Screening for colorectal cancer: which test is best?
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Biomedical subjects
Publications and source records attributed to T Church.
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The voltage (or, equivalently, energy) at which defibrillation occurs for a specific episode of fibrillation can be represented by specifying or estimating the probability of successful defibrillation for each voltage or energy. This relation of voltage to probability is the probability function. For a series of attempts, the probability function predicts the frequency with which defibrillation will occur at a given voltage. By defining the defibrillation threshold (DFT) as the voltage at which the probability function takes on a specific value, say 50%, a method of defibrillation threshold determination can be evaluated by how accurately and precisely it estimates the "true" defibrillation threshold. By utilizing estimated probability functions from animals and humans, the relative performance of different methods of defibrillation threshold determination can be evaluated. Three methods were evaluated using published animal data and human clinical data: (1) stepping down to the first voltage that fails; (2) stepping up to the first voltage that succeeds; and (3) doing both 1 and 2 and averaging. In all cases, Method 3 has lower total error. Definitions of defibrillation threshold other than the 50% level can also be evaluated in this fashion.
Polyurethane leads have been implanted in humans since 1977. Because of cases of stress cracking found in 1981, changes in the manufacturing process were made. Subsequent performance was excellent. There remains concern regarding the ability to predict accurately long-term performance. However, the advent of reliable, statistically accurate actuarial data coupled with accelerated tests predictive of human performance has restored confidence in the newer polyurethane lead technology.
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In the design of a medical screening program, it is standard practice to employ the parameters of sensitivity and specificity of the test, together with the population disease prevalence, in order to obtain the predictive values of the test. Multiphasic screening, i.e. the use of two or more tests on the same occasion to screen for more than a single disease, has stimulated the need for a formulation of the joint predictive value of these tests employed in combination. In this communication a parameterization of joint predictive value is presented in the context of multisite cancer screening. The resulting parameters are related to the separate disease prevalences, as well as to the sensitivities and specificities of the separate tests, under the assumption of statistical independence among cancer screens.
Porcelain occasionally fractures from ceramometal fixed partial dentures following final cementation. Repair of these porcelain fractures can be a challenging task. When the problem occurs on anterior teeth, it is especially difficult because the repair must not only be durable, but esthetically pleasing as well. Although composite resins can be used for some repairs, it is often difficult to match the color and texture to the surrounding intact porcelain. In addition, the bonding between the resin and porcelain is susceptible to margin leakage, which may ultimately cause an esthetic failure. Techniques involving a cemented porcelain-fused-to-metal overcasting have often been successful in restoring the fixed partial denture to form and function. Although the esthetic result of a porcelain/metal overcasting can be quite successful, retention of the overcasting is sometimes poor. The compromised retention and resistance form is due to lack of interproximal walls on the underlying fractured unit. To improve the retention of the overcasting, the following technique of tin plating the overcasting and fractured unit prior to cementing with a composite resin cement is presented.