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Effectiveness of vaginal Papanicolaou smear screening after total hysterectomy for benign disease.

OBJECTIVE: Using literature review, we assessed (1) Papanicolaou smear screening recommendations after hysterectomy for benign disease, (2) total hysterectomy for benign disease as a risk for vaginal dysplasia or carcinoma, and (3) effectiveness of screening for vaginal carcinoma after total hysterectomy for benign disease. DATA SOURCES: We considered (1) organizations' recommendations about screening, (2) references from major textbooks of gynecology, and (3) MEDLINE searches of English-language studies published from 1966 through 1995 using the search strategy (hysterectomy and vaginal smears) or (vaginal smears and vaginal neoplasms). STUDY SELECTION: Published or verbal confirmations of screening recommendations were eligible. Criteria for assessing risk of vaginal dysplasia or carcinoma included original research, documented reports of hysterectomy as an exposure, and evidence of preinvasive vaginal disease or vaginal carcinoma outcomes. We sought data assessing burden of suffering, screening efficacy, and effectiveness of early detection. DATA EXTRACTION: Descriptive and analytic data from each study were abstracted. DATA SYNTHESIS: Screening recommendations were categorized by the organizations' positions: two opposed screening, two supported screening, and six lacked specific guidelines. Data on the risk between total hysterectomy for benign disease and subsequent vaginal carcinoma were organized by study design (three case control, two cohort, and 13 case series) and described. Data on screening effectiveness were organized to address the criteria advocated by the US Preventive Services Task Force. CONCLUSIONS: There are conflicting guidelines on screening after hysterectomy and conflicting data on the risk of vaginal carcinoma after total hysterectomy for benign disease, though the best-designed research suggests no association. There is insufficient evidence to recommend routine vaginal smear screening in women after total hysterectomy for benign disease.

Carcinoma in Situ↗

Transferability of clinical laboratory data within a health care region.

Analytical data for S-Creatinine and S-Urate are presented from seventeen laboratories in the Swedish Uppsala-Orebro regional quality assessment program. The bias and imprecision as well as the instability of the measurement procedures in the participating laboratories were estimated over three 14-week periods. Bias was estimated by a linear least squares fit of the difference between measured and assigned values vs. assigned values, and expressed in absolute and relative terms. Instability of the measurement procedures was estimated by comparing slope and intercept of regression lines of measured vs. assigned values from three fourteen week periods. According to our experiences we recommend regression analysis to describe the performance of the analytical methods of a laboratory over time. The results show that most laboratories fell within the limits of +/- 15% bias for S-Creatinine above 100 mumol l-1 and +/- 17% for S-Urate at concentrations above 250 mumol l-1. Various steps to reduce the inter-laboratory variability are suggested, including numerical correction of individual laboratory results using correction functions. In a few laboratories, instability was too high to allow for numerical corrections of analytical results.

Bias↗

Data management in multi-method surface analysis.

The solution of the problem of interchangeability of surface analytical data is gaining increasing importance in multi-method surface analysis. There are various surface analytical instruments in different laboratories on several automation levels. For these instruments, which are controlled by computer systems working with proprietary software under various operating systems, a standardised data format is necessary to allow an exchange of data. Therefore, a toolkit has been developed for the transfer, archiving and editing of surface analytical data in a standardised public domain format. This format contains all available and necessary information on experimental conditions and all parameters specific for a number of analytical techniques such as AES, SAM, XPS, SIMS, STM, AFM and EPMA. Additionally, all data concerning the conditions of sample-preparation and measurement history are included in order to allow a well-founded evaluation of the data and improved reproducibility of the experiment.

Journal Article↗

Expert systems for the evaluation of data quality for establishing the Recommended Dietary Allowances.

In view of the important role that nutrient intake assessments play in establishing the Recommended Dietary Allowances (RDAs), the quality of food composition data must be assured for accuracy and representativeness. Assurance of data quality requires the definition of critical parameters in the data generation process and the evaluation of specific data for foods and components according to these parameters. An expert systems approach for evaluating the quality of analytical data has been developed by scientists at the Beltsville Human Nutrition Research Center to determine the quality of food composition data for five parameters: sampling plan, sample handling, number of samples, analytical method and analytical quality control. A rating scale for each parameter was developed with 0 representing poor or inadequately documented data and 3 representing optimal data. Specific criteria for each parameter and rating have been developed and incorporated into expert systems software to facilitate the objective assignment of ratings for each data source by the reviewer. After all ratings for a specific food-nutrient combination are assigned, the system calculates a composite score called the "confidence code" which indicates to the user the relative level of confidence in the data. By identifying and rating the important steps in the data generation process, one can begin to partition the possible sources of error or variability in the process. Limitation of the data set relative to specific purposes (e.g., setting the RDAs) can be identified. The evaluation process can provide the basis for focussed research to improve the most critical areas of the data generation process. A similar process could be established to evaluate the quality of analytical data for clinical measurements used to establish the RDAs.

Documentation↗

Introduction and application of secured principal component regression for analysis of uncalibrated spectral features in optical spectroscopy and chemical sensing.

In this study, a novel chemometric algorithm for improved evaluation of analytical data is presented and applied to three spectroscopic data sets obtained by different analytical methods. This so-called secured principal component regression (sPCR) was developed for detecting and correcting uncalibrated spectral features newly emerging in spectra after finalizing the PCR calibration, which may result in major concentration errors. Hence, detection and correction of uncalibrated features is essential. Furthermore, detected uncalibrated features provide qualitative information for sensing and process monitoring applications indicating problems in the process flow. After conventional PCR calibration, sPCR analyzes measurement data in two steps: The first step investigates whether the obtained data set is consistent with the calibration model or not. If spectroscopic features are found that cannot be modeled by the principal components, they are extracted from the measurement spectrum. This corrected spectrum is then evaluated by conventional PCR. In the Experimental Section, sPCR was successfully applied to three data sets obtained by different spectroscopic measurements in order to corroborate general applicability of the proposed concept. For each data set, one of several substances was excluded from the calibration acting in the sPCR assessment as uncalibrated absorber. The test sets consisted of disturbed and undisturbed samples. A total of 109 out of 110 test samples were correctly classified as disturbed or undisturbed by an uncalibrated absorber. It was confirmed that the extracted disturbance spectra are in accordance with the spectra of the uncalibrated analytes. The concentration results obtained with sPCR were found to be equivalent to conventional PCR results in the case of undisturbed samples and more precise for disturbed samples.

Journal Article↗

Seasonal and biological variation of urinary epinephrine, norepinephrine, and cortisol in healthy women.

BACKGROUND: There is a significant circadian and seasonal periodicity in various endocrine functions. The present study describes the within-day and seasonal fluctuation for urinary catecholamines and cortisol and estimates the within- (CV(i)) and between-subject (CV(g)) coefficients of variation for healthy women undertaking their routine work. In addition, index of individuality (I(i)) and power calculations were derived. METHODS: Eleven healthy females undertaking their routine life-style at work participated in the study. Each subject collected six samples during 24 h 15 days over a year, giving a total number of 990 samples. Using a random effect analysis of variance, we estimated CV(g) and total within-subject variation (CV(ti)), i.e. combined within-subject and analytical variation, from logarithmically transformed data. Analytical variation was subtracted from CV(ti) to give CV(i). CV(i) was estimated from samples collected monthly during 1 year (CV(iy)), weekly during 1 month (CV(im)), and six to eight times/day (CV(id)). RESULTS: A seasonal variation was demonstrated for excretion of epinephrine, norepinephrine, and cortisol standardized with creatinine. Concentrations of urinary epinephrine were higher during June and July compared to the rest of the year, whereas concentrations of urinary cortisol were higher during December and January compared to the rest of the year. Excretion of norepinephrine was lower during working hours and higher during hours off work for June and July compared to the rest of the year. There was a high within- and between-subject variation, which could not be explained by menstrual cycle, behavioral, emotional, or cognitive stress reactions. CONCLUSIONS: Despite high biological variation a reasonably low sample size, e.g. 10-50 individuals, is adequate for practical applicability, i.e. studying differences above 150%. The present study recommends to include the sampling time in the statistical evaluation of data and to be aware of the changes in diurnal variations over seasons. When single measurements are to be evaluated, reference intervals are recommended.

Adult↗

Seasonal and biological variation of blood concentrations of total cholesterol, dehydroepiandrosterone sulfate, hemoglobin A(1c), IgA, prolactin, and free testosterone in healthy women.

BACKGROUND: Concentrations of physiological response variables fluctuate over time. The present study describes within-day and seasonal fluctuations for total cholesterol, dehydroepiandrosterone sulfate (DHEA-S), hemoglobin A(1c) (HbA(1c)), IgA, prolactin, and free testosterone in blood, and estimates within- (CV(i)) and between-subject (CV(g)) CVs for healthy women. In addition, the index of individuality, prediction intervals, and power calculations were derived. METHODS: A total of 21 healthy female subjects participated in the study. Using a random effects analysis of variance, we estimated CV(g) and total within-subject variation (CV(ti)), i.e., the combined within-subject and analytical variation, from logarithmically transformed data. Analytical variation was subtracted from CV(ti) to give CV(i). CV(i) was estimated from samples taken monthly during 1 year (CV(iy)), weekly during 1 month (CV(im)), and six times within 1 day (CV(id)). RESULTS: A cyclic seasonal variation was demonstrated for total cholesterol, DHEA-S, HbA(1c), prolactin, and free testosterone. Within-day variation was shown for prolactin and free testosterone. The overall mean values for the group and the variability (CV(iy) and CV(g)) were: 5.1 mmol/L, 13% [corrected], and 12% [corrected] for total cholesterol; 6.6 micromol/L, 20% [corrected], and 49% [corrected] for DHEA-S; 30% [corrected], 7.0% [corrected], and 7.5% [corrected] for HbA(1c)/hemoglobin(total); 2.1 g/L, 5.9%, and 13% for IgA; 136 mIU/L, 58% [corrected], and 63% [corrected] for prolactin; and 5.4 pmol/L, 55% [corrected], and 68% [corrected] for free testosterone. CONCLUSIONS: Collecting samples at specific hours of the day or times of the year may reduce high biological variation. Alternatively, the number of individuals may be increased and a paired study design chosen to obtain adequate statistical power.

Adult↗

Development of a new series of agricultural/food reference materials for analytical quality control of elemental determinations.

Ten new Agricultural/Food Reference Materials--Bovine Muscle Powder (National Institute of Standards and Technology [NIST], code NIST RM 8414), Whole Egg Powder (NIST RM 8415), Microcrystalline Cellulose (NIST RM 8416), Wheat Gluten (NIST RM 8418), Corn Starch (NIST RM 8432), Corn Bran (NIST RM 8433), Whole Milk Powder (NIST RM 8435), Durum Wheat Flour (NIST RM 8436), Hard Red Spring Wheat Flour (NIST RM 8437) and Soft Winter Wheat Flour (NIST RM 8438)--were prepared by application of milling, irradiation, sieving, blending, and packaging procedures. Excellent material homogeneity was found for virtually all major, minor, and trace elements of interest. The reference materials were characterized with respect to elemental composition via an extensive international, interlaboratory characterization (certification) campaign. Chemical analyses conducted in 73 cooperating laboratories applying 13 major classes of independently different analytical methods led to 278 concentration values for 34 nutritionally, toxicologically, and environmentally pertinent elements. A total of 213 best-estimate and 65 informational concentration values are available for Al, As, B, Ba, Br, Ca, Cd, Cl, Co, Cr, Cs, Cu, F, Fe, Hg, I, K, Mg, Mn, Mo, N, Na, Ni, P, Pb, Rb, S, Sb, Se, Sr, Ti, V, W, and Zn. These products make a substantial contribution to the existing world repertoire of biological reference materials with respect to natural matrix and elemental composition. They are expected to be useful to analysts for quality control of analytical data. Applications include evaluations of analytical methods and instruments used in nutritional, toxicological, monitory, regulatory, environmental, agricultural, and other investigations. These products are available to the analytical community from the Standard Reference Materials Program, NIST, Gaithersburg, MD.

Analysis of Variance↗

Statistical methods for longitudinal research on bipolar disorders.

OBJECTIVES: Outcomes research in bipolar disorders, because of complex clinical variation over-time, offers demanding research design and statistical challenges. Longitudinal studies involving relatively large samples, with outcome measures obtained repeatedly over-time, are required. In this report, statistical methods appropriate for such research are reviewed. METHODS: Analytic methods appropriate for repeated measures data include: (i) endpoint analysis; (ii) endpoint analysis with last observation carried forward; (iii) summary statistic methods yielding one summary measure per subject; (iv) random effects and generalized estimating equation (GEE) regression modeling methods; and (v) time-to-event survival analyses. RESULTS: Use and limitations of these several methods are illustrated within a randomly selected (33%) subset of data obtained in two recently completed randomized, double blind studies on acute mania. Outcome measures obtained repeatedly over 3 or 4 weeks of blinded treatment in active drug and placebo sub-groups included change-from-baseline Young Mania Rating Scale (YMRS) scores (continuous measure) and achievement of a clinical response criterion (50% YMRS reduction). Four of the methods reviewed are especially suitable for use with these repeated measures data: (i) the summary statistic method; (ii) random/mixed effects modeling; (iii) GEE regression modeling; and (iv) survival analysis. CONCLUSIONS: Outcome studies in bipolar illness ideally should be longitudinal in orientation, obtain outcomes data frequently over extended times, and employ large study samples. Missing data problems can be expected, and data analytic methods must accommodate missingness.

Bipolar Disorder↗

Spirostanols obtained by cyclization of pseudosaponin derivatives and comparison of anti-platelet agglutination activities of spirostanol glycosides.

Naturally occurring saponins 3 and 4 have a normal type F ring and alpha-arranged CH(3)-21 group. Treatments of pseudosaponin peracetates 18 and 19 derived from 3 and 4, respectively, with alcoholic KOH, followed by acidification with acetic acid, gave spirostanols 20 and 22 having iso type F rings as major products. Structural analyses of sapogenins and saponins derived from pseudo derivatives 11, 12, 18 and 19 were performed by comparisons of their 1H-NMR spectral data and the X-ray analytical data of 3-O-p-bromobenzoyl sarsasapogenin 7, 3-O-acetyl diosgenin 13 and saponin 20. The mechanisms of ring-closure reaction of the side chain at C-22 of pseudosapogenins and pseudosaponins were deduced using stereomodels of the spirostanols derived from 11 under various reaction conditions. Inhibitory activities of saponin diglycosides 3, 4, 20, 21 and 25 on human platelet agglutinations induced by ADP and ristocetin were compared.

Adenosine Diphosphate↗

Design of a study to improve accuracy in reading mammograms.

This paper is concerned with the design and analysis of mammography reading studies. In particular we consider studies aimed at evaluating interventions to improve the accuracy with which mammograms are read. A simple randomized design is suggested in which a relatively large group of readers read sets of mammograms before and after an intervention phase. We propose solutions to three difficult statistical issues that arise in the context of such studies: (i) the choice of primary outcome measure; (ii) the data analysis technique to be employed; and (iii) the methodology for calculating sample sizes for readers and images to be read. First, we argue in favor of using sensitivity and specificity as the primary outcome measures rather than receiver operating characteristic (ROC) curves in mammography studies, although the latter are considered state of the art for many types of radiology reading studies. We argue that sensitivity and specificity are more clinically relevant and conceptually more straightforward than ROC curves. Second, we suggest a bivariate approach to data analysis for evaluating intervention effects on sensitivity and specificity. This accommodates the correlations inherent between these measures and allows for estimation of joint effects on them. Finally we propose a method for power calculations that uses computer simulation techniques. Simple formulas for sample size calculations are not available in part because variability in accuracy amongst readers and variation in difficulty among images introduce complexity into power calculations. The simulation method that we propose accommodates such complexity and is easy to implement. The methodology was motivated by a study funded by the Department of Defense to evaluate the potential efficacy of an educational intervention. In the context of this study we illustrate the steps involved in power calculations and apply the data analytic techniques to the sort of data expected to result from this study. Though the proposed methods were motivated by this particular study, the statistical considerations are relevant more broadly in mammography and indeed in other types of radiologic imaging studies. Standards for the conduct of radiologic reading studies are not yet well developed, as they are for randomized clinical trials and for case-control studies. We hope that the discussion in this paper will add to the dialogue necessary for development of such standards.

Breast Neoplasms↗

Pharmacokinetic and pharmacodynamic properties of insulin aspart and human insulin.

The preferred approach to determine the pharmacokinetic (PK) and pharmacodynamic (PD) properties of insulin analogues is the euglycemic glucose clamp. Currently non-compartmental data analytical approaches are used to analyze data. The purpose of the present study is to propose a novel compartmental-model for analysis of data from glucose clamp studies. Data used in this trial only involved 18 of the 20 originally treated subjects. Data was obtained from a crossover trial where 18 healthy subjects each received a single subcutaneous (s.c.) dose of 1.2 nmol/kg (body weight) insulin aspart (IAsp) or 1.2 nmol/kg human insulin (HI) during a euglycemic glucose clamp after overnight fast. Serum insulin and glucose concentrations were measured and the glucose infusion rate (GIR) was adjusted after dosing, to maintain blood glucose near basal levels. Individual model parameters were estimated for IAsp, HI, and the corresponding glucose and GIR data. We found statistically significant differences between most of the HI and IAsp pharmacokinetic parameters, including the sigmoidicity of the time course of absorption (1.5 for HI vs. 2.1 for IAsp (unit less), P = 0.0005, Wilcoxon Signed-rank test), elimination rate constant (0.010 min-1 for HI vs. 0.016 min-1 for IAsp (P = 0.002)). The PD model parameters were mostly not different, except for the rate of insulin action (0.012 min-1 for HI vs. 0.017 min-1 for IAsp (P = 0.03)). The model may provide a framework to account for different PK properties when estimating the PD properties of insulin and insulin analogues in glucose clamp experiments.

Adult↗

EDMUS, a European database for multiple sclerosis.

EDMUS is a minimal descriptive record developed for research purposes to document clinical and laboratory data in patients with multiple sclerosis (MS). It has been designed by a committee of the European Concerted Action for MS, organised under the auspices of the Commission of the European Communities. The software is user-friendly and fast, with a minimal set of obligatory data. Priority has been given to analytical data and the system is capable of automatically generating data, such as diagnosis classification, using appropriate algorithms. This procedure saves time, ensures a uniform approach to individual cases and allows automatic updating of the classification whenever additional information becomes available. It is also compatible with future developments and requirements since new algorithms can be entered in the programme when necessary. This system is flexible and may be adapted to the users needs. It is run on Apple and IBM-PC personal microcomputers. Great care has been taken to preserve confidentiality of the data. It is anticipated that this "common" language will enable the collection of appropriate cases for specific purposes, including population-based studies of MS and will be particularly useful in projects where the collaboration of several centres is needed to recruit a critical number of patients.

Database Management Systems↗

An Automated Peak Identification/Calibration Procedure for High-Dimensional Protein Measures From Mass Spectrometers.

Discovery of "signature" protein profiles that distinguish disease states (eg, malignant, benign, and normal) is a key step towards translating recent advancements in proteomic technologies into clinical utilities. Protein data generated from mass spectrometers are, however, large in size and have complex features due to complexities in both biological specimens and interfering biochemical/physical processes of the measurement procedure. Making sense out of such high-dimensional complex data is challenging and necessitates the use of a systematic data analytic strategy. We propose here a data processing strategy for two major issues in the analysis of such mass-spectrometry-generated proteomic data: (1) separation of protein "signals" from background "noise" in protein intensity measurements and (2) calibration of protein mass/charge measurements across samples. We illustrate the two issues and the utility of the proposed strategy using data from a prostate cancer biomarker discovery project as an example.

Journal Article↗

Importance of analytical methods in pharmacokinetic and drug metabolism studies.

Pharmacokinetic and drug metabolism studies first request that good analytical data are available. The various methods that permit unchanged drugs and their metabolites to be separated, identified and quantitatively assayed are briefly reviewed. The present importance of gas chromatography/mass spectrometry is emphasized, as well as the limits of immunological assays. The sensitivity of the analytical assay has a direct impact on the validity of the pharmacokinetic model which is built up from plasma concentration data. The precision and accuracy of the assay is also critical, and it is not always easily estimated. A new significant parameter is the speed of analysis, and the resulting massive production of analytical data. New drugs coming from biotechnology, and new dosage forms, like targeted drugs, will create new analytical problems in the future. They will probably call for the development of new biological or pharmacological assay procedures, in addition to the physicochemical means of analysis.

Animals↗

Standard reference materials and data quality assurance in the biomedical analysis of trace elements.

Accurate and precise analytical data of the concentrations of bio-analytes in bioclinical studies are of fundamental importance. Quality assurance procedures should always be performed to check the overall analytical work. This can be conveniently performed if appropriate standard reference materials with known concentrations of the analyte object of study are available. This paper underlines the key points related to the production and use of biological standard materials for trace element analysis. In particular, the present situation in the field of trace element determination in human biological fluids and the related problems are illustrated. The considerations given in this work may contribute to the preparation of the new biomarker standard materials.

Biomarkers↗

[Differences in nutrient intake using different nutrient databases-- an example].

Mean dietary intake calculated from 25 7-day-food records by means of the three nutrient data bases modified Souci/Fachmann/Kraut (mSFK) 1986/87, extract of Bundeslebensmittelschlüssel (BLS) version 2.1, and extract of BLS version 2.2 revealed comparable results only for four of 27 nutrients considered. The greatest deviations were found for zink, fluoride, iodine, vitamin D, vitamin C, and dietary fiber. Comparing the revised BLS version 2.2 and mSFK, the differences in fluoride, iodine and dietary fiber intake data were markedly lower than found with the comparison of BLS 2.1 and mSFK; statistically significant differences no longer existed for the vitamins C and A (equivalents). As expected, using the mSFK data base with some missing fields for analytical data underestimation of nutrient intake could be shown for the trace elements zink, fluoride and iodine. With regard to the given results of the investigated group, care has to be taken with some nutrient intake data gathered by means of BLS 2.1, too.

Diet Records↗

The German Food Code and Nutrient Data Base (BLS II.2).

This article describes the conception and structure of the German Food Code and Nutrient Data Base (BLS). The data bank contains approx. 12,000 coded foods, menus and menu components in different stages of processing with up to 158 nutritional data for each product. Since comparatively few analytical data on the composition of foods are available, the majority of the data in the BLS are based on nutritional data calculated from recipes. Thus, a standard instrument for an uninterrupted (no missing values) evaluation of consumption surveys is made available.

Databases as Topic↗