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Enhanced synonymous site divergence in positively selected vertebrate antimicrobial peptide genes.

Nonrandom patterns associated with adaptively evolving genes can shed light on how selection and mutation produce rapid changes in sequences. I examine such patterns in two independent families of antimicrobial peptide genes: those in frogs, which are known to have evolved under positive selection, and those in flatfishes, which I show have also evolved under positive selection. I address two recently proposed hypotheses about the molecular evolution of antimicrobial peptide genes. The first is that the mature peptide region is replicated by an error-prone polymerase that increases the mutation rate and the transversion/transition ratio compared to the signal sequence of the same genes. The second is that mature peptides evolve in a coordinated fashion with their propieces, such that a change in net charge in one molecular region prompts an opposite change in charge in the other region. I test these hypotheses using alternative methods that minimize alignment errors, correct for phylogenetic nonindependence, reduce sequence saturation, and account for differing selection pressures on different regions of the gene. In both gene families I show that divergence at both synonymous and nonsynonymous sites within the mature peptide region is enhanced. However, in neither gene family is there evidence of an increased mutational transversion/transition ratio or coordinated evolution. My observations are consistent with either an elevated mutation rate in an adaptively evolving gene region or widespread selection on "silent" sites. These hypotheses challenge the assumption that mutations are random and can be measured by the synonymous substitution rate.

Amino Acid Sequence↗

Drug errors and patient safety: the need for a change in practice.

Concerns regarding drug errors and public safety have recently been raised in the British national newspapers and professional nursing journals. This literature review considers why nurses may continue to make drug errors in their practice. The findings suggest that drug errors are not caused by any one factor, but are multifaceted in nature. Factors include calculation error, overdosing/underdosing of drug dosages, covert drug administration in food and drink, and an increasingly relaxed attitude among professional nurses with regard to ensuring that drugs are administered to the standard required by law. This article considers the notion that nurses may breach the legal "duty of care" they owe patients by being complacent in their drug administration practice. Consideration of a system's approach to minimize drug error through proactive action planning, risk identification, and implementation of an anonymous incident-reporting framework is briefly explored.

Attitude of Health Personnel↗

Accurate, reproducible measurement of blood pressure.

The diagnosis of mild hypertension and the treatment of hypertension require accurate measurement of blood pressure. Blood pressure readings are altered by various factors that influence the patient, the techniques used and the accuracy of the sphygmomanometer. The variability of readings can be reduced if informed patients prepare in advance by emptying their bladder and bowel, by avoiding over-the-counter vasoactive drugs the day of measurement and by avoiding exposure to cold, caffeine consumption, smoking and physical exertion within half an hour before measurement. The use of standardized techniques to measure blood pressure will help to avoid large systematic errors. Poor technique can account for differences in readings of more than 15 mm Hg and ultimately misdiagnosis. Most of the recommended procedures are simple and, when routinely incorporated into clinical practice, require little additional time. The equipment must be appropriate and in good condition. Physicians should have a suitable selection of cuff sizes readily available; the use of the correct cuff size is essential to minimize systematic errors in blood pressure measurement. Semiannual calibration of aneroid sphygmomanometers and annual inspection of mercury sphygmomanometers and blood pressure cuffs are recommended. We review the methods recommended for measuring blood pressure and discuss the factors known to produce large differences in blood pressure readings.

Adult↗

Factors affecting the accuracy of near-infrared spectroscopy concentration calculations for focal changes in oxygenation parameters.

Near-infrared spectroscopy (NIRS) can be used to noninvasively measure changes in the concentrations of oxy- and deoxyhemoglobin in tissue. We have previously shown that while global changes can be reliably measured, focal changes can produce erroneous estimates of concentration changes (NeuroImage 13 (2001), 76). Here, we describe four separate sources for systematic error in the calculation of focal hemoglobin changes from NIRS data and use experimental methods and Monte Carlo simulations to examine the importance and mitigation methods of each. The sources of error are: (1). the absolute magnitudes and relative differences in pathlength factors as a function of wavelength, (2). the location and spatial extent of the absorption change with respect to the optical probe, (3). possible differences in the spatial distribution of hemoglobin species, and (4). the potential for simultaneous monitoring of multiple regions of activation. We found wavelength selection and optode placement to be important variables in minimizing such errors, and our findings indicate that appropriate experimental procedures could reduce each of these errors to a small fraction (<10%) of the observed concentration changes.

Adult↗

Measurement of canine left ventricular mass by using MR imaging.

This study assessed the capability of ECG-gated MR imaging for quantitating left ventricular mass by means of signal intensity-based and geometric methods for measuring left ventricular mass of normal dogs and dogs with left ventricular hypertrophy. Mass was measured on transverse images encompassing the left ventricle during both diastole and late systole. Partial-volume errors were minimized by measuring the length of the left ventricle on a sagittal image and weighting the mass of end slices accordingly. The range of postmortem left ventricular mass was 61-100 g. The linear relationship between postmortem left ventricular mass and mass measured via MR images correlated closely when MR imaging measurements were done at either end diastole (r = .94) or late systole (r = .94). The standard errors of the estimate were 13.7 and 14.7 g for images gated to end diastole and late systole, respectively. Inter- and intraobserver reproducibility showed excellent agreement (r = .93 and r = .89 for end diastole and r = .99 and r = .93 for late systole, respectively). Thus, left ventricular mass can be quantified accurately and reproducibly over a wide range of masses by using ECG-gated MR imaging.

Animals↗

Human movement analysis using stereophotogrammetry. Part 2: instrumental errors.

This paper reviews the main aspects involved with the management of instrumental errors associated with video-based optoelectronic stereophotogrammetry. Insights on how such errors propagate to kinematic quantities are of great interest in the field of human movement analysis to improve the precision and reliability of measurements. The review focuses on the technical assessment and analytical compensation procedures to cope with instrumental errors. Relevant contributions dealing with intrinsic sources of systematic and random errors, such as the issues concerning camera calibration and filtering and smoothing of marker position data, are presented. Procedures for marker imaged processing, and missing marker recovery are also surveyed. Methods for checking the accuracy and precision of stereophotogrammetric systems are then reviewed. Finally, since the desired outcome of the movement measurements is a reliable estimate of body segment kinematics, state-of-the-art techniques proposed for minimization of error propagation arising from a cluster of external markers are described.

Biomechanical Phenomena↗

[Technical errors in the application of Graf's hip sonography method].

AIM: The aim of the study is to point out possible examination errors because of a titled transducer, and to analyse their sources. METHODS: The results obtained by experienced examiners using the correct examination technique were compared to results obtained under defined deviations from the standard. With the use of a computer model the course taken by the ultrasound waves in the neonatal hip was simulated and the sonographic image reconstructed. RESULTS: Twisted as well as tilted positions of the transducer lead to significant errors in alpha, the acetabular roof angle. This is in accordance with the computer model predictions. Caudo-cranially tilted probes lead to false-positive, therapeutically relevant incorrect diagnoses. CONCLUSION: The computer simulation predicts a high degree of accuracy of hip sonography in Graf's technique under standard conditions. The effectiveness of sonographic infant hip screening largely depends on the ability to adhere to the standardized approach, minimizing possible errors. A mechanical transducer guide prevents tilting errors by reducing the degrees of variability in positioning the transducer.

Artifacts↗

Evaluation of an automatic oscillometric method and of various cuffs for the measurement of arterial pressure in the neonate.

We compared simultaneous measurement of aortic, direct (Dir) and of indirect (Ind) systolic (S), mean (M) and diastolic (D) arterial pressure (AP) determined by an automatic oscillometric instrument (DINAMAP) in neonates with birthweight of 1000-3680 g. DINAMAP measurements were performed with cuffs of increasing width and length, recommended by the manufacturer for increasing arm circumference, and with a Standard sized cuff (2.5 X 15 cm), previously considered as suitable for neonates of any body size. In addition, we compared simultaneous measurements of Dir SAP and of Ind SAP determined by a Doppler technique and the Standard cuff. In DINAMAP SAP measurements with the Standard cuff, a statistically significant correlation between arm circumference and delta Ind-Dir SAP values (i.e. the difference between simultaneous Ind and Dir SAP measurements) was found. In DINAMAP MAP measurements with the cuff recommended for arm circumference, a statistically significant difference of the mean delta Ind-Dir MAP values was observed in infants whose arm was or was not completely encircled by the bladder of the cuff. In SAP as well as in MAP DINAMAP determinations, the overall error of measurement with the Standard cuff was smaller than with the recommended cuff. The Doppler method was found considerably more accurate than the DINAMAP method for the determination of SAP. In spite of these limitations, the DINAMAP method with the Standard cuff was considered to be reasonably accurate for the clinical determination of SAP and MAP, provided that several consecutive measurements are performed and averaged in order to minimize the error of measurement. When considering DAP measurements the error was so unacceptably high that the DINAMAP method cannot be recommended for clinical use. The need for a careful consideration of the cuff characteristics when evaluating new methods for the indirect measurement of AP in the neonate is emphasized.

Blood Pressure Determination↗

The effect of ocular aberrations on steady-state errors of accommodative response.

It is well accepted that the accommodation system is characterized by steady-state errors in focus. The purpose of this study was to correlate these errors with changes in ocular wavefront aberration and corresponding image quality when accommodating. A wavefront analyzing system, the Complete Ophthalmic Analysis System (COAS), was used in conjunction with a Badal optometer to allow continuous recording of the aberration structure of the eye for a range of accommodative demands (up to 8 D). Fifty consecutive recordings from seven subjects were taken. Monocular accommodative response was calculated as (i) the equivalent refraction minimizing wavefront error and (ii) the defocus needed to optimize the modulation transfer function at high spatial frequencies. Previously reported changes in ocular aberrations with accommodation (e.g., the shift of spherical aberration to negative values) were confirmed. Increased accommodation errors for near targets (lags) were evident for all subjects, although their magnitude showed a significant intersubject variability. It is concluded that the one-to-one stimulus/response slope in accommodation function should not always be considered as ideal, because higher order aberrations, especially changes of spherical aberration, may influence the actual accommodative demand. Fluctuations may serve to preserve image quality when errors of accommodation are moderate, by temporarily searching for the best focus.

Accommodation, Ocular↗

[Measures and criterion of confidence of nerve cell impulse responses].

A new method for evaluation of phasic spike responses is proposed. It is based on defining the time interval deltat in which spikes occur after the stimuli so often that the probability of finding a similar or more "suspicious" interval when the response is known to be absent (i.e., probability of error) is minimal. The offered response measure combines on the probability basis two different parameters: the time interval deltat and the number of trials containing at least one spike in deltat. The deltat interval may have any duration and location acceptable in the physiological sense, and is not supposed to be chosen a priori. This approach has been proved to be adequate and unambiguous. A technique is also proposed for estimating the error probability without using the characteristics of distribution of interspike intervals, which for this reason can be applied to any neurone. By means of this technique a table for non-parametric estimation of significance of spike responses has been compiled.

Mathematics↗

Attenuation deforms time-intensity curves during contrast echocardiography: implications for assessment of mean transit rates.

The mean transit rate of microbubbles of air obtained from time-intensity curves during contrast echocardiography can be used to evaluate flow through a vascular system, provided the volume of distribution of the system remains constant. We hypothesized that attenuation commonly associated with contrast echocardiography distorts the time-intensity curves, producing an error in the estimation of the mean transit rate of the microbubbles. The purpose of this study was to characterize this distortion with computer simulations and to study the effect of attenuation on the estimation of mean transit rate in an in vitro experiment. We also sought to determine if removing the data points from the time-intensity plots that visually can be attributed to attenuation before curve fitting can minimize the error in the estimation of mean microbubble transit rate. In both computer simulations and experimentally acquired in vitro data, attenuation distorted the time-intensity curves, producing an underestimation of mean microbubble transit rates. The mean microbubble transit rate decreased with an increase in microbubble concentration. Removing the points that visually were attributed to attenuation before curve fitting did not correct this error completely in the computer-simulated data and failed to correct it at all in the experimental data. These results have major practical implications in assessing mean microbubble transit rates during contrast echocardiography.

Albumins↗

A new thresholding method for volume determination by SPECT.

The quantification of organ volumes from SPECT images suffers from two major problems: image segmentation and imperfect system transfer function. Image segmentation defines the borders of an organ and allows volume measurements by counting the voxels inside this contour in all slices containing parts of this organ. A review of the literature, showed that several investigators use a fixed threshold (FT) to determine the organ pixels. It is our aim to demonstrate that the threshold has to be adapted to every single case because its value is dependent upon several factors, such as size and contrast. Therefore a threshold selection algorithm, based on the gray level histogram (GLH), is evaluated. It is nearly impossible to calculate and eliminate errors induced by the complex system response function. A correction method based on linear regression is proposed. By minimizing the relative error (sigma), a linear correlation (Y = AX + B) between the true volume (Y) and the measured volume (X) is established for three fixed thresholds (30%, 40%, 50%) and for the GLH method. The methods are evaluated on a series of nineteen phantoms with a volume range between 9.8 and 202.5 ml. The relative error is minimal for the GLH method. The whole procedure is semi-automated and virtually operator independent.

Algorithms↗

Thresholds for significant decrease in hemodialysis access blood flow.

During hemodialysis access surveillance, referral for evaluation and correction of stenosis is based upon determination that a significant decrease in blood flow (Q) has occurred. However, criteria for determining when a decrease is statistically significant have not yet been established. In this study we established such criteria by analyzing Q variation with the glucose pump test (GPT). We took nine Q measurements in each of 25 patients (18 grafts, 7 fistulas) during three dialysis sessions within a 2-week period (predialysis and during hours 1 and 3). We determined thresholds that define a significant percentage decrease in Q (deltaQ) for various p values. In order to confirm the general applicability of these thresholds, we computed the average within-patient Q variation during the three sessions (computed as a coefficient of variation and referred to as short-term variation). We then determined the relative influences of biological (true) variation and analytical error on short-term variation. We found that deltaQ must be > 33% to be significant at p < 0.05, whereas the threshold is > 17% for p < 0.20. Measuring Q at uniform versus different times during the sessions did not significantly reduce these thresholds. We also found that biological variation was nearly as large as short-term Q variation, whereas analytical error contributed minimally to short-term variation. In conclusion, this study defines thresholds for a significant deltaQ that have wide application in determining access referral for evaluation and correction of stenosis. Selection of a particular threshold should consider the relative importance of avoiding thrombosis versus avoiding unnecessary procedures. If avoiding unnecessary procedures is a priority, then we recommend a threshold of > 33%. These thresholds apply to other methods of measuring Q, provided analytical error is significantly less than biological variation.

Arteriovenous Shunt, Surgical↗

Temporal surrogates of spatial turbulent statistics: the Taylor hypothesis revisited.

The Taylor hypothesis, which allows surrogating spatial measurements requiring many experimental probes by time series from one or two probes, is examined on the basis of a simple analytic model of turbulent statistics. The main points are as follows: (i) The Taylor hypothesis introduces systematic errors in the evaluation of scaling exponents. (ii) When the mean wind V0 is not infinitely larger than the root-mean-square longitudinal turbulent fluctuations v(T), the effective Taylor advection velocity V(ad) should take the latter into account. (iii) When two or more probes are employed the application of the Taylor hypothesis and the optimal choice of the effective advecting wind V(ad) need extra care. We present practical considerations for minimizing the errors incurred in experiments using one or two probes. (iv) Analysis of the Taylor hypothesis when different probes experience different mean winds is offered.

Journal Article↗

Reliability of stress radiography for evaluation of posterior knee laxity.

BACKGROUND: Although stress radiography has been recommended for quantifying posterior tibial displacement in knees with posterior cruciate ligament insufficiency, the intratester reliability and intertester reliability of this measurement method have not been evaluated. HYPOTHESIS: Stress radiography is a reproducible measurement method in the assessment of posterior knee laxity in patients with posterior cruciate ligament lesions. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Stress radiographs of 787 patients with suspected posterior cruciate ligament lesions taken using the Telos device were evaluated independently by 3 testers: 2 of the testers were clinically experienced in the evaluation of stress radiographs, and 1 tester was a novice tester. Change in mean, standard error of measurement with calculated confidence intervals, and intra-class correlation coefficients were determined to assess intratester and intertester reliability. RESULTS: There was no significant intratester change in mean. Intratester standard error of measurement was 1.03 mm; 95% confidence intervals were+/-2.02 mm for a single measurement and+/-2.86 mm for a change in measurement. The intratester intra-class correlation coefficient was 0.95. Intertester reliability revealed a significant change in mean between the experienced testers and the novice tester (P<.001). There was no substantial difference for the standard error of measurement of each tester. The mean intertester standard error of measurement was 1.41 mm; 95% confidence intervals were+/-2.77 mm for a single measurement and+/-3.91 mm for a change in measurement. The intertester intraclass correlation coefficient was 0.91. CONCLUSION: Stress radiography was found to be a measurement method with a useful reliability for evaluation of posterior laxity in patients with posterior cruciate ligament lesions. The reproducibility of stress radiography may be influenced by multiple variables, and standardized methods are needed to minimize measurement error.

Adolescent↗

Photoactivated zinc silicate in thin layer chromatography plates: a potential cause for error in liquid scintillation counting.

Thin layer chromatography plates impregnated with fluorescent indicator permit easy identification of many compounds by exposure to ultraviolet light. Exposure of zinc silicate treated plates to ultraviolet light (254 nm) for 30 seconds induced photoluminescence which persisted at significant levels for longer than 24 hours. This artifact significantly interfered with radioactivity quantitation in three commercially available liquid scintillation solutions. Chromatography plates impregnated with calcium silicate demonstrated insignificant ultraviolet light induced photoluminescence. The use of 14C rather than 3H-radiolabeled compounds, protecting the plate with aluminum foil when visualizing reference compounds with ultraviolet light, and heating the photoactivated plate to accelerate disappearance of the photoluminescence minimized the error in liquid scintillation counting.

20-Hydroxysteroid Dehydrogenases↗

Power-law for axon diameters at branch point.

BACKGROUND: Axon calibers vary widely among different animals, neuron classes, and even within the same neuron. What determines the diameter of axon branches? RESULTS: We pursue the hypothesis that the axon caliber has evolved to minimize signal propagation delays, while keeping arbor volume to a minimum. For a general cost function, we show that the optimal diameters of mother and daughter branches at a bifurcation satisfy a power law. The derivation relies on the fact that the axon conduction speed scales as a power of axon diameter. Although available data are consistent with the law, there is a large spread in the data. Future experimental tests will determine whether this spread is due to biological variability or measurement error. CONCLUSIONS: Minimization of arbor volume and signal propagation delay may have been an important factor in the evolution of the brain.

Animals↗

Linear programming models for cost reimbursement.

Tamura, Lauer, and Sanborn (1985) reported a multiple regression approach to the problem of determining a cost reimbursement (rate-setting) formula for facilities providing long-term care (nursing homes). In this article we propose an alternative approach to this problem, using an absolute-error criterion instead of the least-squares criterion used in regression, with a variety of side constraints incorporated in the derivation of the formula. The mathematical tool for implementation of this approach is linear programming (LP). The article begins with a discussion of the desirable characteristics of a rate-setting formula. The development of a formula with these properties can be easily achieved, in terms of modeling as well as computation, using LP. Specifically, LP provides an efficient computational algorithm to minimize absolute error deviation, thus protecting rates from the effects of unusual observations in the data base. LP also offers modeling flexibility to impose a variety of policy controls. These features are not readily available if a least-squares criterion is used. Examples based on actual data are used to illustrate alternative LP models for rate setting.

Computer Simulation↗