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Continuous probability distribution (CUPID) analysis of potentials for internal rotations.

The continuous probability distribution (CUPID) approach for analyzing the rotamer populations from NMR spin-spin couplings and nuclear Overhauser enhancements [Z. Dzakula, W.M. Westler, A.S. Edison, and J.L. Markley, J. Amer. Chem. Soc. 114, 6195 (1992)] can be expanded to allow computation of the rotational potential from the Fourier coefficients of the angular probability distribution. This approach provides a general solution to the nonnegativity problem, which appears when lack of data causes a serious truncation in the Fourier series that defines the probability distribution. In favorable cases, this approach also allows thermodynamic characterization of internal rotation. Use of this extension of the CUPID method is illustrated by the analysis of internal rotations in an amino acid, two peptides, and an oligosaccharide from published experimental data. Three strategies have been devised for dealing with cases where the experimental input data do not provide enough information for complete reconstruction of the potential: (1) two-dimensional grid search for the undetermined third-order Fourier coefficients of the potential, (2) transfer of these coefficients from related model compounds, and (3) restriction of the magnitudes of the Fourier coefficients as required by the assumption of fast-exchange averaging of the input parameters. In addition, equations for translating uncertainties in experimental NMR input data into errors in calculated continuous probability distributions of rotamers are presented. The dependence of errors on various features of the distributions has been studied systematically from simulations. The results show that, typically, the confidence intervals are +/- 30-40 degrees for dihedral angles and +/- 0.2 for rotamer populations. For chi 1 rotamers of amino acids, the analysis is most sensitive to the uncertainties in C'-H beta couplings. A critical reexamination of the use of Gaussian functions to reconstruct a probability distribution is presented. In particular, the simplifying assumption of identical widths for all Gaussian probability peaks has been justified by showing that it does not lead to large errors in other CUPID parameters. finally, the angular dependencies of cross-relaxation rates, their uncertainties, and the potential for their use in studying chi 1 internal rotations in amino acids are discussed.

Electron Spin Resonance Spectroscopy↗

Establishment probability in fluctuating environments: a branching process model.

We study the establishment probability of invaders in stochastically fluctuating environments and the related issue of extinction probability of small populations in such environments, by means of an inhomogeneous branching process model. In the model it is assumed that individuals reproduce asexually during discrete reproduction periods. Within each period, individuals have (independent) Poisson distributed numbers of offspring. The expected numbers of offspring per individual are independently identically distributed over the periods. It is shown that the establishment probability of an invader varies over the reproduction periods according to a stable distribution. We give a method for simulating the establishment probabilities and approximations for the expected establishment probability. Furthermore, we show that, due to the stochasticity of the establishment success over different periods, the expected success of sequential invasions is larger then that of simultaneous invasions and we study the effects of environmental fluctuations on the extinction probability of small populations and metapopulations. The results can easily be generalized to other offspring distributions than the Poisson.

Demography↗

Teaching medical students to estimate probability of coronary artery disease.

The authors conducted a randomized trial of two methods for teaching medical students how to estimate the probability of coronary artery disease in patients with chest pain. Eighty-two students were given a pre-test consisting of written protocols summarizing the histories of 25 patients who had undergone coronary arteriography. The students estimated the likelihood of coronary artery disease for each case and were then randomized to receive one of two short written clinical lessons: a cardiology textbook chapter on interpreting chest pain, or a lesson based on a prediction rule for estimating probability of coronary artery disease. All students were given a post-test similar to the pre-test. Students who were given the textbook lesson showed no change in the accuracy of their probability estimates. Students who were taught the prediction rule significantly improved their probability estimates, as measured by a statistical index of calibration. The authors conclude that traditional teaching methods do not provide students with guidance in estimating disease probability, and that better teaching methods are needed. In this study, a clinical prediction rule fulfilled the need for instruction in probability estimation.

Coronary Disease↗

Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds.

The objectives of the present study were to estimate 10 year probabilities of osteoporotic fractures in men and women according to age and bone mineral density (BMD) at the femoral neck. Risks were computed from the incidence of a first hip, distal forearm, proximal humerus and symptomatic vertebral fracture from patient records in Malmö, Sweden and future mortality rates for each year of age from Poisson models using the Swedish patient register and statistical year book. Fracture probability was computed using the Swedish population and cut-off values for T-scores based on the NHANES III female population. We assumed that the risk of fracture increased with decreasing BMD as assessed by meta-analysis in independent studies. The 10-year probability of any fracture was determined from the proportion of individuals fracture-free from the age of 45 years. With the exception of forearm fractures in men, 10 year probabilities increased with age and T-score. In the case of hip and spine fractures, fracture probabilities for any age with low BMD were similar between men and women. The effect of age on risk independently of BMD suggests that intervention thresholds should not be at a fixed T-score but vary according to absolute probabilities. Intervention thresholds based on hip BMD T-scores are similar between sexes.

Age Factors↗

Pulmonary embolism exclusion: a practical approach to low probability using the PIOPED data. Prospective Investigation of Pulmonary Embolism Diagnosis.

A recent trend among physicians is the categorisation of lung scans as normal [excludes pulmonary embolism (PE)], high probability (confirms PE) and non-diagnostic (no judgement on PE risk). The low probability scan is therefore being eliminated as a functional category. This occasional survey contends that such an approach is misguided. Correction of the original PIOPED data with certain assumptions provides a more reproducible, albeit restricted, low probability scan category which excludes PE in 97% of cases in the low pre-test clinical category. Patients with a low probability scan with risk factors for PE (i.e. medium clinical risk) will require further investigation. More important, the very low probability scan category excludes PE in 98% of patients with low and more than 92% of patients with medium pre-test clinical likelihood. The demise of "low probability" is premature.

Bayes Theorem↗

Diagnostic accuracy of cardiologists compared with probability calculations using Bayes' rule.

Probability analysis has provided insights into the use of diagnostic tests in coronary artery disease, and recent developments may permit clinical application of individual patients. To validate independently two available methods of probability calculation, their diagnostic accuracy was compared with that of cardiologists. Ninety-one cardiologists participated in the study; each evaluated the clinical summaries of eight randomly selected patients. For each patient, the cardiologist assessed the probability of coronary artery disease after reviewing the clinical history, physical examination and laboratory data, including complete results from a treadmill exercise test. The probability of coronary artery disease was also obtained for each patient, using the identical information, from two methods employing Bayes' rule: (1) from a published table of data based on the patient's age, sex, symptoms and degree of S-T segment change during exercise; and (2) from a computer program using the age, sex, risk factors, resting electrocardiogram and multiple exercise measurements. Diagnostic accuracy was assessed on a scale from 0 to 100 with the coronary angiogram as the diagnostic standard. The average diagnostic accuracy on this scale was: 80.2 for the cardiologists' estimates, 78.0 for the estimates based on tables (difference from cardiologists' estimates p less than 0.05) and 83.1 for the estimates based on computer calculations (p less than 0.01). Thus probability analysis incorporating sufficient detail can achieve a diagnostic accuracy comparable with that of cardiologists. Studies of the efficacy of probability analysis in patient care are warranted.

Bayes Theorem↗

Revising ranked probabilities: a Bayesian approach to incomplete knowledge.

Incomplete knowledge refers to situations in which a decision maker can rank the probabilities of occurrence for events of interest, but cannot specify these probabilities exactly. In this paper a Monte Carlo approach is used to investigate how physicians can arrive at revised or posterior rankings of disease probability given only rank order information about both the patient's prior probabilities of disease and the conditional probabilities of specific clinical findings for each disease. Computer-generated estimates of the expected frequencies of the posterior rankings are presented for the cases of 2, 3, and 4 disease states. The application of probability revision under conditions of incomplete knowledge to therapeutic decision making is discussed.

Bayes Theorem↗

Amplitude variations in P300 component due to unpredictable stepwise change of stimulus probability.

The present study investigates whether the amplitude of the P300 in 'normal' subjects adapts to unexpected changes in global stimulus probability. The adaptation level (AL) metrics (in terms of Helson's [1964] theory) was applied to explain the variations in the P300 amplitude. In an oddball paradigm the probability of the deviant tone (target 1000 Hz, 80 dB, 50 ms) occurring randomly in a train of standard ones (non-target 1100 Hz, 80 dB, 50 ms) was changed in a stepwise way from 0.5 to 0.3 and then to 0.1 in 3 blocks without interruption of the stimulus presentation. Two experiments were performed. In the first one the subjects did not receive any prior information about the changes in the stimulus probability, whereas in the second experiment they were aware of such changes. The task always required the subject to silently count the deviants. EEG was recorded monopolarly from Fz, Cz and Pz in a total of 15 subjects. The block averaged P300 increased monotonically with probability, the increase being larger in Expt. II. In contrast to the block averaged P300, the variations in the P300 amplitude following the abrupt change in probability showed a non-linear dependency. On the basis of the AL a simulation of the time course of the P300 variations with probability was performed and a clear similarity between the simulated P300 and the experimental data was found. Some properties of the AL model are discussed.

Acoustic Stimulation↗

Analysis of the probability and risk of cause-specific failure.

PURPOSE: Kaplan-Meier curves are frequently misused in the analysis of nonsurvival endpoints, such as time to local failure or time to late complications. More appropriate analyses are available and described. METHODS AND MATERIALS: Cumulative incidence is an unbiased estimate of probability of cause-specific failure. Cumulative conditional probability of cause-specific failure reflects risk to patients remaining at risk. Hazard rates also measure risk. RESULTS: Kaplan-Meier curves overestimate the probability of late complications when there is a high mortality rate. Cumulative incidence and cumulative conditional probability accurately give the probability and risk of cause-specific failure. CONCLUSION: Kaplan-Meier analysis of cause-specific failure should be avoided because of its misinterpretation as an estimate of probability, in favor of appropriate methods.

Colorectal Neoplasms↗

Development and validation of a clinical score to estimate the probability of coronary artery disease in men and women presenting with suspected coronary disease.

PURPOSE: Guidelines for the management of patients with suspected coronary disease have emphasized stratification into groups with low, intermediate, and high probability of significant coronary disease. Previously derived clinical prediction rules have been difficult to apply in clinical settings. The purpose of this study was to develop and validate a clinical score that facilitates this stratification process. PATIENTS AND METHODS: We performed a retrospective analysis of prospectively acquired data from 915 patients with suspected coronary disease and normal resting electrocardiograms who presented for exercise testing at a university hospital. All patients subsequently underwent coronary angiography. Analysis included logistic regression with significant coronary disease (> or = 1 vessel with a > or = 50% lesion) presence as the dependent variable and clinical variables as independent variables. From this analysis, a coronary disease score was developed to estimate prevalence of coronary disease from clinical variables. Validation of this score was performed in a separate prospectively acquired cohort of 348 patients. RESULTS: For the entire validation group, the prevalence of significant coronary disease was 16% (10/63) in the low probability group, 44% (86/195) in the intermediate probability group, and 69% (62/90) in the high probability group. Both men and women were stratified equally well into the 3 probability groups. CONCLUSION: The clinical score is an easily memorized and accurate method for categorizing patients with suspected but not proven coronary disease and normal resting electrocardiograms into clinically meaningful probability groups upon which decisions concerning appropriate diagnostic test selection could potentially be based.

Aged↗

The influence of hierarchy on probability judgment.

Consider the task of predicting which soccer team will win the next World Cup. The bookmakers may judge Brazil to be the team most likely to win, but also judge it most likely that a European rather than a Latin American team will win. This is an example of a non-aligned hierarchy structure: the most probable event at the subordinate level (Brazil wins) appears to be inconsistent with the most probable event at the superordinate level (a European team wins). In this paper we exploit such structures to investigate how people make predictions based on uncertain hierarchical knowledge. We distinguish between aligned and non-aligned environments, and conjecture that people assume alignment. Participants were exposed to a non-aligned training set in which the most probable superordinate category predicted one outcome, whereas the most probable subordinate category predicted a different outcome. In the test phase participants allowed their initial probability judgments about category membership to shift their final ratings of the probability of the outcome, even though all judgments were made on the basis of the same statistical data. In effect people were primed to focus on the most likely path in an inference tree, and neglect alternative paths. These results highlight the importance of the level at which statistical data are represented, and suggest that when faced with hierarchical inference problems people adopt a simplifying heuristic that assumes alignment.

Adult↗

Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda.

BACKGROUND: The probability of HIV-1 transmission per coital act in representative African populations is unknown. We aimed to calculate this probability overall, and to estimate how it is affected by various factors thought to influence infectivity. METHODS: 174 monogamous couples, in which one partner was HIV-1 positive, were retrospectively identified from a population cohort in Rakai, Uganda. Frequency of intercourse and reliability of reporting within couples was assessed prospectively. HIV-1 seroconversion was determined in the uninfected partners, and HIV-1 viral load was measured in the infected partners. Adjusted rate ratios of transmission per coital act were estimated by Poisson regression. Probabilities of transmission per act were estimated by log-log binomial regression for quartiles of age and HIV-1 viral load, and for symptoms or diagnoses of sexually transmitted diseases (STDs) in the HIV-1-infected partners. RESULTS: The mean frequency of intercourse was 8.9 per month, which declined with age and HIV-1 viral load. Members of couples reported similar frequencies of intercourse. The overall unadjusted probability of HIV-1 transmission per coital act was 0.0011 (95% CI 0.0008-0.0015). Transmission probabilities increased from 0.0001 per act at viral loads of less than 1700 copies/mL to 0.0023 per act at 38 500 copies/mL or more (p=0.002), and were 0.0041 with genital ulceration versus 0.0011 without (p=0.02). Transmission probabilities per act did not differ significantly by HIV-1 subtypes A and D, sex, STDs, or symptoms of discharge or dysuria in the HIV-1-positive partner. INTERPRETATION: Higher viral load and genital ulceration are the main determinants of HIV-1 transmission per coital act in this Ugandan population.

Adolescent↗

Can the probability for obliteration after radiosurgery for arteriovenous malformations be accurately predicted?

PURPOSE: To investigate how accurate different models predict the probability for obliteration following radiosurgery for an arteriovenous malformation (AVM). METHODS AND MATERIALS: The probability for obliteration was calculated for all 838 AVMs with a known treatment outcome and treated at the Karolinska Hospital with Gamma Knife surgery 1970-1993. Four different models were used for the calculation, resulting in four different values of the probability for obliteration. The calculated prediction values were added for each model, and the total number of predicted obliteration compared to that observed in the whole patient material as well as in different subgroups. RESULTS: Three of the four models predicted the total number of obliterations accurately. In two of those three models, the accuracy of the prediction was dependent on AVM volume and treatment dose. In one model only, the prediction was accurate and independent of all investigated parameters. CONCLUSIONS: The probability for obliteration was accurately predicted by one of the models analyzed. In this model, the probability for obliteration was related to the dose to the AVM periphery only. The AVM volume had no independent impact on the probability for obliteration. There was a trend that AVMs with a central location had a better obliteration rate than predicted.

Adult↗

Orthodontic probability tables for black patients of African descent: mixed dentition analysis.

Mixed dentition space analyses form an essential part of orthodontic diagnostic procedures to determine the amount of space available for the accommodation of permanent teeth. The Moyers' probability tables for computing the sizes of unerupted canines and premolars were formulated at the University of Michigan from a sample consisting of northern European white subjects and are currently used worldwide. Because tooth sizes vary significantly between different population groups, it was the purpose of this study to construct relevant probability tables that would be more applicable to black subjects. Data were collected from a series of 100 randomly selected study models of black patients. The sample was equally subdivided by gender and all subjects had Angle Class I molar relationships with only minor malocclusions such as minor crowding, rotations, or diastemas. Two investigators independently measured the teeth on the study casts with a Vernier gauge that had sharpened calliper tips. Intraexaminer and interexaminer reliability was determined at 0.2 mm. All teeth to and including the first molars were measured. These data were then utilized in regression equations for both maxillary and mandibular arches, to enable the prediction of the mesiodistal widths of the canines and two premolars. The equations and predicted values were compared with those of the Moyers' probability tables, and significant differences (p <0.05) were found (except for the prediction of maxillary canines and premolars in females at the 85 and 95 percentile probability level). New probability tables for black subjects were formulated. It is envisaged that the proposed probability tables would be more accurate for black patients of African ancestry.

Adolescent↗

Probabilities for a probabilistic network: a case study in oesophageal cancer.

With the help of two experts in gastrointestinal oncology from The Netherlands Cancer Institute, Antoni van Leeuwenhoekhuis, a decision-support system is being developed for patient-specific therapy selection for oesophageal cancer. The kernel of the system is a probabilistic network that describes the presentation characteristics of cancer of the oesophagus and the pathophysiological processes of invasion and metastasis. While the construction of the graphical structure of the network was relatively straightforward, probability elicitation with existing methods proved to be a major obstacle. To overcome this obstacle, we designed a new method for eliciting probabilities from experts that combines the ideas of transcribing probabilities as fragments of text and of using a scale with both numerical and verbal anchors for marking assessments. In this paper, we report experiences with our method in eliciting the probabilities required for the oesophagus network. The method allowed us to elicit many probabilities in reasonable time. To gain some insight in the quality of the probabilities obtained, we conducted a preliminary evaluation study of our network, using data from real patients. We found that for 85% of the patients, the network predicted the correct cancer stage.

Decision Support Techniques↗

Adolescents' and adults' understanding of probability expressions.

PURPOSE: To examine whether there are differences between adolescents and adults in their interpretation of probability terms. METHODS: Participants were 20 fifth graders, 54 seventh graders, 45 ninth graders, and 34 young adults (mean adult age = 26.24 years, standard deviation = 2.09) from the San Francisco Bay area. They completed a self-administered survey asking them to assign percentage estimates (0% to 100%) to 30 randomly ordered probability terms. RESULTS: Significant age differences in the mean percentage estimates for 8 of the 30 terms were shown. Moreover, we found large variation in the interpretation of most probability terms studied, with larger variation among the adolescents than adults. Finally, all age groups had some difficulty correctly differentiating between "possibly" and "probably". CONCLUSIONS: Owing to wide variation in the interpretation of probability terms, both within and across age groups, we suggest health practitioners use percentages rather than probability terms to convey risk to both adolescents and adults.

Adolescent↗

Fixation probability in spatially changing environments.

The fixation probability of a mutant in a subdivided population with spatially varying environments is investigated using a finite island model. This probability is different from that in a panmictic population if selection is intermediate to strong and migration is weak. An approximation is used to compute the fixation probability when migration among subpopulations is very weak. By numerically solving the two-dimensional partial differential equation for the fixation probability in the two subpopulation case, the approximation was shown to give fairly accurate values. With this approximation, we show in the case of two subpopulations that the fixation probability in subdivided populations is greater than that in panmictic populations mostly. The increase is most pronounced when the mutant is selected for in one subpopulation and is selected against in the other subpopulation. Also it is shown that when there are two types of environments, further subdivision of subpopulations does not cause much change of the fixation probability in the no dominance case unless the product of the selection coefficient and the local population size is less than one. With dominance, the effect of subdivision becomes more complex.

Biological Evolution↗

Conditionals and conditional probability.

The authors report 3 experiments in which participants were invited to judge the probability of statements of the form if p then q given frequency information about the cases pq, p not q, not pq, and not p not q (where not = not). Three hypotheses were compared: (a) that people equate the probability with that of the material conditional, 1 - P(p not q); (b) that people assign the conditional probability, P(q/p); and (c) that people assign the conjunctive probability P(pq). The experimental evidence allowed rejection of the 1st hypothesis but provided some support for the 2nd and 3rd hypotheses. Individual difference analyses showed that half of the participants used conditional probability and that most of the remaining participants used conjunctive probability as the basis of their judgments.

Color Perception↗