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Correlations among WISC-R IQs and several measures of receptive and expressive language for children referred for Special Education.

For 42 children from rural north central Kansas school districts (27 boys, 15 girls) who were referred for Special Education testing, the WISC-R IQs (Full Scale, Verbal, and Performance), the means on the Expressive One Word Picture Vocabulary Test, the Peabody Picture Vocabulary Test--Revised, and the Test of Language Development were recorded from the children's files. No sex differences on any variable were noted; all variables correlated (Pearson) significantly but varied in magnitude. This group of tests, being intercorrelated, can be used to collect information on children's academic, speech, and language abilities. Valid judgments can be made regarding children's academic abilities for school when multiple tests are administered by professional staff.

Child↗

Fetal maturity cascade: a rapid and cost-effective method for fetal lung maturity testing.

One hundred ninety-three amniotic fluid samples were tested for fetal lung maturity using a maturity cascade scheme involving the sequential use of, in order, the shake test, fluorescence polarimetry, and lecithin: sphingomyelin (L:S) ratio. If any of these tests indicated maturity, the sequence was terminated and no further test was performed, and the fetus was considered mature. Seventy percent of the tests yielded mature values and of these, 85 (63%) required a shake test only, 37 (27%) had a shake test and a fluorescence polarimetry, and only 14 (10%) required all three tests. From these 193 amniocenteses, 111 patients delivered within 72 hours of the procedure. One of 94 infants had respiratory distress syndrome after a mature test (1% false maturity) and ten of 17 had respiratory distress syndrome after an immature cascade (41% falsely immature). This approach saves time and cost and by confirming immaturity with multiple tests only when necessary and may improve predictability of neonatal respiratory distress syndrome.

Amniocentesis↗

Empirical genomewide significance levels established by whole genome simulations.

The advent of high-resolution genetic maps and semiautomated genotyping technology has opened the way for genome screening in genetically complex traits. Many such screens are now under way, or completed, most using multipoint nonparametric linkage analysis of affected sibling pairs. This type of linkage analysis uses all the available genotype information to calculate the maximum lod score (MLS) value at each point in the genome, and thereby generates MLS profiles along each chromosome. Any positive MLS values indicate potential linkage, but the peaks in these profiles, which may be referred to as "hits," identify the most likely locations of disease susceptibility genes. However, such analysis presents serious problems of multiple testing, and the assessment of the statistical significance of hits has become a contentious issue [Lander and Kruglyak (1995) Nat Genet 11:241-247; Curtis (1996) Nat Genet 12:356-357; Witte et al. (1996) Nat Genet 12:355-356]. Having recently completed a genome screen in multiple sclerosis, we decided to investigate the statistical properties of our study by simulation. We report here in detail the results of this simulation study. Our main conclusion is that, for the particular set of families and markers used in our screen, an MLS of 3.2 carries a genome-wide significance of 5% (that is, there is a 5% probability of observing at least one false hit, above this threshold in a complete genome screen). This value is closer to the familiar limit of 3.0, originally suggested by Morton [1955; Am J Hum Genet 7:277-318] than to the more stringent limit of 4.0 recently proposed by Lander and Kruglyak [1995; Nat Genet 11:241-247]. This is somewhat reassuring, in view of the very large sample sizes that would be necessary to achieve adequate power to detect linkage at the more stringent threshold.

Female↗

High prevalence of multiple resistance to antibiotics in Salmonella serovars isolated from a poultry slaughterhouse in Spain.

Salmonellosis is a major foodborne infection in Spain, and strains that are resistant to a great variety of antibiotics have become a major public health concern. The aim of this study was to determine the level of antibiotic resistance in 133 Salmonella isolates obtained from a poultry slaughterhouse in Zaragoza (NE Spain). Antimicrobial resistance testing was performed by disk diffusion method using 19 antibiotics. Results were interpreted following the NCCLS criteria. Overall, the highest percentage of resistance was found to the following antimicrobial agents: sulfadiazine (96.2%), neomycin (53.4%), tetracycline (21.8%), and streptomycin (11.3%). All isolates were found to be resistant to one or more of the antibiotics tested. Multiple resistance was observed in 87 strains (65.4%). We found 23 different patterns of resistance in Salmonella Enteritidis. Resistance to sulfadiazine was the most common single resistance. The most frequent patterns of multiresistant strains were neomycin+sulfadiazine and neomycin+tetracycline+sulfadiazine. S. 4,5,12:b: showed the highest percentages of resistance to the tested drugs, with five different resistance patterns found. Ampicillin+chloramphenicol+streptomycin+sulphonamides+tetracycline (ACSSuT) resistance pattern, commonly associated with S. Typhimurium DT 104, was not detected in strains of the same phage type from broilers. The appearance of substantial multiresistance in foodborne Salmonella isolates suggests the need for more prudent use of antibiotics by farmers, veterinarians, and physicians.

Abattoirs↗

Treatment of autoimmune diseases through manipulation of antigen presentation.

In rheumatoid arthritis, HLA-DR alleles associated with elevated relative risk share a common sequence in the third hypervariable domain of the major histocompatibility complex class II molecule (MHC II). Immunization of mice with a peptide vaccine comprised of the appropriate MHC II sequence in adjuvant blocked the onset and reduced the relapse rate of experimental autoimmune encephalomyelitis (EAE). A phase I clinical trial testing a single injection of a third hypervariable domain peptide from the HLA-DRB1*0401 sequence in alum adjuvant showed that the vaccine is well tolerated and generates an anti-HLA-DR antibody response in approximately 25% of the treated patients. A phase II trial testing multiple boosts is in progress. In a more antigen-specific approach, solubilized MHC II molecules loaded with an autoantigenic peptide are injected intravenously to induce unresponsiveness by the binding of the T-cell receptor (TCR) in the absence of costimulation. Appropriate soluble MHC II:autoantigenic peptide complexes inhibit the recall antigen proliferative response of T clones or draining lymph node cells, and reduce the progression of EAE and experimental autoimmune myasthenia gravis (EAMG). A test of a soluble HLA-DR2:myelin basic protein (MBP) complex in multiple sclerosis is progressing in phase I.

Animals↗

A comparative evaluation of wavelet-based methods for hypothesis testing of brain activation maps.

Wavelet-based methods for hypothesis testing are described and their potential for activation mapping of human functional magnetic resonance imaging (fMRI) data is investigated. In this approach, we emphasise convergence between methods of wavelet thresholding or shrinkage and the problem of hypothesis testing in both classical and Bayesian contexts. Specifically, our interest will be focused on the trade-off between type I probability error control and power dissipation, estimated by the area under the ROC curve. We describe a technique for controlling the false discovery rate at an arbitrary level of error in testing multiple wavelet coefficients generated by a 2D discrete wavelet transform (DWT) of spatial maps of fMRI time series statistics. We also describe and apply change-point detection with recursive hypothesis testing methods that can be used to define a threshold unique to each level and orientation of the 2D-DWT, and Bayesian methods, incorporating a formal model for the anticipated sparseness of wavelet coefficients representing the signal or true image. The sensitivity and type I error control of these algorithms are comparatively evaluated by analysis of "null" images (acquired with the subject at rest) and an experimental data set acquired from five normal volunteers during an event-related finger movement task. We show that all three wavelet-based algorithms have good type I error control (the FDR method being most conservative) and generate plausible brain activation maps (the Bayesian method being most powerful). We also generalise the formal connection between wavelet-based methods for simultaneous multiresolution denoising/hypothesis testing and methods based on monoresolution Gaussian smoothing followed by statistical testing of brain activation maps.

Algorithms↗

Association between DQB1 and cervical cancer in patients with human papillomavirus and family controls.

OBJECTIVE: The role of human leukocyte antigen (HLA) DQB1 alleles and human papillomavirus (HPV) as contributing factors to invasive cervical cancer was investigated. To overcome problems of misleading causal inferences common in traditional case-control studies, a family-based test, the transmission/disequilibrium test, was used. METHODS: Ninety-six patients with pathologically confirmed invasive cervical cancer were ascertained. Human papillomavirus types were determined in 80 patients, of whom 81.25% were HPV-positive, and 18.75% were HPV-negative. Deoxyribonucleic acid was extracted from samples, taken from patients and their parents, and sequenced to determine DQB1 genotypes. Nuclear family data were used to test whether the DQB1 locus is associated with invasive cervical cancer while controlling for high-risk HPV-positive patients. The transmission/disequilibrium test evaluates whether the frequency of transmission of parental marker alleles to their affected offspring deviates from the expected Mendelian frequency of 50%. RESULTS: The HLA DQB1 locus showed evidence for allelic association with invasive cervical cancer in high-risk HPV-positive patients (P = .006). The transmission/disequilibrium test showed that the DQB1*0303 allele was transmitted to high-risk HPV patients more often than expected by chance, chi2(1) = 8.0, P = .005 (P = .035 when correcting for multiple tests). Tests of association were negative when applied to all 96 patients, irrespective of HPV status. No significant differences were found in the distribution of the DQB1 alleles among HPV-positive patients compared with those who were HPV-negative, indicating that HLA alleles are not associated with susceptibility to HPV infection. CONCLUSION: These results suggest that the DQB1*0303 allele increases the risk for invasive cervical cancer in women who are HPV-positive.

Adenocarcinoma↗

Randomization tests of disease-marker associations.

A powerful test for population association of a disease with alleles at a bi-allelic marker locus is the transmission/disequilibrium test (TDT). A generalization of the test to multi-allelic marker loci is proposed which utilizes the maximal association of individual alleles with the disease, given by the maximum TDT statistic, TDT(max). To overcome the multiple testing problem encountered when using the maximal association to test the null hypothesis of no disease-marker association, a randomization procedure is developed. An investigation of the power of the test suggests that the randomization procedure performs almost as well as a recently proposed likelihood based test of linkage disequilibrium. The advantage of the new test is that it can be applied sequentially, based on a one-sided version of the TDT statistic, for investigating patterns of association of several individual alleles with the disease.

Alleles↗

The electrodiagnostic evaluation of nerve root function.

Electrodiagnostic testing is an important part of the investigation of spinal nerve root and cord function. These tests are utilized to confirm and document suspected neuronal lesions. Characteristics of a spinal nerve root lesion, including chronicity, level, sensory or motor dysfunction, and severity, can be estimated by utilizing multiple testing procedures. Tests available include needle electromyography. H-reflexes, F-responses, bulbocavernosus reflex responses, and somatosensory evoked responses recorded over the spine and head. Each test has unique advantages and disadvantages and none can be considered of sufficient sensitivity to exclude the other tests. By using case examples the lack of correlation between electrodiagnostic testing and spinal pain has been illustrated.

Adult↗

Nonreplication in genetic studies of complex diseases--lessons learned from studies of osteoporosis and tentative remedies.

Inconsistent results have accumulated in genetic studies of complex diseases/traits over the past decade. Using osteoporosis as an example, we address major potential factors for the nonreplication results and propose some potential remedies. Over the past decade, numerous linkage and association studies have been performed to search for genes predisposing to complex human diseases. However, relatively little success has been achieved, and inconsistent results have accumulated. We argue that those nonreplication results are not unexpected, given the complicated nature of complex diseases and a number of confounding factors. In this article, based on our experience in genetic studies of osteoporosis, we discuss major potential factors for the inconsistent results and propose some potential remedies. We believe that one of the main reasons for this lack of reproducibility is overinterpretation of nominally significant results from studies with insufficient statistical power. We indicate that the power of a study is not only influenced by the sample size, but also by genetic heterogeneity, the extent and degree of linkage disequilibrium (LD) between the markers tested and the causal variants, and the allele frequency differences between them. We also discuss the effects of other confounding factors, including population stratification, phenotype difference, genotype and phenotype quality control, multiple testing, and genuine biological differences. In addition, we note that with low statistical power, even a "replicated" finding is still likely to be a false positive. We believe that with rigorous control of study design and interpretation of different outcomes, inconsistency will be largely reduced, and the chances of successfully revealing genetic components of complex diseases will be greatly improved.

Animals↗

Colchicine-binding properties of hepatic tubulin. The role of "time-decay".

Determination of total and polymerized tubulin in the liver by the [3H]colchicine-binding assay is hampered by rapid loss of binding sites. One solution, which has been proposed to overcome this problem, is the use of a "time-decay" corrected assay that extrapolates to an initial binding capacity based on the results of testing multiple aliquots of liver supernatants over time. If such an approach is valid, it follows that the extrapolated initial value should be independent of the rate of time-decay. To test this relationship, we modulated the half-life (T1/2) for time-decay of a fixed amount of hepatic microtubule-derived tubulin using various concentrations of organic acids, sodium glutamate and glucose-1-phosphate. We found that the initial binding capacity based on simple first order decay did vary with the T1/2. Similar results were also obtained with bovine brain tubulin added to hepatic supernatants. These results indicate that the quantification of hepatic tubulin derived by extrapolated time-decay values is inaccurate and may overestimate the actual amount of tubulin present, especially when time-decay is rapid.

Animals↗

Analysis of pilot and early phase studies with small sample sizes.

The need for statistical methodologies for analysing a small size study, such as a pilot or so-called 'proof of concept' study, has not been paid much attention in the past. Recently the Institute of Medicine (IOM) formed a committee and held a workshop to discuss methodologies for conducting clinical trials with small number participants. In this paper we argue that the hypothesis of treatment effect in a small pilot study should be set up to test whether any individual subject has an effect rather than whether the group mean or median has shifted as often done for large, confirmatory clinical trials. Based on this paradigm we propose multiple test procedures as one option when individuals have enough observations, and a mixture-distribution approach when individuals have one or more observations. The latter approach may be used in either a one- or two-group setting, and is our focus in this paper. We present the likelihood ratio tests for the mixture models. Examples are given to demonstrate the methods.

Clinical Trials, Phase I as Topic↗

Biochemical profiles. Applications in ambulatory screening and preadmission testing of adults.

Evidence bearing on the utility of biochemical profiles for ambulatory care screening and preadmission testing was reviewed, and recommendations were formulated. Certain biostatistical principles relevant to this analysis include the concepts of regression to the mean, the meaning of biochemical "normality" (particularly as it relates to multiple testing), and the effects of disease prevalence on the post-test probability of disease for individual test results. Applying these principles to a typical 12-test battery in asymptomatic adults, one would expect a low yield of unanticipated diagnoses and a high proportion of false-positive results. For the typical test battery, the empirical evidence supports these expectations in ambulatory care screening. In addition, routine preadmission use of biochemical profiles is not supported by studies examining their impact on patient care, hospital costs, or lengths of stay. Whereas components of these profiles can be endorsed for screening or preadmission testing, we recommend that the routine use of the entire profile be abandoned in these settings.

Adult↗

Paternity exclusion and probability of paternity.

The principles of paternity exclusion and current systems of paternity testing are reviewed. Recent advances, especially the utilization of human leukocyte antigens (HLA), have greatly improved the likelihood of exclusion of the innocent accused male. Failure to exclude an alleged father through multiple test systems increases the suspicion that he is the biological father. This can be expressed mathematically as the Probability of Paternity, for which the principle of calculation is explained. Legal obligations of the laboratory are briefly explored.

Blood Group Antigens↗

Activity profiles of developmental toxicity: design considerations and pilot implementation.

The available literature was searched for quantitative test results from both in vitro and in vivo assays for developmental toxicity for five model compounds: cyclophosphamide, methotrexate, hydroxyurea, caffeine, and ethylenethiourea. These compounds were chosen on the basis of their extensive utilization in a variety of assay systems for developmental toxicity as evidenced by their representation in the ETIC database (each generally has 100-500 citations encompassing multiple test systems). Nine cellular-based assays, six assays using whole embryos in culture, as well as Segment II and abbreviated exposure tests for mammalian test species are included in the database. For each assay, the critical endpoints were identified, each of which was then provided a three-letter code, and the criteria for extraction of quantitative information were established. The extracted information was placed into a computerized reference file and subsequently plotted such that the qualitative (positive/negative) and quantitative (e.g., IC50, highest ineffective dose (HID), lowest effective dose (LED] results across all test systems could be displayed. The information contained in these profiles can be used to compare qualitative and quantitative results across multiple assay systems, to identify data gaps in the literature, to evaluate the concordance of the assays, to calculate relative potencies, and to examine structure-activity relationships.

Animals↗

Candidate-gene association study of mothers with pre-eclampsia, and their infants, analyzing 775 SNPs in 190 genes.

Pre-eclampsia (PE) affects 5-7% of pregnancies in the US, and is a leading cause of maternal death and perinatal morbidity and mortality worldwide. To identify genes with a role in PE, we conducted a large-scale association study evaluating 775 SNPs in 190 candidate genes selected for a potential role in obstetrical complications. SNP discovery was performed by DNA sequencing, and genotyping was carried out in a high-throughput facility using the MassARRAY(TM) System. Women with PE (n = 394) and their offspring (n = 324) were compared with control women (n = 602) and their offspring (n = 631) from the same hospital-based population. Haplotypes were estimated for each gene using the EM algorithm, and empirical p values were obtained for a logistic regression-based score test, adjusted for significant covariates. An interaction model between maternal and offspring genotypes was also evaluated. The most significant findings for association with PE were COL1A1 (p = 0.0011) and IL1A (p = 0.0014) for the maternal genotype, and PLAUR (p = 0.0008) for the offspring genotype. Common candidate genes for PE, including MTHFR and NOS3, were not significantly associated with PE. For the interaction model, SNPs within IGF1 (p = 0.0035) and IL4R (p = 0.0036) gave the most significant results. This study is one of the most comprehensive genetic association studies of PE to date, including an evaluation of offspring genotypes that have rarely been considered in previous studies. Although we did not identify statistically significant evidence of association for any of the candidate loci evaluated here after adjusting for multiple testing using the false discovery rate, additional compelling evidence exists, including multiple SNPs with nominally significant p values in COL1A1 and the IL1A region, and previous reports of association for IL1A, to support continued interest in these genes as candidates for PE. Identification of the genetic regulators of PE may have broader implications, since women with PE are at increased risk of death from cardiovascular diseases later in life.

Adult↗

The chemokine (C-C-motif) receptor 3 (CCR3) gene is linked and associated with age at menarche in Caucasian females.

Chemokine (C-C-motif) receptor 3 (CCR3), playing an important role in endometrium related metabolic pathways, may influence the onset of menarche. To test linkage and/or association between CCR3 polymorphisms with the variation of age at menarche (AAM) in Caucasian females, we recruited a sample of 1,048 females from 354 Caucasian nuclear families and genotyped 16 SNPs spanning the entire CCR3 gene. Linkage disequilibrium and haplotype blocks were inferred by Haploview. Both single-SNP markers and haplotypes were tested for linkage and/or association with AAM using QTDT (quantitative transmission disequilibrium test). We also tested associations between CCR3 polymorphisms and AAM in a selected random sample of daughters using ANOVA (analysis of variance). We identified two haplotype blocks. Only block two showed significant results. After correction for multiple testing, significant total associations of SNP7, SNP9 with AAM were detected (P = 0.009 and 0.006, respectively). We also detected significant within-family association of SNP9 (P = 0.01). SNP14 was linked to AAM (P = 0.02) at the nominal level. In addition, there was evidence of significant total association and nominal significant linkage (P = 0.008 and 0.03, respectively) with AAM for the haplotype AGA reconstructed by SNP7, SNP9 and SNP13. ANOVA confirmed the results by QTDT. For the first time we reported that CCR3 is linked and associated with AAM variation in Caucasian women. However, further studies are necessary to substantiate our conclusions.

Aging↗

Salmonella and Shigella in adult diarrhoea in Addis Ababa--prevalence and antibiograms.

Ninety Shigella and 45 Salmonella strains were isolated from 1000 adult diarrhoeal out-patients from various hospitals and clinics in Addis Ababa. The Shigella species were isolated in the order of frequency of S. flexneri, S. dysenteriae, S. boydii and S. sonnei and the Salmonella in the order of Group C, Group B, S. typhi, other Group D and Groups A and E. Almost all Shigella isolates were sensitive to cephalothin, gentamicin, kanamycin, polymyxin B and trimethoprim-sulphamethoxazole. About 17% were sensitive to the 11 drugs tested. Multiple resistance was detected in 62%, the most common to six drugs (27%). All Salmonella isolates were sensitive to gentamicin, polymyxin B and trimethoprim-sulphamethoxazole. About 69% were sensitive to all drugs tested. 22% were multiply resistant and the most common was to eight drugs (18%).

Anti-Bacterial Agents↗