the optimal cutoff of serum GM was 0.96 with a sensitivity of 0.29 (95%CI: 0.14–0.51); specificity of 0.88 (95%CI: 0.73–0.95); and AUC of 0.529 (with a CI: [0.415–0.682] [0.307–0.713]). The AUC for the non-parametric ROC model was 0.631. For BAL GM the cutoff was 0.67 with a sensitivity of 0.68 (95%CI: 0.51–0.82), specificity of 0.84 (95%CI: 0.70–0.92), and AUC of 0.814 (with a CI: [0.696–0.895] [0.733–0.881]). The AUC for the non-parametric model was 0.789. Conclusion: The diagnosis of CPA requires the assessment of a combination of mycological and serological factors, as no single serum and/or BAL GM antigen test is adequate. BAL GM performed better than serum, with better sensitivity and excellent accuracy. [ABSTRACT FROM AUTHOR]

We study the multi-component Ising model, which is also known as the block Ising model. In this model, the particles are partitioned into a fixed number of groups with a fixed proportion, and the interaction strength is determined by the group to which each particle belongs. We demonstrate that the Glauber dynamics on our model exhibits the cutoff -- metastability phase transition as passing the critical inverse-temperature β cr , which is determined by the proportion of the groups and their interaction strengths, regardless of the total number of particles. For β < β cr , the dynamics shows a cutoff at α n log n with a window size O(n), where α is a constant independent of n. For β = β cr , we prove that the mixing time is of order n 3 / 2 . In particular, we deduce the so-called non-central limit theorem for the block magnetizations to validate the optimal bound at β = β cr . For β > β cr , we examine the metastability, which refers to the exponential mixing time. Our results, based on the position of the employed Ising model on the complete multipartite graph, generalize the results of previous versions of the model. [ABSTRACT FROM AUTHOR]

• Anatabine and anabasine allow differentiation of tobacco users from abstainers. • Current cutoff values may be too high, leading to misclassification. • The misclassification has an impact on insurance premiums and patients' care. • We propose more adequate cutoffs: >0.097 ng/mL (anatabine), >0.236 ng/mL (anabasine) • These cutoff values greatly increase the clinical sensitivity. Anatabine and anabasine are two tobacco alkaloids used to differentiate between tobacco users and abstainers, including users of nicotine replacement therapy. Cutoff values (>2 ng/mL for both alkaloids) have not been revised since their implementation in 2002. These values may be too high, leading to increased likelihood of misclassification between smokers and abstainers. This results in major consequences, especially adverse outcomes of transplantation when smokers were incorrectly identified as being abstinent. This study proposes that a lower threshold for anatabine and anabasine will better distinguish tobacco users from non-users and thereby improve patients' care. A new and more sensitive analytical method by liquid chromatography-mass detection was developed to allow the quantification of low concentrations. Anatabine and anabasine were measured in urine samples of 116 self-reported daily smokers and 47 long-term non-smokers (confirmed by the analysis of nicotine and its metabolites). The best compromise between sensitivity and specificity allowed us to determine new cutoff values. The thresholds >0.097 ng/mL for anatabine and >0.236 ng/mL for anabasine were associated with a sensitivity of 97% (anatabine) and 89% (anabasine) and a specificity of 98% for both alkaloids. These cutoff values greatly increased the sensitivity given that it dropped to 75% (anatabine) and 47% (anabasine) when using the reference value (>2 ng/mL). The cutoff values >0.097 ng/mL for anatabine and >0.236 ng/mL for anabasine appear to better differentiate tobacco users from abstainers than the current reference threshold (>2 ng/mL for both alkaloids). It may considerably impact patients' care, especially in transplantation settings in which smoking abstinence is essential to avoid adverse outcomes of transplantation. [ABSTRACT FROM AUTHOR]

Introduction: The hyperinflammation phase of severe SARS-CoV-2 is characterised by complete blood count alterations. In this context, the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) can be used as prognostic factors. We studied NLR and PLR trends at different timepoints and computed optimal cutoffs to predict four outcomes: use of continuous positive airways pressure (CPAP), intensive care unit (ICU) admission, invasive ventilation and death. Methods: We retrospectively included all adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia admitted from 23 January 2020 to 18 May 2021. Analyses included non-parametric tests to study the ability of NLR and PLR to distinguish the patients' outcomes at each timepoint. Receiver operating characteristic (ROC) curves were built for NLR and PLR at each timepoint (minus discharge) to identify cutoffs to distinguish severe and non-severe disease. Their statistical significance was assessed with the chi-square test. Collection of data under the SMACORE database was approved with protocol number 20200046877. Results: We included 2169 patients. NLR and PLR were higher in severe coronavirus disease 2019 (COVID-19). Both ratios were able to distinguish the outcomes at each timepoint. For NLR, the areas under the receiver operating characteristic curve (AUROC) ranged between 0.59 and 0.81, and for PLR between 0.53 and 0.67. From each ROC curve we computed an optimal cutoff value. Conclusion: NLR and PLR cutoffs are able to distinguish severity grades and mortality at different timepoints during the course of disease, and, as such, they allow a tailored approach. Future prospects include validating our cutoffs in a prospective cohort and comparing their performance against other COVID-19 scores. [ABSTRACT FROM AUTHOR]

Study Design.: Retrospective cohort. Objective.: Compare the performance of and provide cutoff values for commonly used prognostic models for spinal metastases, including Revised Tokuhashi, Tomita, Modified Bauer, New England Spinal Metastases Score (NESMS), and Skeletal Oncology Research Group model, at three- and six-month postoperative time points. Summary of Background Data.: Surgery may be recommended for patients with spinal metastases causing fracture, instability, pain, and/or neurological compromise. However, patients with less than three to six months of projected survival are less likely to benefit from surgery. Prognostic models have been developed to help determine prognosis and surgical candidacy. Yet, there is a lack of data directly comparing the performance of these models at clinically relevant time points or providing clinically applicable cutoff values for the models. Materials and Methods.: Sixty-four patients undergoing surgery from 2015 to 2022 for spinal metastatic disease were identified. Revised Tokuhashi, Tomita, Modified Bauer, NESMS, and Skeletal Oncology Research Group were calculated for each patient. Model calibration and discrimination for predicting survival at three months, six months, and final follow-up were evaluated using the Brier score and Uno's C, respectively. Hazard ratios for survival were calculated for the models. The Contral and O'Quigley method was utilized to identify cutoff values for the models discriminating between survival and nonsurvival at three months, six months, and final follow-up. Results.: Each of the models demonstrated similar performance in predicting survival at three months, six months, and final follow-up. Cutoff scores that best differentiated patients likely to survive beyond three months included the Revised Tokuhashi score=10, Tomita score=four, Modified Bauer score=three, and NESMS=one. Conclusion.: We found comparable efficacy among the models in predicting survival at clinically relevant time points. Cutoff values provided herein may assist surgeons and patients when deciding whether to pursue surgery for spinal metastatic disease. Level of Evidence.: 4. [ABSTRACT FROM AUTHOR]

We aimed to evaluate cutoff values of immunoreactive trypsinogen (IRT)/IRT and determine relationship between IRT values and clinical characteristics of children with cystic fibrosis (CF). This study is cross-sectional study. Data of children with positive newborn screening (NBS) between 2015 and 2021 were evaluated in three pediatric pulmonology centers. Age at admission, sex, gestational age, presence of history of meconium ileus, parental consanguinity, sibling with CF, and doll-like face appearance, first and second IRT values, sweat chloride test, fecal elastase, fecal fat, biochemistry results, and age at CF diagnosis were recorded. Sensitivity and specificity of IRT cutoff values were evaluated. Of 815 children with positive NBS, 58 (7.1%) children were diagnosed with CF. Median values of first and second IRT were 157.2 (103.7–247.6) and 113.0 (84.0–201.5) μg/L. IRT values used in current protocol, sensitivity was determined as 96.6%, specificity as 17.2% for first IRT, and 96.6% sensitivity, 20.5% specificity for second IRT. Positive predictive value (PPV) was determined as 7.1%. When cutoff value for first IRT was estimated as 116.7 μg/L, sensitivity was 69.0% and specificity was 69.6%, and when cutoff value was set to 88.7 μg/L for second IRT, sensitivity was 69.0% and specificity was 69.0%. Area under curve was 0.757 for first and 0.763 for second IRT (p < 0.001, p < 0.001, respectively). PPV was calculated as 4.3%. Conclusion: Although sensitivity of CF NBS is high in our country, its PPV is significantly lower than expected from CF NBS programs. False-positive NBS results could have been overcome by revising NBS strategy. What is Known: • Although immunoreactive trypsinogen elevation is a sensitive test used in cystic fibrosis newborn screening, its specificity is low. • In countries although different algorithms are used, all strategies begin with the measurement of immunoreactive trypsinogen in dried blood spots. What is New: • In our study, it was shown that use of the IRT/IRT protocol for cystic fibrosis newborn screening is not sufficient for the cut-off values determined by the high number of patients. • Newborn screening strategy should be reviewed to reduce false positive newborn screening results. [ABSTRACT FROM AUTHOR]

We prove the global existence of the non-negative unique mild solution for the Cauchy problem of the cutoff Boltzmann equation for soft potential model - 1 ≤ γ < 0 with the small initial data in three dimensional space. Thus our result fixes the gap for the case γ = - 1 in three dimensional space in the authors’ previous work (He and Jiang in J Stat Phys 168(2):470–481, 2017) where the estimate for the loss term was improperly used. The other gap in He and Jiang (2017) for the case γ = 0 in two dimensional space is recently fixed by Chen et al. (Arch Ration Mech Anal 240:327–381, 2021). The initial data f 0 is non-negative and satisfies that ‖ ⟨ v ⟩ ℓ γ f 0 (x , v) ‖ L x , v 3 ≪ 1 and ‖ ⟨ v ⟩ ℓ γ f 0 ‖ L x , v 15 / 8 < ∞ where ℓ γ = 0 when γ = - 1 and ℓ γ = (1 + γ) + when - 1 < γ < 0 . We also show that the solution scatters with respect to the kinetic transport operator. The novel contribution of this work lies in the exploration of the symmetric property of the gain term in terms of weighted estimate. It is the key ingredient for solving the model - 1 < γ < 0 when applying the Strichartz estimates. [ABSTRACT FROM AUTHOR]

Study Design.: Retrospective review of prospectively collected data. Objective.: To determine the Oswestry Disability Index (ODI) cutoff for achieving Patient Acceptable Symptom State (PASS) at one year following minimally invasive lumbar spine surgery. Summary of Background Data.: An absolute score denoting PASS, rather than a change score denoting minimal clinically important difference (MCID), might be a better metric to assess clinical outcomes. Materials and Methods.: Patients who underwent primary minimally invasive transforaminal lumbar interbody fusion or decompression were included. The outcome measure was ODI. The anchor question was the Global Rating Change: "Compared with preoperative, you feel (1) much better, (2) slightly better, (3) same, (4) slightly worse, or (5) much worse." For analysis, it was collapsed to a dichotomous outcome variable (acceptable=response of 1 or 2, unacceptable=response of 3, 4, or 5). Proportion of patients achieving PASS and the ODI cutoff using receiver operating characteristic curve analyses were assessed for the overall cohort as well as subgroups based on age, sex, type of surgery, and preoperative ODI. Differences between the PASS and MCID metrics were analyzed. Results.: A total of 137 patients were included. In all, 87% of patients achieved PASS. Patients less than or equal to 65 years and those undergoing fusion were more likely to achieve PASS. The receiver operating characteristic curve analysis revealed an ODI cutoff of 25.2 to achieve PASS (area under the curve: 0.872, sensitivity: 82%, specificity: 83%). The subgroup analyses based on age, sex, and preoperative ODI revealed area under the curve >0.8 and ODI threshold values consistent between 25.2 and 25.5 (except 28.4 in patients with preoperative ODI >40). PASS was found to have significantly higher sensitivity compared with MCID (82% vs. 69%, P =0.01). Conclusions.: Patients with ODI <25 are expected to achieve PASS, irrespective of age, sex, and preoperative disability. PASS was found to have significantly higher sensitivity than MCID. Level of Evidence.: 3. [ABSTRACT FROM AUTHOR]

In the electric dipole approximation, the model of a charged harmonic oscillator interacting with the radiation field becomes quadratic and soluble, but it needs a UV cutoff for the photon frequency. The model's renormalizability is only apparent; physics requires that the cutoff be kept finite. The cutoff plays the role of a parameter that characterizes the high frequency behavior of the photon cross-section. [ABSTRACT FROM AUTHOR]

TP53‐altered myelodysplastic syndrome with excess blasts and TP53‐altered acute myeloid leukemia should be considered under one unifying classification term for their study in clinical trials. Ultimately, such a unification would simplify the screening processes for clinical trials and allow a focus on treating the patient for a genetically defined disorder rather than one based on an arbitrary blast threshold. [ABSTRACT FROM AUTHOR]

Objective: In this phase II psychometric study on the Montreal cognitive assessment (MoCA), we tested the clinicometric properties of Italian norms for patients with mild cognitive impairment (PwMCI) and early dementia (PwD) and provided optimal cutoffs for diagnostic purposes. Methods: Retrospective data collection was performed for consecutive patients with clinically and biologically defined MCI and early dementia. Forty-five patients (24 PwMCI and 21 PwD) and 25 healthy controls were included. Raw MoCA scores were adjusted according to the conventional 1-point correction (Nasreddine) and Italian norms (Conti, Santangelo, Aiello). The diagnostic properties of the original cutoff (< 26) and normative cutoffs, namely, the upper limits (uLs) of equivalent scores (ES) 1, 2, and 3, were evaluated. ROC curve analysis was performed to obtain optimal cutoffs. Results: The original cutoff demonstrated high sensitivity (0.93 [95% CI 0.84–0.98]) but low specificity (0.44 [0.32–0.56]) in discriminating between patients and controls. Nominal normative cutoffs (ES0 uLs) showed excellent specificity (SP range = 0.96–1.00 [0.88–1.00]) but poor sensitivity (SE range = 0.09–0.24 [0.04–0.36]). The optimal cutoff for Nasreddine's method was 23.50 (SE = 0.82 [0.71–0.90]; SP = 0.72 [0.60–0.82]). Optimal cutoffs were 20.97, 22.85, and 22.29 (SE range = 0.69–0.73 [0.57–0.83], SP range = 0.88–0.92 [0.77–0.97]) for Conti's, Santangelo's, and Aiello's methods, respectively. Conclusion: Using the 1-point correction, combined with a cutoff of 23.50, might be useful in ambulatory settings with a large turnout. Our optimal cutoffs can offset the poor sensitivity of Italian cutoffs. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to provide a complete description of the eigenvalues of the generator of a neutral multi-type Moran model, and the applications to the study of the speed of convergence to stationarity. The Moran model we consider is a non-reversible in general, continuoustime Markov chain with an unknown stationary distribution. Specifically, we consider N individuals such that each one of them is of one type among K possible allelic types. The individuals interact in two ways: by an independent irreducible mutation process and by a reproduction process, where a pair of individuals is randomly chosen, one of them dies and the other reproduces. Our main result provides explicit expressions for the eigenvalues of the infinitesimal generator matrix of the Moran process, in terms of the eigenvalues of the jump rate matrix. As consequences of this result, we study the convergence in total variation of the process to stationarity and show a lower bound for the mixing time of the Moran process. Furthermore, we study in detail the spectral decomposition of the neutral multi-allelic Moran model with parent independent mutation scheme, which is the unique mutation scheme that makes the neutral Moran process reversible. Under the parent independent mutation, we also prove the existence of a cutoff phenomenon in the chi-square and the total variation distances when initially all the individuals are of the same type and the number of individuals tends to infinity. Additionally, in the absence of reproduction, we prove that the total variation distance to stationarity of the parent independent mutation process when initially all the individuals are of the same type has a Gaussian profile. [ABSTRACT FROM AUTHOR]

Introduction The Young Mania Rating Scale (YMRS) is the gold standard to assess manic symptoms of bipolar disorder, yet the clinical meaning of scores is unknown. To clinically understand and interpret YMRS scores, we examined linkages between the total and change scores of YMRS with the Clinical Global Impression (CGI) ratings. Methods Individual participant data (N=2,988) from eight randomized, double-blind, placebo-controlled trials were included. Data were collected at baseline and subsequent visits. Spearman's correlation coefficients ρ were computed, and equipercentile linking was implemented. Results A YMRS score of 6 points corresponded approximately to 'borderline mentally ill,' 12 points to 'mildly ill,' 20 points to 'moderately ill,' 30 points to 'markedly ill,' 40 points to 'severely ill,' and 52 points to 'among the most extremely ill' patients on the CGI-S. A reduction of CGI-S by one point as well as 'minimally improved' on the CGI-I corresponded approximately to an absolute decrease of 4 to 8 YMRS points or a 21% to 29% reduction of YMRS baseline score whereas a reduction of CGI-S by two points and 'much improved' on the CGI-I corresponded to an absolute decrease of 10 to 15 points or a 42% to 53% reduction of YMRS baseline score. Discussion The current study findings offer clinicians meaningful cutoff values to interpret YMRS scores. Moreover, these values contribute to the definition of treatment targets, response, remission, and entry criteria in mania trials. [ABSTRACT FROM AUTHOR]

Objectives: We compared the pregnancy prolongation effect attributable to cervical cerclage to that achieved by conservative management, and determined the cervical length for which cervical cerclage is effective. Methods: We retrospectively examined medical records of 281 women admitted to our hospital between January 2013 and December 2017 for management of threatened preterm birth at 22–28 weeks of gestation. Obstetricians determined suitability for cervical cerclage, which was performed using the McDonald procedure in all cases. Of the 281 subjects, 71 underwent cervical cerclage (cerclage group); the other 210 received conservative therapy (non-cerclage group). We recorded maternal and neonatal characteristics of all patients. The two groups were compared in terms of length of extension of pregnancy and weeks of gestation at delivery. Multivariate analysis was performed to identify factors associated with extension of time to delivery. Results: Our analyses revealed that the cerclage group was hospitalized earlier in pregnancy than the non-cerclage group (23.7 ± 1.5 weeks vs. 26.4 ± 1.9 weeks, p < .001) and had shorter cervixes (6.0 ± 9.4 mm vs. 16.9 ± 13.0 mm, p < .001). The two groups did not differ significantly in terms of gestational weeks at delivery. Multivariate analysis regarding extension of pregnancy revealed significant differences in extension of pregnancy related with cervical cerclage (26.65 days, 95% CI 17.0 – 36.3, p < .001) and cervical length <10 mm (–27.4 days, 95% CI –36.0––18.8, p < .001). While the time to delivery was extended by cervical cerclage in women with short cervixes (<25 mm), the two groups did not differ when cervical length was ≥15 mm. Conclusions: Cervical cerclage was a significant positive factor and short cervix was a significant negative factor for elongating pregnancy. In primigravida and multigravida women with no history of preterm birth, when the cervix is short (<10 mm), cervical cerclage should be recommended. [ABSTRACT FROM AUTHOR]

Background and aims: Although the Ten-Item Internet Gaming Disorder Test (IGDT-10) has been translated into Japanese and widely used, the Japanese version has not previously been validated. We used the clinical diagnosis of IGD as a gold standard for validating the test. Methods: The Japanese version was validated using 244 gamers drawn from the general young population in Japan. Expert interviews using the Japanese version of the Structured Clinical Interview for Internet Gaming Disorder evaluated diagnoses of Internet gaming disorder (IGD). This resulted in a diagnosis of IGD for eight individuals, categorized as the gold standard group. The screening performance of the two Japanese versions with different scoring conditions was examined: the scoring method proposed by the original study (original version) and a less stringent scoring method where responses of either "often" or "sometimes" were regarded as affirmative (modified version). Results: The results of the sensitivity and specificity analyses, the Cronbach's alpha and the receiver operating characteristics analysis revealed a higher screening performance for the modified versus the original version. The optimum cutoff for the modified version was 5 or more - the sensitivity, specificity, and Youden's index were 87.5, 85.2, and 72.7%, respectively. The rate of probable IGD using the original and modified versions were 1.8% and 11.3%, respectively. Discussion and conclusion: A less stringent scoring method for the Japanese version of IGDT-10 showed a higher screening performance than the original scoring method. Future studies comprising different ethnic groups and gaming cultures should further examine the suggested scoring method. [ABSTRACT FROM AUTHOR]

In this paper, which is a culmination of our previous research efforts, we provide a general framework for studying mixing profiles of non-backtracking random walks on dynamic random graphs generated according to the configuration model. The quantity of interest is the scaling of the mixing time of the random walk as the number of vertices of the random graph tends to infinity. Subject to mild general conditions, we link two mixing times: one for a static version of the random graph, the other for a class of dynamic versions of the random graph in which the edges are randomly rewired but the degrees are preserved. With the help of coupling arguments we show that the link is provided by the probability that the random walk has not yet stepped along a previously rewired edge. To demonstrate the utility of our framework, we rederive our earlier results on mixing profiles for global edge rewiring under weaker assumptions, and extend these results to an entire class of rewiring dynamics parametrised by the range of the rewiring relative to the position of the random walk. Along the way we establish that all the graph dynamics in this class exhibit the trichotomy we found earlier, namely, no cut-off, one-sided cut-off or two-sided cut-off. For interpolations between global edge rewiring, the only Markovian graph dynamics considered here, and local edge rewiring (i.e., only those edges that are incident to the random walk can be rewired), we show that the trichotomy splits further into a hexachotomy, namely, three different mixing profiles with no cut-off, two with one-sided cutoff, and one with two-sided cut-off. Proofs are built on a new and flexible coupling scheme, in combination with sharp estimates on the degrees encountered by the random walk in the static and the dynamic version of the random graph. Some of these estimates require sharp control on possible short-cuts in the graph between the edges that are traversed by the random walk. • We give a framework to study mixing of non-backtracking random walks on dynamic graphs. • We describe mixing profiles for a class of graph dynamics parametrised by their range. • For a class of graph dynamics we observe a hexachotomy in their mixing profiles. [ABSTRACT FROM AUTHOR]

The accuracy of neuropsychological assessments relies on participants exhibiting their true abilities during administration. The Test of Memory Malingering (TOMM) is a popular performance validity test used to determine whether an individual is providing honest answers. While the TOMM has proven to be highly sensitive to those who are deliberately exaggerating their symptoms, there is a limited explanation regarding the significance of using 45 as a cutoff score. The present study aims to further investigate this question by examining TOMM scores obtained in a large sample of active-duty military personnel (N = 859, M = 26 years, SD = 6.14, 97.31% males, 72.44% white). Results indicated that no notable discrepancies existed between the frequency of participants who scored a 45 and those who scored slightly below a 45 on the TOMM. The sensitivity and specificity of the TOMM were derived using the forced-choice recognition (FCR) scores obtained by participants on the California Verbal Learning Test, Second Edition (CVLT-II). The sensitivity for each trial of the TOMM was 0.84, 0.55, and 0.63, respectively; the specificity for each trial of the TOMM was 0.69, 0.93, and 0.92, respectively. Because sensitivity and specificity rates are both of importance in this study, balanced accuracy scores were also reported. Results suggested that various alternative cutoff scores produced a more accurate classification compared to the traditional cutoff of 45. Further analyses using Fisher's exact test also indicated that there were no significant performance differences on the FCR of the CVLT-II between individuals who received a 44 and individuals who received a 45 on the TOMM. The current study provides evidence on why the traditional cutoff may not be the most effective score. Future research should consider employing alternative methods which do not rely on a single score. [ABSTRACT FROM AUTHOR]

Background: While cutoffs for abnormal levels of the cerebrospinal fluid (CSF) biomarkers amyloid-β 1-42 (Aβ142), total tau (t-tau), phosphorylated tau (p-tau), and the ratios of t-tau/Aβ142 and p-tau/Aβ142, have been established in Alzheimer's disease (AD), biologically relevant cutoffs have not been studied extensively in Parkinson's disease (PD). Objective: Assess the suitability and diagnostic accuracy of established AD-derived CSF biomarker cutoffs in the PD population. Methods: Baseline and longitudinal data on CSF biomarkers, cognitive diagnoses, and PET amyloid imaging in 423 newly diagnosed patients with PD from the Parkinson's Progression Markers Initiative (PPMI) cohort were used to evaluate established AD biomarker cutoffs compared with optimal cutoffs derived from the PPMI cohort. Results: Using PET amyloid imaging as the gold standard for AD pathology, the optimal cutoff of Aβ142 was higher than the AD cutoff, the optimal cutoffs of t-tau/Aβ142 and p-tau/Aβ142 were lower than the AD cutoffs, and their confidence intervals (CIs) did not overlap with the AD cutoffs. Optimal cutoffs for t-tau and p-tau to predict cognitive impairment were significantly lower than the AD cutoffs, and their CIs did not overlap with the AD cutoffs. Conclusion: Optimal cutoffs for the PPMI cohort for Aβ142, t-tau/Aβ142, and p-tau/Aβ142 to predict amyloid-PET positivity and for t-tau and p-tau to predict cognitive impairment differ significantly from cutoffs derived from AD populations. The presence of additional pathologies such as alpha-synuclein in PD may lead to disease-specific CSF biomarker characteristics. [ABSTRACT FROM AUTHOR]

Purpose: Magnetic resonance imaging (MRI) findings in multiple sclerosis (MS) overlap with numerous MS mimics. The central vein sign (CVS) can help to differentiate MS from other mimics. This study aimed to determine the value of CVS as a diagnostic biomarker for distinguishing MS from its mimics. Patients and Methods: Patients were prospectively recruited into two groups: a typical clinical (TC) MS presentation with an atypical MRI for MS and an atypical clinical (ATC) MS presentation with a typical MRI for MS. Patients underwent a 1.5T MRI brain scan with a T2*-weighted gradient-echo sequence. The presence of the central vein was assessed by a radiologist blinded to patients' clinical presentation. The MS consultant made the final diagnosis without reviewing the T2*-weighted gradient-echo sequence or the CVS analysis results. Results: Forty-two patients were included. Ten (40%) out of 25 TC patients were diagnosed with clinically definite MS (CDMS), with a mean percentage of CV-positive lesions of 65.5% among CDMS patients. Four (23.5%) out of 17 ATC patients were diagnosed with CDMS with a mean CV-positive lesions percentage of 68.25% among CDMS patients. TC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 10.13%, while ATC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 16.38%. The CVS showed 85.7% sensitivity and 100% specificity (95% confidence interval: 0.919– 1.018) for diagnosis of MS at a cut off value of 45% (p < 0.001). The percentage of CV-positive lesions was significantly higher in oligoclonal bands (OCBs) positive patients compared to OCBs negative patients (p < 0.001) and those with spinal cord lesions compared to patients with no spinal cord lesions (p = 0.017). Conclusion: The CVS has 85.7% sensitivity and 100% specificity for the diagnosis of MS at a cutoff value of 45%. [ABSTRACT FROM AUTHOR]

Background: It is worthwhile to identify women at risk of developing postpartum depression during pregnancy. This study aimed to determine the optimal time and cutoff score for antenatal screening for prediction of postpartum depressive symptoms (PDS) using the Edinburgh Postnatal Depression Scale (EPDS) and to identify risk factors for PDS.Methods: The target population was healthy pregnant women receiving antenatal care at a university hospital in Tokyo, Japan. During the first, second, and third trimesters, 3-4 days postpartum, and one month postpartum, they were asked to take the Japanese version of the EPDS questionnaire. The primary outcome of the study was PDS, defined as an EPDS score ≥ 9 at one month postpartum. The area under the receiver operating characteristics curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of EPDS scores at each antenatal screening time were calculated.Results: From 139 pregnant women, 129 were successfully followed up throughout the study. The number of women with an EPDS score ≥ 9 during the first, second, and third trimesters, 3-4 days postpartum, and one month postpartum were 6/126 (4.8%), 9/124 (7.3%), 5/117 (4.3%), 17/123 (13.8%), and 15/123 (12.2%), respectively. Screening during the second trimester had the highest AUC to predict PDS (0.89) among antenatal screenings. The optimal EPDS cutoff score during the second trimester was 4/5 (sensitivity: 85.7%; specificity: 77.1%; PPV: 33.3%; NPV: 97.6%). An EPDS score ≥ 5 during the second trimester (adjusted odds ratio [aOR]: 15.9; 95% confidence interval [95%CI]: 3.2-78.1) and a family history of mental illness (aOR: 4.5; 95%CI: 1.2-17.5) were significantly associated with PDS.Conclusions: Our study suggests that the EPDS score at the second trimester with the cutoff value of 4/5 may be adequate for initial screening for prediction of PDS. Women with an EPDS score ≥ 5 at the second trimester require more elaborate follow-up. [ABSTRACT FROM AUTHOR]

Purpose: To determine cutoff values for the Knee Society Scores (KSS) indicative of a categorical scale of medium-term outcomes. Methods: One hundred and fifty-five patients who underwent primary cruciate-retaining TKA with a patellar button for osteoarthritis at a single-centre were assessed prospectively by the KSS and short-form Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) simultaneously at the 3-year follow-up. A validated categorization of the WOMAC score was used as a standard. The area under the curve (AUC) of receiver-operating characteristic (ROC) was used to assess the discriminative analysis accuracy of the, and the Youden index estimated the optimal cutoff point. Results: For the KSS-knee score, the cutoff for an excellent outcome was 90.3 (AUC 0.75, 95% CI 0.71–0.78), 76.6 (AUC 76.6, 95% CI 0.70–076) for good, 64.8 (AUC 0.76, 95% CI 0.72–0.79) for fair, and < 64.8 (AUC 0.69, 95% CI 0.67–0.73) for poor. For the KSS-function score, the cutoff values were 85.2 (AUC 0.71, 95% CI 0.69–0.75), 73.1 (AUC 0.72, 95% CI, 0.70–0.76), 55.7 (AUC 0.70, 95% CI 0.71–0.74), and < 55.7 (AUC 0.68, 95% CI 0.66–0.72), respectively. Conclusion: A KSS-knee score ≥ of 90 was considered an excellent outcome, 77 good, 65 fair, and < 65 poor. For the KSS-function, those values are 85, 73, 56 and < 56, respectively. The treatment outcome's judgement may be clearer for the surgeon concerning a particular patient when using cutoff values for the scoring system employed, such as those determined in the present study. Level of evidence: II. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic elicited fear. The Fear of COVID-19 Scale (FCV-19S) is a newly developed self-reported measure, originally developed in Persian to assess COVID-19-related fear. To date, the scale has been translated and validated in 19 other languages, among which Greek. This study, conducted through an online survey, aimed to further explore the validity of the Greek FCV-19S version, as well as to identify appropriate cutoff scores. A total of 538 respondents completed the sociodemographic data sheet, the Generalized Anxiety Disorder 7-item scale, the Short Health Anxiety Inventory, and the Posttraumatic Stress Disorder-8 inventory. According to the results, a cutoff point score of 16.5 or higher revealed a significant predictive power for anxiety, health anxiety, and posttraumatic stress symptoms. Altogether, although the cutoff scores of the Greek FCV-19S version were explored to further evaluate the scale's validity, they may facilitate discrimination of adults with extreme COVID-19-related fear from those with normal fear reactions. [ABSTRACT FROM AUTHOR]

Context: There is a need for a clear cutoff to use noise sensitivity (NS) scale as a prediagnostic tool in research and clinical use.Aims: : Noise sensitivity questionnaire (NoiSeQ) was adapted into Turkish language (Tr-NoiSeQ); validity and reliability of the Tr-NoiSeQ were assessed. The cutoff for the Tr-NoiSeQ was determined.Settings and design: : A descriptive study within subject design.Materials and methods: A group of 402 participants aged between 18 and 52 years filled the Tr-NoiSeQ and the Turkish version of Weinstein noise sensitivity scale (Tr-WNSS) via internet.Statistical analysis used: Cronbach alpha (α) and the Spearman‒Brown coefficient were calculated for the reliability; Pearson correlation coefficient (r) and confirmatory factor analysis (CFA) were used for the validity. The receiver-operating characteristic (ROC) curve was used to calculate cutoff value of the Tr-NoiSeQ.Results: For the Tr-NoiSeQ, Cronbach α was 0.92, Spearman‒Brown coefficient was 0.93 (P < 0.05). A high significant correlation between the Tr-WNSS and the Tr-NoiSeQ was obtained (r = 0.76, P < 0.05). The fit indexes of the model were obtained as (χ2 = 1361.06, df = 546, P < 0.001), χ2 / df = 2.49, root mean square error of approximation = 0.06, comparative fit index = 0.83, goodness of fit index = 0.82. The ROC curve showed that the cutoff for the Tr-NoiSeQ was 53 with a 0.92 sensitivity and a 0.85 specificity (P ≤ 0.05).Conclusion: The Tr-NoiSeQ is a valid and reliable tool for use in both clinical practice and research. The Tr-NoiSeQ seems to be consistent with the Tr-WNSS and can be used as a screening tool to evaluate NS in audiology. [ABSTRACT FROM AUTHOR]

Background: Rapid development of high-throughput omics technologies generates an increasing interest in algorithms for cutoff point identification. Existing cutoff methods and tools identify cutoff points based on an association of continuous variables with another variable, such as phenotype, disease state, or treatment group. These approaches are not applicable for descriptive studies in which continuous variables are reported without known association with any biologically meaningful variables. Results: The most common shape of the ranked distribution of continuous variables in high-throughput descriptive studies corresponds to a biphasic curve, where the first phase includes a big number of variables with values slowly growing with rank and the second phase includes a smaller number of variables rapidly growing with rank. This study describes an easy algorithm to identify the boundary between these phases to be used as a cutoff point. Discussion: The major assumption of that approach is that a small number of variables with high values dominate the biological system and determine its major processes and functions. This approach was tested on three different datasets: human genes and their expression values in the human cerebral cortex, mammalian genes and their values of sensitivity to chemical exposures, and human proteins and their expression values in the human heart. In every case, the described cutoff identification method produced shortlists of variables (genes, proteins) highly relevant for dominant functions/pathways of the analyzed biological systems. Conclusions: The described method for cutoff identification may be used to prioritize variables in descriptive omics studies for a focused functional analysis, in situations where other methods of dichotomization of data are inaccessible. [ABSTRACT FROM AUTHOR]

In a recent breakthrough, Teyssier (Ann Probab 48(5):2323–2343, 2020) introduced a new method for approximating the distance from equilibrium of a random walk on a group. He used it to study the limit profile for the random transpositions card shuffle. His techniques were restricted to conjugacy-invariant random walks on groups; we derive similar approximation lemmas for random walks on homogeneous spaces and for general reversible Markov chains. We illustrate applications of these lemmas to some famous problems: the k-cycle shuffle, sharpening results of Hough (Probab Theory Relat Fields 165(1–2):447–482, 2016) and Berestycki, Schramm and Zeitouni (Ann Probab 39(5):1815–1843, 2011), the Ehrenfest urn diffusion with many urns, sharpening results of Ceccherini-Silberstein, Scarabotti and Tolli (J Math Sci 141(2):1182–1229, 2007), a Gibbs sampler, which is a fundamental tool in statistical physics, with Binomial prior and hypergeometric posterior, sharpening results of Diaconis, Khare and Saloff-Coste (Stat Sci 23(2):151–178, 2008). [ABSTRACT FROM AUTHOR]

We aimed to predict subsequent gestational diabetes mellitus (GDM) by fasting plasma glucose (FPG) in the first trimester. Healthy pregnant women who were screened for GDM at 24–28 gestational weeks and had FPG levels calculated during their first antenatal visit and less than 14 gestational weeks were included in this study. Of the 2605 women who were recruited for the study, 245 (9.4%) were diagnosed with GDM at weeks 24–28. The diagnostic accuracy for FPG predicting GDM was 66.5, 78.4, and 88.2 for the cutoff values of 87.5 mg/dl, 92 mg/dl, and 99.5 mg/dl, respectively. FPG values which are within the normoglycaemic range constitute an independent risk factor for the development of GDM. The threshold for gestational diabetes diagnosis must be revised. [ABSTRACT FROM AUTHOR]

The earliest formulation of the Higgs naturalness argument has been criticized on the grounds that it relies on a particular cutoff-based regularization scheme. One response to this criticism has been to circumvent the worry by reformulating the naturalness argument in terms of a renormalized, regulator-independent parametrization. An alternative response is to deny that regulator dependence poses a problem for the naturalness argument, because nature itself furnishes a particular, physically correct regulator for any effective field theory (EFT) in the form of that EFT’s physical cutoff, together with an associated set of bare parameters that constitute the unique physically preferred “fundamental parameters” of the EFT. Here, I argue that both lines of defense against the initial worry about regulator dependence are flawed. I argue that reformulation of the naturalness argument in terms of renormalized parameters simply trades dependence on a particular regularization scheme for dependence on a particular renormalization scheme, and that one or another form of scheme dependence afflicts all formulations of the Higgs naturalness argument. Concerning the second response, I argue that the grounds for suspending the principle of regularization or renormalization scheme independence in favor of a physically preferred parametrization are thin; the assumption of a physically preferred parametrization, whether in the form of bare “fundamental parameters” or renormalized “physical parameters,” constitutes a theoretical idle wheel in generating the confirmed predictions of established EFTs, which are invariably scheme-independent. I highlight certain features of the alternative understanding of EFTs, and the EFT-based approach to understanding the foundations of QFT, that emerges when one abandons the assumption of a physically preferred parametrization. I explain how this understanding departs from several dogmas concerning the mathematical formulation and physical interpretation of EFTs in high-energy physics. [ABSTRACT FROM AUTHOR]

Human growth hormone (hGH) provocation test is an essential tool to assess growth hormone deficiency (GHD) in children and young adults. It is important to have a robust method to determine the hGH peak of stimulation. This work aimed to compare three common automated immunoassays for hGH quantification and to ascertain whether there are still result-related differences which can impact clinical decision. We analyzed the GH provocation test for 39 young subjects from pediatric department of Montpellier hospital, admitted for suspicion of growth hormone deficiency. The full range of measurements as well as the peak level of serum GH were compared using three automated immunoassays on three different immunoanalyzers: IDS-hGH on iSYS, LIAISON-hGH on Liaison XL and Elecsys ROCHE-hGH, on COBAS 8000. A good correlation was obtained between methods for all measurements (r2>0.99) by using Passing–Bablok regression analysis. Bland–Altman analysis showed the best agreement between IDS-hGH and LIAISON-hGH systems (bias=−14.5%) compared to Elecsys ROCHE-hGH (bias=28.3%). When considering stratification of the study population and a unique cutoff, there were some discrepancies in interpretation of the results especially concerning the more recent Elecsys ROCHE-hGH assay. Nevertheless, when the adequate cutoff for each method was taken into account results were well correlated for all systems. A cutoff for Elecsys Roche-hGH method was established to better explain the results. Clinician must be aware of the use of assay-specific cutoff to correctly integrate the results of GH tests in the GHD diagnosis. [ABSTRACT FROM AUTHOR]

The Fredrickson-Andersen one spin facilitated model belongs to the class of Kinetically Constrained Spin Models. It is a non attractive process with positive spectral gap. In this paper we give a precise result on the relaxation for this process on an interval [1, L] starting from any initial configuration. A consequence of this result is that this process exhibits cutoff at time L/(2v) with window O(√L) for a certain positive constant v. The key ingredient is the study of the evolution of the leftmost empty site in a filled infinite half-line called the front. In the process of the proof, we improve recent results about the front motion by showing that it evolves at speed v according to a uniform central limit theorem. [ABSTRACT FROM AUTHOR]

Cefquinome is the fourth generation of cephalosporin approved solely in animal usage. In order to slow down the resistance development of E. coli to cefquinome, and to protect and maintain the effectiveness of cefquinome, an ex vivo PK/PD modeling of cefquinome against E. coli in cows after intramammary infusion administration was conducted. The epidemiologic cutoff (ECOFF) and pharmacodynamic cutoff (COPD) of cefquinome against E. coli in lactation cows after intramammary infusion administration were recommended. The MICs of cefquinome against 1073 clinical E. coli isolates ranged from 0.015 to >64 μg/ml, and the ECOFF was defined as 0.125 μg/ml. The pharmacokinetic results showed that cefquinome maintained high concentration in milk for a long period with the T1/2β of 10.60 h after intramammary infusion in dairy cows. The drug concentration in skimmed milk was still as high as 0.15 mg/ml after 48 h. Cefquinome displayed bacterial killing effect at 2× MIC with the initial inoculum of 106 cfu/ml in vitro; however, the same effect was attained with a concentration as high as 32× MIC with the initial inoculum of 108 cfu/ml both in artificial medium and in skimmed milk. The initial inoculum is an important factor on time‐killing curve accounting for weakened killing pattern of cefquinome. The AUC0–24 h/MIC index correlated well with ex vivo efficacy. The AUC0–24 h/MIC values for bactericidal effect were 50, 016, and 67,644, respectively, for initial inoculum of 106 and 108 cfu/ml, indicating the bacterial loading or the severity of infection would infect the PK/PD modeling results. The ex vivo PK/PD‐based population dose prediction indicated a target attainment rate (TAR) at the existing daily dose (75 mg/udder) of 84.77% against E. coli. Thus, it was recommended as rational dosage. The COPD of cefquinome against E. coli was determined as 8 μg/ml at the dose of 75 mg/udder. The derived ECOFF, COPD, together with ex vivo PK/PD‐based population dose prediction served as important steps in the establishment of optimum dose regimen and provided a useful interpretative criterion to categorize the antimicrobial susceptibility testing results of cefquinome. [ABSTRACT FROM AUTHOR]

Recently, the asymptotic mean value of the height for a birth-and-death process is given in Videla [Videla, L.A. (2020)]. We consider the asymptotic variance of the height in the case when the number of states tends to infinity. Further, we prove that the heights exhibit a cutoff phenomenon and that the normalized height converges to a degenerate distribution. [ABSTRACT FROM AUTHOR]

Establishing the virological cutoff point, during epidemics, such as the COVID-19 Pandemic, is crucially important as inadequate standardization and the false qualitative results, have enormous clinical and economic consequences when screening for SARS-CoV-2. Moreover, a cutoff point is a crucial step in ensuring a minimal risk of clinical misclassification. Therefore complying with such statutory requirements is an essential part of obligatory good laboratory and clinical practices. In this concise report, we propose a novel methodology for establishing cutoff points for all samples exhibiting detectable levels of the measured parameter, even those from the disease-free group. Based on target specificity and sensitivity levels of 100 % and 95 %, a value of 1209 A is identified as the "best cutoff". In fact, the ROC decision matrixes play a crucial role in determining optimal cutoff points. The most effective discriminators are those that meet specified accuracy criteria. The selection process is influenced by finding the right clinical sensitivity/specificity trade-off. [ABSTRACT FROM AUTHOR]

Peak stimulated growth hormone (GH) levels are known to decrease with increasing body mass index (BMI), possibly leading to overdiagnosis of GH deficiency (GHD) in children with overweight and obesity. However, current guidelines do not guide how to interpret the peak GH values of these children. This systematic review and meta-analysis aimed to study the effect of the BMI standard deviation score (SDS) on stimulated peak GH values in children, to identify potential moderators of this association, and to quantify the extent to which peak GH values in children with obesity are decreased. This systematic review was performed by the PRISMA guidelines. Medline, Embase, Cochrane, Web of Science, and Google Scholar databases were searched for studies reporting the impact of weight status on peak GH in children. Where possible, individual participant data was extracted and/or obtained from authors. Quality and risk of bias were evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) checklists. The primary outcome was the association between peak GH values and BMI SDS. The pooled correlation coefficient r, 95% confidence interval (CI), and heterogeneity statistic I2 were calculated under a multilevel, random-effects model. In addition, exploratory moderator analyses and meta-regressions were performed to investigate the effects of sex, pubertal status, presence of syndromic obesity, mean age and mean BMI SDS on the study level. For the individual participant dataset, linear mixed-models regression analysis was performed with BMI SDS as the predictor and ln(peak GH) as the outcome, accounting for the different studies and GH stimulation agents used. In total, 58 studies were included, providing data on n = 5135 children (576 with individual participant data). Thirty-six (62%) studies had high, 19 (33%) medium, and 3 (5%) low risks of bias. Across all studies, a pooled r of −0.32 (95% CI −0.41 to −0.23, n = 2434 patients from k = 29 subcohorts, I2 = 75.2%) was found. In meta-regressions, larger proportions of males included were associated with weaker negative correlations (p = 0.04). Pubertal status, presence of syndromic obesity, mean age, and mean BMI SDS did not moderate the pooled r (all p > 0.05). Individual participant data analysis revealed a beta of −0.123 (95% CI −0.160 to −0.086, p < 0.0001), i.e. per one-point increase in BMI SDS, peak GH decreases by 11.6% (95% CI 8.3–14.8%). To our knowledge, this is the first systematic review and meta-analysis to investigate the impact of BMI SDS on peak GH values in children. It showed a significant negative relationship. Importantly, this relationship was already present in the normal range of BMI SDS and could lead to overdiagnosis of GHD in children with overweight and obesity. With the ever-rising prevalence of pediatric obesity, there is a need for BMI (SDS)-specific cutoff values for GH stimulation tests in children. Based on the evidence from this meta-analysis, we suggest the following weight status-adjusted cutoffs for GH stimulation tests that have cutoffs for children with normal weight of 5, 7, 10, and 20 µg/L: for overweight children: 4.6, 6.5, 9.3, and 18.6 µg/L; and for children with obesity: 4.3, 6.0, 8.6, and 17.3 µg/L. [ABSTRACT FROM AUTHOR]

We study the convergence to stationarity for random walks on dynamic random digraphs with given degree sequences. The digraphs undergo full regeneration at independent geometrically distributed random time intervals with parameter α. Relaxation to stationarity is the result of an interplay of regeneration and mixing on the static digraph. When the number of vertices n tends to infinity and the parameter α tends to zero, we find three scenarios according to whether α log n converges to zero, infinity or to some finite positive value: when the limit is zero, relaxation to stationarity occurs in two separate stages, the first due to mixing on the static digraph, and the second due to regeneration; when the limit is infinite, there is not enough time for the static digraph to mix and the relaxation to stationarity is dictated by the regeneration only; finally, when the limit is a finite positive value we find a mixed behavior interpolating between the two extremes. A crucial ingredient of our analysis is the control of suitable approximations for the unknown stationary distribution. [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcome measures are widely utilized to assess health-related quality of life (HRQOL) in patients with adolescent idiopathic scoliosis (AIS). However, the association between HRQOL and curve severity is mostly unknown. The aim of this study is to clarify the association between HRQOL and curve severity, and to determine the optimal cutoff values of patient-reported outcomes for major curve severity in female patients with AIS.Methods: Female patients with AIS treated conservatively were recruited. The patients' HRQOL outcomes were examined using the revised Scoliosis Research Society-22 (SRS-22r) and the Scoliosis Japanese Questionnaire-27 (SJ-27). The correlations of the SRS-22r and SJ-27 scores with the major Cobb angle were assessed using Spearman's correlation coefficient analysis. The association between HRQOL issues in the SJ-27 and the major Cobb angle was evaluated by calculating Akaike's Information Criterion (AIC). Furthermore, the optimal cutoff values of the SRS-22r and SJ-27 scores for the major Cobb angle were determined by AIC analysis.Results: The study cohort comprised 306 female patients with AIS. The SRS-22r and SJ-27 scores were significantly correlated with the major Cobb angle. Questions in the SJ-27 regarding discomfort when wearing clothes showed a lower AIC value in patients with severe scoliosis. The optimal cutoff values were a SRS-22r score of 3.2 for the discrimination of severe scoliosis (Cobb angle ≥48°), and a SJ-27 score of 32 for the discrimination of moderate scoliosis (Cobb angle ≥33°).Conclusion: Discomfort when wearing clothes was the most important HRQOL problem caused by severe scoliosis. The SRS-22r and SJ-27 scores are useful for the discrimination of clinical status in female patients with severe scoliosis or moderate scoliosis. [ABSTRACT FROM AUTHOR]