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PubMed2003

Clinical experience and pre-test probability scores in the diagnosis of pulmonary embolism.

BACKGROUND: The Geneva and Wells pre-test probability scores are intended to replace empirical assessment of patients with suspected pulmonary embolism (PE). The effect of clinical experience on the inter-rater variability of these scores, and on empirical judgement, is unknown. AIM: To determine whether medical staff appointment grade affects the inter-rater variability of these pre-test probability scores, or empirical assessment, in patients with suspected PE. DESIGN: Questionnaire survey. METHODS: Doctors were grouped by grade (mean number of years since graduation+/-SEM): house officers 0.7+/-0.2, registrars 6.3+/-0.6, consultants 25+/-4 and applied pre-test probability scores to actual case scenarios. RESULTS: The Geneva score was the most consistent method of determining pre-test probability and was unaffected by clinical experience (Geneva kappa=0.73, Wells kappa=0.38, empirical kappa=0.23, p<0.001 ). With empirical judgement, inter-rater variability was inversely proportional to clinical experience (house officers kappa=0.37, registrars kappa=0.24, consultants kappa= 0.16, p<0.05). DISCUSSION: The Geneva score was the least variable method and can be applied by junior or senior doctors. Using empirical judgement, junior doctors were more likely to agree on the pre-test probability of PE than were their more senior colleagues. This may imply that as physicians gain experience, they recognize that the diagnosis of PE can be difficult to assess and are reluctant to exclude it on clinical grounds.

Aged↗

PubMed2006

Alpha-hit, cellular dose, cell transformation and inactivation probability distributions of radon progenies in the bronchial epithelium.

A fluid dynamics based model has been used to determine the deposition patterns of inhaled radon daughters in a realistic approach of the bronchial airway geometry. The interaction of the emitted alpha particles with epithelial cells has been analyzed by applying a complex hit probability model (Bronchial Alpha Hit Model). The biological response of the hit cells has been calculated by the Probability-Per-Unit-Track-Length Model, which relates the probability of a specific biological effect to the track length of alpha particles as a function of the particles' LET. The models mentioned above form a complex lung-radon interaction description. The calculations indicate that compared to the average values the transformation and cell killing probabilities are higher at bronchial carinal ridges. In addition, a considerable number of cells possessing a not negligible transformation and cell killing probabilities can also be found in the outer sides of the central zone.

Aerosols↗

PubMed2006

Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma.

BACKGROUND: To develop a simple scoring system that allows an early and reliable estimation for the probability of mass transfusion (MT) as a surrogate for life threatening hemorrhage following multiple trauma. METHODS: Potential clinical and laboratory variables documented in the Trauma Registry of the German Trauma Society (DGU) (1993-2003; n=17,200) were subjected to univariate and multivariate logistic regression analysis to predict the probability for MT. RESULTS: Clinical and laboratory variables available from data sets were screened for their association with mass transfusion. MT was defined by transfusion requirement of >or=10 units of packed red blood cells from emergency room (ER) to intensive care unit admission. Seven independent variables were identified to be significantly correlated with an increased probability for MT: systolic blood pressure (<100 mm Hg=4 pts, <120 mm Hg=1 pt), hemoglobin (<7 g/dL=8 pts, <9 g/dL=6 pts, <10 g/dL=4 pts, <11 g/dL=3 pts, and <12 g/dL=2 pts), intra-abdominal fluid (3 pts), complex long bone and/or pelvic fractures (AIS 3/4=3 pts and AIS 5=6 pts), heart rate (>120=2 pts), base excess (<-10 mmol/L=4 pts, <-6 mmol/L=3 pts, and <-2 mmol/L=1 pt), and gender (male=1 pt). These variables were incorporated into a risk score, the Trauma Associated Severe Hemorrhage Score (TASH-Score, 0-28 points). Performance of the score was tested with respect to discrimination, precision, and calibration. Increasing TASH-Score points were associated with an increasing probability for MT. CONCLUSION: The TASH-Score is an easy-to-use scoring system that reliably predicts the probability for MT after multiple trauma. Taken as a surrogate for life threatening bleeding calculation may focus attention on relevant variables indicative for risk and impact strategies to stop bleeding and stabilize coagulation in acute trauma care.

Adult↗

PubMed2006

Properties of the probability distribution associated with the largest event in an earthquake cluster and their implications to foreshocks.

The space-time epidemic-type aftershock sequence model is a stochastic branching process in which earthquake activity is classified into background and clustering components and each earthquake triggers other earthquakes independently according to certain rules. This paper gives the probability distributions associated with the largest event in a cluster and their properties for all three cases when the process is subcritical, critical, and supercritical. One of the direct uses of these probability distributions is to evaluate the probability of an earthquake to be a foreshock, and magnitude distributions of foreshocks and nonforeshock earthquakes. To verify these theoretical results, the Japan Meteorological Agency earthquake catalog is analyzed. The proportion of events that have 1 or more larger descendants in total events is found to be as high as about 15%. When the differences between background events and triggered event in the behavior of triggering children are considered, a background event has a probability about 8% to be a foreshock. This probability decreases when the magnitude of the background event increases. These results, obtained from a complicated clustering model, where the characteristics of background events and triggered events are different, are consistent with the results obtained in [Ogata, Geophys. J. Int. 127, 17 (1996)] by using the conventional single-linked cluster declustering method.

Journal Article↗

PubMed2003

Target-to-target interval versus probability effects on P300 in one- and two-tone tasks.

The P3(00) is an electrophysiological index of neural processing that varies with such stimulus parameters as interstimulus interval (ISI) and target probability, with a common view being that it reflects an endogenous form of memory update. Building on previous research, we argue that relations between P3 amplitude and both ISI and probability may be attributable to the target-to-target interval (TTI). Employing between-subject (Experiment 1; N = 24) and within-subject (Experiment 2; N = 10) designs, the present paper addresses this by testing subjects on a standard two-tone auditory oddball task as well as a one-tone task. In both studies, P3 amplitude increased and latency decreased linearly with TTI, and these relations were relatively unaffected by ISI or probability. This suggests that ISI and probability per se do not independently affect P3 amplitude, and that TTI offers a strong explanation of the reported relations between P3 amplitude and both ISI and probability.

Acoustic Stimulation↗

PubMed1997

Exclusion probabilities of 22 bovine microsatellite markers in fluorescent multiplexes for semiautomated parentage testing.

Six multiplexes developed for semiautomated fluorescence genotyping were evaluated for parentage testing. These multiplexes contained primer pairs for the amplification of 22 microsatellites on 17 bovine autosomes. Exclusion probabilities were determined from genotypes of 1022 Holstein cattle and 311 beef cattle belonging to five breeds. Two cases were considered: case 1, genotypes are known for an alleged parent and an offspring but genotypes of a confirmed parent are unknown; and case 2, genotypes are known for an alleged parent, a confirmed parent and an offspring. If the alleged parent is not the true parent, then the 22 markers will exclude the alleged parent with a probability of > 0.9986 for case 1 and with a probability of > 0.99999 for case 2. On the basis of these exclusion probabilities, the probability that an alleged parent will be falsely included as a parent is in the range of 1/716 to 1/2845 for case 1 and 1/1.2 million to 1/159753 for case 2. In addition to these results, a rapid and efficient non-organic method for extraction of DNA from semen is described.

Animals↗

PubMed1993

The probability of passing at resits in the Part I Fellowship examination.

The study aimed to determine the relationship of a candidate's attempt number and proximity of the aggregate score to the pass mark, individually and in combination, to the probability of passing at the next attempt at the Part I FRACS examination. The results of 36 examinations, in which 3513 candidates sat 5891 tests, were analysed. While 40.5% of all candidates who sat these examinations passed, the first attempt pass rate was 44%. Overall about one-third of the candidates who had sat the examination previously passed at the next attempt, the probability of passing remained fairly constant up to the fourth attempt and fell thereafter. As expected, the further the candidate's aggregate score was below the pass mark, the lower the probability of passing at the next attempt. Considering both attempt number and proximity to the pass mark, probability of passing decreased with successive attempts except for very weak candidates. The results indicate that, while the imposition of an upper limit on the number of resits at the examination is not justified, candidates who fall significantly below the pass mark should be advised against resitting for a reasonable period, and those who repeatedly do so should be advised against resitting for a reasonable period, and those who repeatedly do so should another career. It is suggested that feedback to the candidates about the probability of passing at the next attempt be based on the results obtained in this study.

Australia↗

PubMed2004

Transiently higher release probability during critical period at thalamocortical synapses in the mouse barrel cortex: relevance to differential short-term plasticity of AMPA and NMDA EPSCs and possible involvement of silent synapses.

Thalamocortical connections undergo remarkable plasticity during the critical period and mounting evidence serves to demonstrate that the activation of silent synapses at postsynaptic sites is an important underlying mechanism in this process. However, relatively little is known about the nature of the presynaptic properties. In the present study, we examined the release probability (Pr) of thalamocortical synaptic terminals on a layer IV neuron in the developing mouse barrel cortex. Using the conventional paired-pulse ratio (PPR) method, both AMPA and NMDA receptor-mediated PPR were observed during development. We found that the NMDA PPR increased gradually (thus, a reduction in Pr) from postnatal day (P)4 to P22 but, unexpectedly, the AMPA PPR exhibited a simultaneous decrease. We then used an additional method for assessing release probability, the observation of a progressive block of NMDA receptor-mediated EPSCs using MK-801. With this method, we were able to identify two classes of terminals with high or low probabilities of release. Interestingly, the higher release showed a reduction in probability during the critical period, consistent with the NMDA PPR results. We confirmed that the discrepancy between the NMDA and the AMPA PPR results was due to the existence of silent, or NMDA-only, synapses, as suggested in previous literature. By analysing the correlation between the NMDA or AMPA PPR and the PPR discrepancy, we discuss the hypothesis that the terminals with transiently higher probability of release were found preferentially on silent synapses. Our results suggest that these presynaptic sites may also have an active role in plasticity by working concomitantly with postsynaptic sites during the critical period.

Age Factors↗

PubMed2000

Probability of occurrence of life-threatening ventricular arrhythmias in Chagas' disease versus non-Chagas' disease.

The implantable cardioverter defibrillator (ICD) is highly effective in the treatment of ventricular arrhythmias (VA) responsible for sudden cardiac death. However, the probability of occurrence of these arrhythmic events in presence of cardiomyopathy remains uncertain. The aim of this study was to compare the probability of nonoccurrence of life-threatening VA in ICD recipients with Chagas' versus non-Chagas' heart disease. Over a mean follow-up of 10.5 months, 53 ICD recipients (mean age = 50.1 years, 48 male) were evaluated. Eleven patients had Chagas' heart disease, 19 had idiopathic dilated cardiomyopathy and 23 had ischemic cardiomyopathy. Ventricular tachyarrhythmias with a cycle length < 315 ms were considered life-threatening. The cumulative probability of nonoccurrence of life-threatening VA was examined by Kaplan-Meyer method and the outcomes were submitted to the log rank test. At 2 years, the cumulative probability of life-threatening VA nonoccurrence was 0 in the Chagas' heart disease group versus 40% up to 55 months of follow-up in the non-Chagas' disease group (P = 0.0097). Among patients with cardiomyopathies of different etiologies, those with Chagas' heart disease had the lowest cumulative probability of nonoccurrence of life-threatening VA, confirming its unfavorable prognosis and the importance of preventive measures against sudden death in this disease.

Adult↗

PubMed2003

Always Good Turing: asymptotically optimal probability estimation.

While deciphering the Enigma code, Good and Turing derived an unintuitive, yet effective, formula for estimating a probability distribution from a sample of data. We define the attenuation of a probability estimator as the largest possible ratio between the per-symbol probability assigned to an arbitrarily long sequence by any distribution, and the corresponding probability assigned by the estimator. We show that some common estimators have infinite attenuation and that the attenuation of the Good-Turing estimator is low, yet greater than 1. We then derive an estimator whose attenuation is 1; that is, asymptotically it does not underestimate the probability of any sequence.

Journal Article↗

PubMed1979

Rapid, single-step most-probable-number method for enumerating fecal coliforms in effluents from sewage treatment plants.

A single-step most-probable-number method for enumerating fecal coliforms in sewage treatment plant effluents is described. The method requires the use of only one lactose-based medium and a single incubation temperature of 44.5 degrees C, and it can be completed in 18 h or less, as compared with up to 72 h for the standard most-probable-number method. The appearance of growth is the sole criterion used for designating positives, which can be determined either by increases in the electrical impedance ratio of inoculated medium, as compared to an uninoculated control using a Bactometer model 32, or by visual examination of inoculated medium for turbidity. In trials with 53 samples of unchlorinated sewage treatment plant effluent, fecal coliform counts by the single-step most-probable-number method, throughout a range of less than 10 to almost 10(7) fecal coliforms per 100 ml of effluent, were in excellent agreement with counts abtained by the standard most-probable-number procedure. Similar agreement was obtained in comparative trials with 31 chlorinated effluent samples from two sewage treatment plants. Overall, 87% of 452 positives were confirmed as containing fecal coliforms. The applicability of the single-step most-probable-number method to automated sewage treatment plant operations is discussed.

Bacteriological Techniques↗

PubMed1999

Post-test probability that men in the community with raised plasma ferritin concentrations are hazardous drinkers.

BACKGROUND: Raised plasma ferritin concentrations occur unexpectedly during iron studies done by primary care physicians. Plasma ferritin concentration has been positively associated with alcohol use among men. AIM: To determine the post-test probability that men in the community with raised plasma ferritin concentrations are hazardous drinkers. METHODS: The subjects were 152 men, randomly selected from a city's electoral roll. Nineteen (12.5 (2.7)%, mean (SEM)) admitted to drinking hazardously. The pretest probability of a man being a hazardous drinker was 0.125. This was converted to pretest odds of 0.14. The likelihood ratio (the ratio of the probability of obtaining a raised plasma ferritin concentration in a hazardous drinker (sensitivity) to the probability of obtaining a raised plasma ferritin concentration in a non-hazardous drinker (1-specificity)) was calculated for different plasma ferritin cut off points. RESULTS: A plasma ferritin level of > 652 micrograms/l gave the largest likelihood ratio, 4.16. Post-test odds were obtained by multiplying the pretest odds (0.14) by the likelihood ratio (4.16). A plasma ferritin level of > 652 micrograms/l had a post-test odds for a man being a hazardous drinker of 0.58. This was converted to a post-test probability of 0.37. CONCLUSIONS: Inquiries could usefully be made into the alcohol consumption of men with a plasma ferritin concentration > 652 micrograms/l, as approximately one in three would admit to drinking hazardously.

Adult↗

PubMed2005

MELPREDICT: a logistic regression model to estimate CDKN2A carrier probability.

BACKGROUND: Heritable alterations in CDKN2A account for a subset of familial melanoma cases although no robust method exists to identify those at risk of being a mutation carrier. METHODS: We set out to construct a model for estimating CDKN2A mutation carrier probability using a cohort of 116 consecutive familial cutaneous melanoma patients evaluated at Massachusetts General Hospital Pigmented Lesion Center between April 2001 and September 2004. Germline CDKN2A and CDK4 status on the familial melanoma cases and clinical features associated with mutational status were then used to build a multiple logistic regression model to predict carrier probability and performance of model on external validation. RESULTS: From the 116 kindreds prone to melanoma in the Boston area, 13 CDKN2A mutation carriers were identified and 12 were subsequently used in the modeling. Proband age at diagnosis, number of proband primaries, and number of additional family primaries were most closely associated with germline mutations. The estimated probability of the proband being a mutation carrier based on the logistic regression model (MELPREDICT) is given by e(L)/(1 + e(L) where L = 1.99+[0.92x(no. of proband primaries)]+[0.74x(no. of additional family primaries)]-[2.11xln(age)]. The mean estimated probabilities for subjects in the Boston dataset were 55.4% and 5.1% for the mutation carriers and non-carriers respectively. In a receiver operator characteristic analysis, the area under the curve was 0.881 (95% confidence interval 0.739 to 1.000) for the Boston model set (n = 116) and 0.803 (0.729 to 0.877) for an external Toronto hereditary melanoma cohort (n = 143). CONCLUSIONS: These results represent the first-iteration logistic regression model to approximate CDKN2A carrier probability. Validation of this model with an external dataset revealed relatively robust performance.

Adolescent↗

PubMed2001

Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography.

PURPOSE: To evaluate short-term follow-up of nonpalpable probably benign lesions in a 2-year mammographic screening. MATERIALS AND METHODS: Of 13,790 women aged 45-65 years who underwent first-round screening, 795 (5.8%) underwent short-term mammographic follow-up (every 6 months for 2 years) of nonpalpable probably benign lesions (eg, masses, focal asymmetric densities, and calcifications) previously assessed at an additional imaging evaluation, including ultrasonography. When no changes were found at short-term mammographic follow-up, women were assigned to the 2-year screening interval. Needle localization and surgical biopsy were performed when the lesion progressed (was enlarged or had an increased number or size of calcifications or modification of their initial characteristics). The effectiveness of this approach was evaluated with statistical analysis. RESULTS: Of 795 lesions, 788 (99%) remained stable, and seven (1%) had changes prompting surgical biopsy. Two cancers (0.3%), one microinvasive intraductal carcinoma and one 7-mm invasive ductal carcinoma without positive nodes, were found. Four of the five benign histologic results were probably benign calcifications with progression at short-term follow-up. The sensitivity, specificity, accuracy, and positive and negative predictive values were 100%, 99%, 99%, 29%, and 100%, respectively. CONCLUSION: The benign nature of most nonpalpable probably benign lesions can be typified with short-term mammographic follow-up. This approach permitted identification of a few low-stage carcinomas, but progression in the probably benign calcifications was usually unrelated to malignancy.

Aged↗

PubMed2002

Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest.

BACKGROUND: Cardiopulmonary resuscitation (CPR) creates artifacts on the ECG and, with automated defibrillators, a pause in CPR is mandatory during rhythm analysis. The rate of return of spontaneous circulation (ROSC) is reduced with increased duration of this hands-off interval in rats. We analyzed whether similar hands-off intervals in humans with ventricular fibrillation causes changes in the ECG predicting a lower probability of ROSC. METHODS AND RESULTS: The probability of ROSC after a shock was continually determined from ECG signal characteristics for up to 20 seconds of 634 such hands-off intervals in patients with ventricular fibrillation. In hands-off intervals with an initially high (40% to 100%) or median (25% to 40%) probability for ROSC, the probability was gradually reduced with time to a median of 8% to 11% after 20 seconds (P<0.001). In episodes with a low initial probability (0% to 25%; median, 5%), there was no further reduction with time. CONCLUSIONS: The interval between discontinuation of chest compressions and delivery of a shock should be kept as short as possible.

Artifacts↗

PubMed2004

Probability of cortical infarction predicted by flumazenil binding and diffusion-weighted imaging signal intensity: a comparative positron emission tomography/magnetic resonance imaging study in early ischemic stroke.

BACKGROUND AND PURPOSE: The differentiation of reversible from irreversible ischemic damage is essential for identifying patients with acute ischemic deficits who may benefit from therapeutic interventions. Diffusion-weighted imaging (DWI) has become the method of choice to detect ischemic lesions. Positron emission tomography (PET) of the central benzodiazepine receptor ligand 11C flumazenil (FMZ) has been shown to be a reliable marker of neuronal integrity. These 2 imaging parameters were compared with respect to the probability to predict cortical infarction in early ischemic stroke. METHODS: In 12 patients with acute stroke, results from DWI (median, 6.5 hours after symptom onset) and FMZ-PET (interval, 85 minutes between DWI and PET) were compared with infarct extension 24 to 48 hours after onset of stroke on T2-weighted magnetic resonance imaging (T2-MRI). Probability curves predictive of eventual infarction were computed using respective DWI, FMZ, and apparent diffusion coefficient (ADC) values for voxels of interest (VOI) later classified as representing infarcted or noninfarcted tissue. RESULTS: Ninety-five percent limits predictive of cortical infarction were determined for relative FMZ binding (< or =3.2), DWI signal intensity (> or =1.18), and ADC values (< or =0.83). Cortical regions with values beyond these 95% limits did not necessarily overlap with nor were fully congruous with final cortical infarct volumes. The respective median volumes for these regions were FMZ median 10.9, range 0 to 99.7 cm3; DWI median 15.2, range 0 to 116.0 cm3; ADC median 12.4, range 0 to 112.7 cm3; and final infarct median 14.9, range 0 to 114.7 cm(3). Overall, 83.5% of the final infarct, on average, was predicted by decreased FMZ binding, 84.7% by increased DWI signal intensity, and 70.9% by a decreased ADC value. The portions of the final infarct not predicted in the early investigation (false-negatives) were 4.8 cm3 (median) for FMZ, 3.7 cm3 for DWI, and 6.0 cm3 for ADC. The false-positive volumes not included in the final infarct were 0 cm3 (median) for FMZ, 5.1 cm3 for DWI, and 3.6 cm3 for ADC. CONCLUSIONS: These results indicate that FMZ-PET and DWI are comparable in the prediction of probability of ischemic cortical infarction, but FMZ-PET carries a lower probability of false-positive prediction. The final infarcts include tissue not identified by these imaging modalities; at the time of the study, these tissue compartments are viable and could benefit from treatment. The discrepancy in predictive probability could be related to the fundamental difference of the measured variables: benzodiazepine receptor activity is a reliable marker of neuronal integrity in the cortex, and movement of water molecules in the extracellular space might be a more variable indicator of tissue damage.

Adult↗

PubMed2004

Probability of stimulus detection in a model population of rapidly adapting fibers.

The goal of this study is to establish a link between somatosensory physiology and psychophysics at the probabilistic level. The model for a population of monkey rapidly adapting (RA) mechanoreceptive fibers by Güçlü and Bolanowski (2002) was used to study the probability of stimulus detection when a 40 Hz sinusoidal stimulation is applied with a constant contactor size (2 mm radius) on the terminal phalanx. In the model, the detection was assumed to be mediated by one or more active fibers. Two hypothetical receptive field organizations (uniformly random and gaussian) with varying average innervation densities were considered. At a given stimulus-contactor location, changing the stimulus amplitude generates sigmoid probability-of-detection curves for both receptive field organizations. The psychophysical results superimposed on these probability curves suggest that 5 to 10 active fibers may be required for detection. The effects of the contactor location on the probability of detection reflect the pattern of innervation in the model. However, the psychophysical data do not match with the predictions from the populations with uniform or gaussian distributed receptive field centers. This result may be due to some unknown mechanical factors along the terminal phalanx, or simply because a different receptive field organization is present. It has been reported that human observers can detect one single spike in an RA fiber. By considering the probability of stimulus detection across subjects and RA populations, this article proves that more than one active fiber is indeed required for detection.

Action Potentials↗

PubMed1998

Forty-five-year tooth survival probabilities among men in Oslo, Norway.

Changes in tooth survival probabilities over a person's lifetime have remained largely unexplored. The goal of this study was to evaluate changes in the 45-year tooth survival probabilities in a cohort of 565 Norwegian males who were examined in 1969 as young adults, and followed up into mid-life (examination years and sample sizes (n): 1971 (n = 381), 1973 (n = 292), 1975 (n = 245), 1981 (n = 228), 1988 (n = 202), and 1995 (n = 223). The results indicated that the tooth survival probabilities varied considerably both (i) among teeth within individuals, and (ii) over time. The 45-year survival probabilities for the 28 teeth fell into the following ranges: larger than 95% for incisors and cuspids; between 84% and 92% for premolars; and between 59% and 96% for molars. Over the first 4 post-eruptive decades, the tooth mortality risks (excluding orthodontic extractions) were: 1st decade, 2.0% (from 1.7 to 2.4%); 2nd decade, 0.2% (from 0.1 to 0.4%); 3rd decade, 0.6% (from 0.4 to 0.8%); and 4th decade, 1.1% (from 0.8 to 1.5%). The tooth mortality risks in the 2nd, 3rd, and 4th decades were probably somewhat underestimated (due to dropout bias), suggesting that the true underlying tooth mortality hazard function may have been V-shaped. The conclusions were that the tooth mortality hazard during the first 4 post-eruptive decades was bathtub-shaped and that it varied considerably among teeth within individuals.

Adolescent↗