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PubMed2005

Estimating the pretest probability threshold to justify empiric administration of heparin prior to pulmonary vascular imaging for pulmonary embolism.

Expertly interpreted pulmonary vascular imaging (either ventilation-perfusion scan or computed tomography chest angiography) is not uniformly available at most hospitals, including those in the US. When evaluating a patient with suspected pulmonary embolism during times when pulmonary vascular imaging is not available, clinicians frequently face the decision of whether to administer heparin while awaiting availability of imaging. In this report, we analyze published data to quantitate the probability of death or disability from untreated pulmonary embolism versus the probability of serious bleeding for one, two and seven days of heparin therapy. For these three time points, we estimate the pretest probability of pulmonary embolism to justify the empiric administration of heparin.

Data Interpretation, Statistical↗

PubMed2001

The effect of medical care by a helicopter trauma team on the probability of survival and the quality of life of hospitalised victims.

In 1995, an experiment was started to give extra medical help by helicopter to patients who needed emergency treatment. The aim of the experiment was not to reduce the transportation time to the hospital, but to bring specialised medical care directly to patients as soon as possible. An evaluation study was carried out to assess the effect of the treatment given by the Helicopter Trauma Team (HTT) on survival and quality of life. The study focused on hospitalised patients suffering from polytrauma. A direct comparison between an experimental and control group was not possible, because the HTT group consisted of more severely injured patients. A refined severity index was constructed on the basis of the Revised Trauma Scale (RTS) and the Injury Severity Scale (ISS) and their sub-scores. Using this index, it was possible to make a clear distinction between three groups of patients, i.e. those with a high probability of survival (with or without special medical treatment), those with a very low probability of survival and the patients in between. It was shown that the HTT-treatment was effective. The survival rate increased for patients in the 'in between' group, but not for patients with a low probability of survival. There was no difference in the quality of life of patients from the HTT and non-HTT groups 15 months after the accident. These findings refute the hypothesis that only the most severely injured patients with a low quality of life profit from HTT-treatment.

Adolescent↗

PubMed1999

Does the specific intravascular ultrasound criterion used to optimize stent expansion have an impact on the probability of stent restenosis?

Intravascular ultrasound (IVUS) imaging has been used to optimize stent implantation in coronary arteries, but the criteria used were chosen on an empiric basis. The aim of this study was to determine whether any of these criteria have an independent role in predicting the probability of freedom from restenosis. The study population consisted of 425 patients (496 lesions) who underwent angiographically successful IVUS-guided stenting. Five IVUS criteria were studied: (1) intrastent minimal lumen cross-sectional area (ISMLCSA) > or =9 mm2; (2) ISMLCSA (> or =9 mm2 and > or =80% of average reference lumen cross-sectional area [CSA]); (3) ISMLCSA > or =90% of average reference lumen CSA; (4) ISMLCSA > or =90% of distal reference lumen CSA; and (5) ISMLCSA > or =55% of average reference vessel CSA. These criteria were met in 33%, 29%, 68%, 82%, and 69% of lesions, respectively. Angiographic follow-up was performed in 335 of 421 eligible patients (80%) at 5.3 +/- 2.7 months. An absolute ISMLCSA > or =9 mm2 was associated with the lowest restenosis, but this criterion was primarily achieved in large vessels. The only criterion that was associated with higher probability of freedom from restenosis independently from vessel size was an ISMLCSA > or =55% of average reference vessel CSA. Therefore, when IVUS is used to guide stent implantation an effort should be made to achieve the largest lumen safely possible. An ISMLCSA > or =55% of the average reference vessel CSA seems to be the most appropriate criterion in terms of frequency of achievement and in terms of increasing the probability of freedom from restenosis.

Coronary Angiography↗

PubMed2002

Effects of event probability and sequence on children with attention-deficit/hyperactivity, reading, and math disorder.

BACKGROUND: We investigated the impact of stimulus probability and sequence on performance and event-related potentials of 310 children classified into 12 combinations of attention-deficit/hyperactivity disorder (Not-attention-deficit/hyperactivity disorder, Inattentive and Combined subtypes) with presence/absence of reading disorder and math disorder. METHODS: Subjects pressed buttons to displays of the letters O and X, which were presented with probabilities of either .17/.83 or .50/.50. Greater response selection was required in the .17/.83 condition. RESULTS: Stimulus probability had comparable effects on all diagnostic groups. The extent of mismatch between a stimulus and preceding events elicited less systematic increases in errors, P3b latency, and P3b amplitude among both attention-deficit/hyperactivity disorder subtypes than controls. Mismatch with preceding trials more greatly reduced math disorder and reading disorder + math disorder children's speed in the Rare task and accuracy in both conditions. Math disorder and reading disorder + math disorder subjects also registered less the effects of alternations of the infrequent O on N2 amplitude and on P3b latency. CONCLUSIONS: Math disorder and reading disorder + math disorder youngsters' lower sensitivity to sequence irregularity in their event-related potentials along with greater disruption of performance suggest working memory deficits that adversely affected response selection. Comorbidity of attention-deficit/hyperactivity disorder and reading disorder did not affect the results.

Adolescent↗

PubMed1983

Lexical decision time as a function of visual field and stimulus probability.

Two experiments were performed to study lexical decision time to word and non-word Hebrew trigrams as a function of stimulus probability, visual hemifield and responding hand. The results indicate that lexical decision time to words is shorter than to non-words. In addition, although decision time to words is significantly shorter with right hemifield stimulation than with left hemifield stimulation, decision time to non-words is the same whether they are presented to the right or left hemifield. Decision time to non-words decreases almost linearly as stimulus probability increases from 0.25 to 0.75, whereas decision time to words decreases in a concave manner apparently approaching an asymptote at a stimulus probability of 0.75. Responding hand is not significant as a main effect or in any interaction with any other variable. The data are discussed in terms of several models of hemispheric linguistic superiority.

Decision Making↗

PubMed2002

Assessment of proteasomal cleavage probabilities from kinetic analysis of time-dependent product formation.

Proteasomes are multicatalytic cellular protease complexes that degrade intracellular proteins into smaller peptides. Proteasomal in vitro digests have revealed that the various peptide bonds of a given substrate are cleaved in a highly selective manner. Regarding the key role of proteasomes as the main supplier of antigenic peptides for MHC class I-mediated antigen presentation, it is important to know to what extent these preferences for specific peptide bonds may vary among proteasomes of different cellular origin and of different subunit composition. Here, we quantify such cleavage rates by means of a kinetic proteasome model that relates the time-dependent changes of the amount of any generated peptide to the rates with which this peptide can be either generated from longer precursor peptides or degraded into smaller successor peptides. Numerical values for these rates are estimated by minimizing the distance between simulated and measured time-courses. The proposed method is applied to kinetic data obtained by combining HPLC fractionation and mass spectrometry (MS) to trace the degradation of two model peptides (pp89-25mer and LLO-27mer) by either the constitutive (T2) or immunoproteasome (T2.27). To convert the intensity of the MS signals into the respective peptide amounts, we use two methods leading to similar results: experimental calibration curves and theoretically determined linear scaling functions based on a novel approach using mass conservation rules. Comparison of the cleavage probabilities and procession rates obtained for the two types of proteasomes reveals that the striking differences between the time-dependent peptide profiles can be accounted for mainly by a generally higher turnover rate of the immunoproteasome. For the pp89-25mer, there is no significant change of the cleavage probabilities for any of the ten observed cleavage sites. For the LLO-27mer, there appears to be a significant change in the cleavage probabilities for four of the nine observed cleavage sites when switching from the constitutive to the immunoproteasome.

Amino Acid Sequence↗

PubMed1982

Age-related probability of development of hereditary medullary thyroid carcinoma.

Hereditary medullary thyroid carcinoma is inherited as an autosomal dominant trait; at birth each child of an affected parent has a 50% chance of developing the disease. Measurement of plasma calcitonin concentrations after provocative calcium or pentagastrin stimulation has proved useful in the early diagnosis of this disease. To determine the age-related risk of conversion from a negative to a positive provocative test, 445 members of 11 kindreds were studied with sequential tests. Of 159 family members with a 50% risk at birth of developing medullary thyroid carcinoma 38 converted from a negative to a positive test result (mean age of conversion was 15 years). By means of methods previously described for determining the age-related probability for developing Huntington chorea, we present a method for determining the probability of development of medullary thyroid carcinoma. An individual at risk whose test result was negative had the following probability of converting to a positive test result at a later date: age (years)/probability, 0/0.5; 5/0.49; 10/0.41; 15/0.25; 20/0.16; 25/0.10, 30/0.05; and 35/0. We conclude that hereditary medullary thyroid carcinoma is regularly detectable in the pediatric age group and that screening should begin by age 5 years and be continued at regular intervals until age 35.

Adolescent↗

PubMed1991

Maximum likelihood estimation of non-uniform transmitter release probabilities at the crayfish neuromuscular junction.

The classical model of quantal release of neurotransmitter assumes that a fixed number of quantal units are available for release in the presynaptic terminal, and that each unit has the same probability of being released. This model also assumes that different units are released independently of one another. We consider two variations of the classical model. In the first case we assume that release is independent, but with potentially different release probabilities at different sites. In the second case we allow for dependence among the release units. A maximum likelihood procedure for the estimation of model parameters is developed, and an estimator of the number of quantal units is proposed. The performance of the method is assessed through a simulation study, and the procedures are applied to the analysis of a sequence of post-synaptic potentials recorded intracellularly at the crayfish neuromuscular junction. Goodness of fit and hypothesis test procedures reject the classical model in favor of an independent release mechanism with differing release probabilities. A more general release mechanism, allowing for dependence in the release process, also provides a good fit to the data analyzed.

Animals↗

PubMed2002

[Diagnostic value of D-dimer in patients with a low pretest probability of deep venous thrombosis of lower extremities].

BACKGROUND: We aimed to assess the accuracy of a diagnostic strategy including broth clinical assessment and determination of D-dimer (DD) in patients with clinically suspicion of low pretest probability of deep venous thrombosis (DVT). METHOD: 149 outpatients (mean age 69; SD 16) with clinically suspected proximal DVT attending our Emergency Department and classified as low pretest probability were included in an observational prospective study. In patients with a DD (STA Liatest D-Di, Diagnostica Stago, Asnières sur Seine, France) concentration below the cut-off value (0.4 ng/ml) the diagnosis of DVT was readily ruled out, whereas those individuals with a positive DD result underwent compression Doppler venous ultrasound. A 3-month clinical follow-up was carried out in those patients in whom a diagnosis of DVT was initially excluded. RESULTS: Only 2 cases of DVT were confirmed (prevalence 1.3%; CI 95%, 0.2-5.3). In 47.6% of cases, a DD negativity ruled out the diagnosis of DVT. The rate of negative DD results was significantly lower in patients below 70 years of age as compared to older patients (73.6 versus 33.3%) (p < 0.001). Sensitivity, specificity, positive predictive value and negative predictive value of DD in our series were 100% (CI 95%,19.7-95.1), 48.3% (CI 95%, 40.0-56.7), 2.6% (CI 95%, 0.4-9.8) and 100% (CI 95%, 93.6-99.8) respectively, the latter being similar in the two age groups. No case of DVT was diagnosed during the follow-up period. CONCLUSIONS: In patients with a low pretest probability of DVT a negative DD result reliably and safely rules out such diagnosis. However, the diagnostic value of DD is lower in elderly patients (>= 70 years of age) due to a lower rate of negative results in these individuals.

Aged↗

PubMed2001

Comparing Early to Middle Miocene floras and probable vegetation types of Oberdorf N Voitsberg (Austria), Bohemia (Czech Republic), and Wackersdorf (Germany).

The Early Miocene vegetation of western Styria, Austria, is reconstructed on the basis of detailed investigations of leaves and diaspores from the mining area Oberdorf N Voitsberg. In this paper, the flora and probable vegetation are compared with other assemblages of similar age from the Czech Republic and Germany to elucidate the diversity of wetland and mesophytic plant communities. The floristic composition and the vegetational units represented in Oberdorf are compared to the middle part of the Most Formation (M Most Fm), Cypris Shale, Mydlovary Formation (Mydlovary Fm) of Bohemia, and the Wackersdorf mining area of Bavaria. Among these sites, Oberdorf is extremely poor in hydrophytes and reed-like monocotyledons, indicating rare pond-like habitats as well as possibly more closed swamp forest conditions than, e.g. in the M Most Fm. In Oberdorf, relatively high pH-values in the lignite-forming swamps and the possible scarcity of acidic, nutrient-poor (sandy) soils have probably influenced the floristic composition of the azonal communities. The peat-forming associations in all regions share the abundance of Glyptostrobus europaeus. However, distinct differences in the accompanying elements, such as Taxodium dubium (present and abundant only in the M Most Fm) indicate even stronger floristic variability of Early(/Middle) Miocene peat-forming and riparian plant communities than previously expected. The virtual absence of Pinus, Engelhardia, Comptonia, and probably also of Quercus kubinyii/Quercus drymeja in the megafossil record of Oberdorf can possibly be explained by the edaphic conditions. The abundance of Sequoia abietina (absent in all the other compared sites), which we assign to riparian (and mesophytic) forests in Oberdorf, may have been favoured by rich alluvial soils.In the mesophytic associations, thermophilous elements of the Lauraceae, Mastixiaceae, Symplocaceae, and Rutaceae are diverse. Usually they include Trigonobalanopsis rhamnoides/Trigonobalanopsis exacantha, an evergreen Fagaceae. This assemblage type corresponds with the Younger Mastixioid Flora sensu Mai. The Younger Mastixioid Flora is best developed in Wackersdorf, less distinct in Oberdorf, and likely in the Cypris Shale and Mydlovary Fm. It is not traceable in the M Most Fm.

Journal Article↗

PubMed2003

Weak correlation between bladder outlet obstruction and probability to void to completion.

OBJECTIVES: To investigate the weak correlation between bladder outlet obstruction (BOO), as diagnosed using the provisional International Continence Society nomogram for the definition of BOO in men, and postvoid residual urine volume. METHODS: The relationship between voiding to completion and several indexes for bladder outlet resistance and bladder contractility was studied in 131 pressure flow studies in male patients using multivariate logistic regression analysis. RESULTS: The International Continence Society nomogram and the related BOO index weakly predict for postvoid residual urine volume (areas under the receiver operating characteristic curve 0.63 and 0.64, respectively). The BOO index primarily measures bladder outlet resistance. If the nomogram or BOO index is augmented with bladder contractility information, the postvoid residual urine volume can be predicted significantly better (eg, area under the receiver operating characteristic curve [0.89] for the combination of the BOO index and bladder contractility information). CONCLUSIONS: The weak correlation between BOO and postvoid residual urine volume is related to the fact that emptying the bladder to completion depends on bladder contractility, as well as bladder outlet resistance. It is possible to estimate the probability to void to completion quite accurately on the basis of bladder outlet resistance and bladder contractility. We named this probability "relative bladder outlet resistance." A high probability of a postvoid residual urine volume may be assumed to indicate "relative BOO." By its very nature, the correlation between "relative BOO" and postvoid residual urine volume is good.

Area Under Curve↗

PubMed1996

Free and complexed prostate-specific antigen serum ratios to predict probability of primary prostate cancer and benign prostatic hyperplasia.

OBJECTIVES: Ratios of free to total prostate-specific antigen (f/t PSA ratio) improved differentiation of benign prostatic hyperplasia (BPH) from prostate cancer (CaP). Using sera obtained at least 1 month prior to biopsy-confirmed diagnosis and logistic regression adjusted for disease prevalence, probability curves are constructed to predict the presence of CaP. METHODS: The patient population included 122 (44%) BPH sera and 155 (56%) prostate carcinoma sera collected prior to any therapy. The total PSA range = 2.0-20.0 ng/mL; median age = 69 years. External reference standards for both free and total PSA assays were used to standardize the assays and correct the ratio. Probability curves and tables for cancer incidence were formulated for a subset of the total test population (total PSA range = 2.0-10.0 ng/mL; 98 BPH, 118 CaP patients) by using logistic regression and prior cancer prevalence statistics derived from a published patient screening study. RESULTS: Median f/t PSA ratios were 0.18 and 0.12 in the overall sample and 0.19 and 0.12 in the subset for BPH and CaP, respectively (P = 0.0001). The median total PSA concentrations for BPH and CaP were 5.8 and 6.7 ng/mL when total PSA range = 2.0-20.0 ng/mL and were 4.9 and 5.9 ng/mL when total PSA range = 2.0-10.0, respectively. CONCLUSIONS: Cancer probability curves were constructed to help guide decisions concerning biopsy and other aspects of prostate cancer disease management. Further validation of this approach in another series of patients is necessary and is planned.

Adult↗

PubMed1999

Development of a nomogram that predicts the probability of a positive prostate biopsy in men with an abnormal digital rectal examination and a prostate-specific antigen between 0 and 4 ng/mL.

OBJECTIVES: Early detection of prostate cancer traditionally involves both digital rectal examination (DRE) and serum prostate-specific antigen (PSA) determination in an informed patient population. Abnormalities in either of these studies typically lead to additional evaluations, including prostate biopsy. In this study, we analyzed the operational characteristics of serum PSA between 0 and 4 ng/mL as an initial test for prostate cancer. METHODS: From January 1990 through May 1997, transrectal biopsies were obtained from 700 men with a serum PSA level less than 4.0 ng/mL but DRE suspicious for cancer. Patient age, race, and serum PSA level were reviewed for this study. RESULTS: Of the 700 men studied, 445 were white (64%) and 255 were African American (36%). In multivariate analysis of prebiopsy risk factors (age, race, serum PSA), serum PSA was the only independent predictor of a positive prostate biopsy. A nomogram was created that determines the worst-case probability of a positive prostate biopsy in men with PSA between 0 and 4 ng/mL and a DRE suspicious for cancer. The predictions from the nomogram appeared accurate and discriminating, with a bias-corrected area under the receiver operating characteristic curve (i.e., comparison of the predicted probability with the actual outcome) of 0.75. CONCLUSIONS: Although early detection of prostate cancer has traditionally used both PSA measurement and DRE, PSA testing alone could be more easily implemented and may encourage some men to seek consultation who might not otherwise have done so. By providing a nomogram which provides a worse-case scenario (assuming a positive DRE) of the probability of a positive biopsy, the patient and clinician can make an informed decision as to whether additional evaluation is warranted.

Adult↗

PubMed1998

The probability of blindness from open-angle glaucoma.

OBJECTIVE: This study aimed to determine the probability of a patient developing legal blindness in either one or both eyes from newly diagnosed and treated open-angle glaucoma (OAG) after starting medical or surgical therapy or both. DESIGN: The study design was a retrospective, community-based descriptive study. PARTICIPANTS: Two hundred ninety-five residents of Olmsted County, Minnesota, newly diagnosed with, and treated for, OAG between 1965 and 1980 with a mean follow-up of 15 years (standard deviation +/- 8 years) participated. INTERVENTION: Kaplan-Meier cumulative probability of blindness was estimated for patients treated and followed for OAG. MAIN OUTCOME MEASURES: Legal blindness, defined as a corrected visual acuity of 20/200 or worse, and/or visual field constricted to 20 degrees or less in its widest diameter with the Goldmann 1114e test object or its equivalent on automated perimetry, secondary to glaucomatous loss, was measured. RESULTS: At 20-years' follow-up, the Kaplan-Meier cumulative probability of glaucoma-related blindness in at least one eye was estimated to be 27% (95% confidence interval, 20%-33%), and for both eyes, it was estimated to be 9% (95% confidence interval, 5%-14%). At the time of diagnosis, 15 patients were blind in at least 1 eye from OAG. CONCLUSION: A retrospective study of a white population determined that the risk of blindness from newly diagnosed and treated OAG may be considerable.

Aged↗

PubMed1997

Variations of tumor control and rectum complication probabilities due to random set-up errors during conformal radiation therapy of prostate cancer.

BACKGROUND AND PURPOSE: The effect of random set-up errors on tumor control probability (TCP) and rectum complication probability (NTCP) on 3D conformal treatment planning of prostate cancer has been investigated by applying the convolution method originally proposed by Leong (Leong, J. Implementation of random positioning error in computerized radiation treatment planning systems as a result of fractionation. Phys. Med. Biol. 32: 327-334, 1987). MATERIALS AND METHODS: The combined influence of the standard deviation of the random shifts probability distribution (sigma) of the dose and of the Beam's-eye-view margin (M) between the clinical target volume (CTV) and the edge of the blocks have been investigated in two patients. RESULTS AND CONCLUSIONS: Random set-up error has been found to decrease TCP (for a typical 70 Gy CTV mean dose) by up to 6% for a 1 cm margin (sigma = 7 mm). When M is equal to or larger than 1.5 cm, no relevant effects on TCP are obtained. Maximum acceptable TCP values (corresponding to a rectum NTCP equal to 5%) have been derived and the dependence on sigma and M has been investigated.

Humans↗

PubMed1999

Estimation of tumor control probability model parameters from 3-D dose distributions of non-small cell lung cancer patients.

Tumor control probability (TCP) model calculations may be used in a relative manner to evaluate and optimize three-dimensional (3-D) treatment plans. Using a mathematical model which makes a number of simplistic assumptions, TCPs can be estimated from a 3-D dose distribution of the tumor given the dose required for a 50% probability of tumor control (D50) and the normalized slope (gamma) of the sigmoid-shaped dose-response curve at D50. The purpose of this work was to derive D50 and gamma from our clinical experience using 3-D treatment planning to treat non-small cell lung cancer (NSCLC) patients. Our results suggest that for NSCLC patients, the dose to achieve significant probability of tumor control may be large (on the order of 84 Gy) for longer (> 30 months) local progression-free survival.

Carcinoma, Non-Small-Cell Lung↗

PubMedDate not supplied

Analgesic efficacy and bioavailability of ketorolac in postoperative pain: a probability analysis.

BACKGROUND: The analgesic efficacy and bioavailability of 30 mg intramuscular ketorolac was studied in 24 patients with severe or very severe postoperative pain. METHODS: Pain and pain relief were determined by a five-point verbal rating scale and data were submitted to a probability analysis. Ketorolac plasma levels were determined by high-performance liquid chromatography. RESULTS: Two patients chose not to finish the study; 22 patients completed the study achieving at least good pain relief. Of these 22 patients, 13 reached complete pain relief. Ketorolac was rapidly absorbed. Notwithstanding, pain relief increased gradually, showing considerable delay with regard to plasma concentrations. Analysis of the probability-time curves revealed that 25% of the patients obtained moderate pain relief at 7 min after ketorolac administration, 50% at 11 min, 75% at 29 min, and 95% at 60 min. Good pain relief was achieved in 25, 50, and 75% of the patients at 1.1, 1.8, and 2.7 h, respectively. Complete pain relief was achieved in 25% and 50% of the patients at 2.6 h and 3.7 h, respectively. The probability of exhibiting an acceptable pain relief in responsive patients for more than 5 h was 0.97. No serious side effects were detected. CONCLUSIONS: Results show that 30 mg intramuscular ketorolac is an adequate treatment for postoperative pain in the Mexican population. Therefore, the use of higher doses is not justified. Due to gradual installation of analgesia, administration of additional analgesic medication before 1 h is not recommended.

Adult↗

PubMed2003

Estimation of "needs" and "probable uptake" for HIV/AIDS preventive vaccines based on possible policies and likely acceptance (a WHO/UNAIDS/IAVI study).

Once an effective HIV vaccine is discovered, a major challenge will be to ensure its world wide access. A preventive vaccine with low or moderate efficacy (30-50%) could be a valuable prevention tool, especially if targeted to populations at higher risk of HIV infection. High efficacy vaccines (80-90%) could be used in larger segments of the population. Estimated "needs" for future HIV vaccines were based on anticipated policies regarding target populations. Estimated "needs" were adjusted for "accessibility" and "acceptability" in the target populations, to arrive at an estimate of "probable uptake", i.e. courses of vaccine likely to be delivered. With a high efficacy vaccine, global needs are in the order of 690 million full immunization courses, targeting 22 and 69%, respectively, of the 15-49 years old, world wide and in sub-Saharan Africa, respectively. With a low/moderate efficacy vaccine targeted to populations at higher risk of HIV infection, the global needs were estimated to be 260 million full immunization courses, targeting 8 and 41%, respectively, of the world and sub-Saharan African population aged 15-49 years. The current estimate of probable uptake for hypothetical HIV vaccines, using existing health services and delivery systems, was 38% of the estimated need for a high efficacy vaccine, and 19% for a low/moderate efficacy vaccine. Bridging the gap between the estimated needs and the probable uptake for HIV vaccines will represent a major public health challenge for the future. The potential advantages and disadvantages of targeted versus universal vaccination will have to be considered.

AIDS Vaccines↗