ObjectiveTo evaluate whether clinicians differ in how they evaluate and interpret diagnostic test information.DesignSystematic review.Data sourcesMEDLINE, EMBASE and PsycINFO from inception to ...September 2013; bibliographies of retrieved studies, experts and citation search of key included studies.Eligibility criteria for selecting studiesPrimary studies that provided information on the accuracy of any diagnostic test (eg, sensitivity, specificity, likelihood ratios) to health professionals and that reported outcomes relating to their understanding of information on or implications of test accuracy.ResultsWe included 24 studies. 6 assessed ability to define accuracy metrics: health professionals were less likely to identify the correct definition of likelihood ratios than of sensitivity and specificity. –25 studies assessed Bayesian reasoning. Most assessed the influence of a positive test result on the probability of disease: they generally found health professionals’ estimation of post-test probability to be poor, with a tendency to overestimation. 3 studies found that approaches based on likelihood ratios resulted in more accurate estimates of post-test probability than approaches based on estimates of sensitivity and specificity alone, while 3 found less accurate estimates. 5 studies found that presenting natural frequencies rather than probabilities improved post-test probability estimation and speed of calculations.ConclusionsCommonly used measures of test accuracy are poorly understood by health professionals. Reporting test accuracy using natural frequencies and visual aids may facilitate improved understanding and better estimation of the post-test probability of disease.
Abstract
The Joint European Torus (JET) has recently conducted its second deuterium–tritium (DT) experimental campaign DTE2, providing unique opportunity for studying both physics and engineering ...aspects of nuclear fusion plasmas. This also allowed the exploitation of new diagnostics and technologies that were not available during the first JET DT campaign held in 1997. Among these new instruments, the enhancement projects of the JET nuclear diagnostics lead to the development and installation of synthetic single crystal diamond detectors along different collimated line of sights. This paper describes the single crystal diamond-based diagnostic suite of the JET tokamak and the enhanced 14 MeV neutron diagnostic capabilities in terms of neutron yield and high resolution neutron spectroscopy. The diamond characterization measurements and the calibration procedure at JET are shown, together with performance of the diamond based neutron spectrometer as 14 MeV neutron yield monitor which allows the separation of 2.5 MeV and 14 MeV neutrons in trace tritium plasmas. The first high-resolution 14 MeV neutron spectroscopy measurements in neutral beam injection-heated DT plasmas are presented, allowing thermal and non-thermal neutron component separation. Prospects for the diagnose of DT burning plasmas such as ITER and SPARC will be presented.
Background: Anatomy is critical in risk stratification and therapeutic decision making in coronary disease. The relationship between anatomy and outcomes is not well described in PAD. We sought to ...develop an angiographic core lab within the VOYAGER-PAD trial. The current report describes the methods of creating this core lab, its study population, and baseline anatomic variables. Methods: Patients undergoing lower-extremity revascularization for symptomatic PAD were randomized in VOYAGER-PAD. The median follow up was 2.25 years. Events were adjudicated by a blinded Clinical Endpoint Committee. Angiograms were collected from study participants; those with available angiograms formed this core lab cohort. Angiograms were scored for anatomic and flow characteristics by trained reviewers blinded to treatment. Ten percent of angiograms were evaluated independently by two reviewers; inter-rater agreement was assessed. Clinical characteristics and the treatment effect of rivaroxaban were compared between the core lab cohort and noncore lab participants. Anatomic data by segment were analyzed. Results: Of 6564 participants randomized in VOYAGER-PAD, catheter-based angiograms from 1666 patients were obtained for this core lab. Anatomic and flow characteristics were collected across 16 anatomic segments by 15 reviewers. Concordance between reviewers for anatomic and flow variables across segments was 90.5% (24,417/26,968). Clinical characteristics were similar between patients in the core lab and those not included. The effect of rivaroxaban on the primary efficacy and safety outcomes was also similar. Conclusions: The VOYAGER-PAD angiographic core lab provides an opportunity to correlate PAD anatomy with independently adjudicated outcomes and provide insights into therapy for PAD. (ClinicalTrials.gov Identifier: NCT02504216)
Objectives To review the evidence for an association of white matter hyperintensities with risk of stroke, cognitive decline, dementia, and death.Design Systematic review and meta-analysis.Data ...sources PubMed from 1966 to 23 November 2009.Study selection Prospective longitudinal studies that used magnetic resonance imaging and assessed the impact of white matter hyperintensities on risk of incident stroke, cognitive decline, dementia, and death, and, for the meta-analysis, studies that provided risk estimates for a categorical measure of white matter hyperintensities, assessing the impact of these lesions on risk of stroke, dementia, and death.Data extraction Population studied, duration of follow-up, method used to measure white matter hyperintensities, definition of the outcome, and measure of the association of white matter hyperintensities with the outcome.Data synthesis 46 longitudinal studies evaluated the association of white matter hyperintensities with risk of stroke (n=12), cognitive decline (n=19), dementia (n=17), and death (n=10). 22 studies could be included in a meta-analysis (nine of stroke, nine of dementia, eight of death). White matter hyperintensities were associated with an increased risk of stroke (hazard ratio 3.3, 95% confidence interval 2.6 to 4.4), dementia (1.9, 1.3 to 2.8), and death (2.0, 1.6 to 2.7). An association of white matter hyperintensities with a faster decline in global cognitive performance, executive function, and processing speed was also suggested.Conclusion White matter hyperintensities predict an increased risk of stroke, dementia, and death. Therefore white matter hyperintensities indicate an increased risk of cerebrovascular events when identified as part of diagnostic investigations, and support their use as an intermediate marker in a research setting. Their discovery should prompt detailed screening for risk factors of stroke and dementia.
The fungal genus
is one of the most important groups of plant-pathogenic fungi and affects a huge diversity of crops in all climatic zones across the globe. In addition, it is also a human pathogen ...and produces several extremely important mycotoxins in food products that have deleterious effects on livestock and humans. These fungi have been plagued over the past century by different perspectives of what constitutes the genus
and how many species occur within the genus. Currently, there are conflicting views on the generic boundaries and what defines a species that impact disease diagnosis, management, and biosecurity legislation. An approach to defining and identifying
that places the needs of the community of users (especially, in this case, phytopathologists) to the forefront is presented in this review.
The article developed a methodological basis for implementing automatic diagnostics based on thermal analysis of bearing assemblies. The diagnostic criteria of the technical operation condition and ...the procedure for determining the temperature ratio inside and outside the bearing unit based on the finite element analysis (FEA) of stable thermal conductivity have proven to be justified. Method of simulation of stable thermal conductivity of bearing units using KOMPAS-3D software and APM FEM finite element analysis module is proposed. The developed method was tested in practice and verified based on the results of theoretical and experimental studies. The developed method enables the determination of the relationship between the observed temperature on the surface of the bearing units and the friction temperature in the wear zone.
Recent technological developments in cardiac magnetic resonance imaging (MRI) have resulted in the rapid acquisition of images of the heart with high spatial and temporal resolution and excellent ...myocardial tissue characterization. Cardiac MRI allows the noninvasive assessment of cardiac function, myocardial perfusion and viability, detection and characterization of inflammatory heart disease and other cardiomyopathies and congenital heart disease. This article will review the basic cardiac sequences and common indications for MRI in cardiology.
The enzyme creatine kinase (CK) is present in large concentrations in skeletal muscle, smooth muscle and cardiac muscle. Elevated levels of CK in the blood can occur in conditions where there is ...damage to cardiac or skeletal muscle. This article briefly discusses the underlying biology and clinical applications of serum CK testing.
Highlights • We discuss the frontiers of POC diagnostic technologies using a drop of blood obtained from a finger prick. • A great challenge is still required to develop simple, inexpensive, rapid, ...and easy-to-use technologies for blood molecular diagnostics. • Proteins, nucleic acids, and other molecules, as well as downstream molecular analyses based on cancer cells isolated from the blood are surveyed for molecular diagnostics in a drop of blood. • Various technologies, including emerging biotechnologies, nanotechnologies, and microfluidics, hold the potential for rapid, accurate, and nonexpensive disease diagnostics.
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