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The use of dermal antigen testing in predicting the outcome of renal transplantation.

The responses to dermal antigen testing to a variety of antigens were measured in patients on regular dialysis. Forty-eight patients have received renal allografts and graft survival was assessed at 6 months. The antigens used were mumps, monilia, streptokinase/streptodornase, tuberculin and dinitrochlorobenzene (DNCB). The responses to these antigens were recorded using standard methodology. The response failed to correlate with graft survival in these patients when compared singly or in combination. Matching at the HLA-B locus was also correlated with graft survival. Of 31 patients with a match at this locus, 22 (71 per cent) have functioning grafts at 6 months, compared with only 4 of 13 (31 per cent) of patients with no match at the B locus (P less than 0.05). When matching at the B locus and DNCB scores were taken in combination, it became evident that those patients with no match at the B locus and low DNCB reactivity all rejected their kidneys within 4 months of transplantation.

Adolescent↗

Validation studies of a quick test for predicting the sorption and washing properties of refillable plastic bottles.

Quick tests are proposed in the literature as alternatives to the large scale contamination and washing studies performed to date to assess the acceptability of plastic beverage bottles for refilling. These tests use small plastic specimens ('strips') in place of bottles and use mixtures of surrogate contaminants to model the myriad of chemicals that could in principle contaminate returned bottles because of consumer mis-use. The work reported here has measured the sorption and wash performance using the quick test protocol with PET (polyethyleneterephthalate) strips and laboratory washing and compared the results with tests using actual bottles and a commercial washing process. The comparison indicates that the quick test satisfactorily simulated contamination and commercial washing of intact bottles. The results also show that repeated washing of PET bottles does not cause higher sorption of contaminants.

Absorption↗

Does the nutrient drink test accurately predict postprandial gastric volume in health and community dyspepsia?

Nutrient drink tests have been proposed as a surrogate for measurement of gastric accommodation. To study the relationship of maximum tolerated volume (MTV) during nutrient drink test and gastric volumes measured by single-photon emission computed tomography (SPECT) in healthy controls and functional dyspepsia (FD) patients. We reviewed data from 85 healthy controls and 35 FD residents of south-eastern Minnesota. All underwent standardized nutrient drink and SPECT studies between August 2000 and June 2003. To test for associations between nutrient drink test and SPECT gastric volumes, we used multiple linear regression and partial regression analyses, assigning age, gender, dyspepsia status and postprandial symptoms as covariates in the model. In the combined group (healthy and FD), MTV was weakly associated with fasting gastric volume (r = 0.43, P = 0.0001) and with volume response to feeding (r = 0.25, P = 0.006). In the FD group, associations were similar (fasting r = 0.53, P = 0.001; postmeal r = 0.32, P = 0.06). After accounting for covariates, MTV only explained 13 and 3% of variations in fasting and postprandial volumes measured by SPECT. MTV during the nutrient drink test does not accurately reflect gastric volume measurements by SPECT in healthy controls and a sample of people in the community with FD.

Adolescent↗

Use of the E test to predict high-level resistance to aminoglycosides among enterococci.

The E test and the reference agar dilution methods were compared for detecting high-level aminoglycoside resistance (HLAR) among 71 selected clinical isolates, including 62 Enterococcus faecalis and 9 Enterococcus faecium isolates. High-level gentamicin resistance alone was found in 11% (5 E. faecalis and 3 E. faecium strains) and high-level streptomycin resistance was found in 42% (28 E. faecalis, 2 E. faecium strains) of the strains tested, and 31% of the strains demonstrated high-level resistance to both antimicrobial agents (21 E. faecalis and 1 E. faecium strains). The E test detected all HLAR populations, but the streptomycin strip may require recalibration to achieve absolute MIC comparisons with the reference value (twofold less) or the use of an alternative interpretive resistance breakpoint, e.g., > 1,000 micrograms/ml. By the E test, MIC results indicate that ampicillin, imipenem, penicillin, piperacillin, and vancomycin remain active against the HLAR E. faecalis isolates; however, these tested drugs were less effective on the HLAR E. faecium isolates (< 50%).

Agar↗

Falsifying mental models: testing the predictions of theories of syllogistic reasoning.

Four experiments are reported that tested the claim, drawn from mental models theory, that reasoners attempt to construct alternative representations of problems that might falsify preliminary conclusions they have drawn. In Experiment 1, participants were asked to indicate which alternative conclusion(s) they had considered in a syllogistic reasoning task. In Experiments 2-4, participants were asked to draw diagrams consistent with the premises, on the assumption that these diagrams would provide insights into the mental representation being used. In none of the experiments was there any evidence that people constructed more models for multiple-model than for single-model syllogisms, nor was there any correlation between number of models constructed and overall accuracy. The results are interpreted as showing that falsification of the kind proposed by mental models theory may not routinely occur in reasoning.

Humans↗

Predicting first-quarter test scores from the new Medical College Admission Test.

The predictive validity of the new Medical College Admission Test as it relates to end-of-quarter examinations in anatomy, histology, physiology, biochemistry, and "ages of man" is presented. It is recognized that the maximum predictive power is attenuated by the reliability of the criterion variables. To determine the value of attempting to increase the reliability in the criteria, the authors corrected the validity coefficients for attenutation. Regression analyses were also undertaken to examine the extent to which the new MCAT subtests can predict scores on end-of-quarter examinations. Results indicate that the Science Knowledge assessment areas of chemistry and physics and the Science Problems subtest were the most useful in predicting student performance, followed by the Skills Analysis: Quantitative and Skills Analysis: Reading subtests and the biology area of the Science Knowledge subtest.

Achievement↗

The independence of cycle length variability and exercise testing on predicting mortality of patients surviving acute myocardial infarction. The Multicenter Postinfarction Research Group.

Cycle length variability (CLV), defined as the standard deviation of normal cycle length intervals, has been found to be a powerful predictor of subsequent mortality in a population of 808 survivors of acute myocardial infarction. Decreased CLV is associated with a significant increase in mortality. CLV remained an independent predictor of outcome even after adjusting for left ventricular ejection fraction, clinical risk factors, heart rate and ventricular arrhythmias. In the same population of survivors of acute myocardial infarction, the results of exercise testing also strongly predicted outcome, with those failing to take the test having the worst survival, and those completing the low-level stress test taken before discharge having the best prognosis. The hypothesis that the status of stress test (completed; did not complete; failed to take) and CLV were measuring the same factor related to mortality was tested. Although the distribution of CLV was shifted to higher CLV in patients who completed the test and to lower CLV in those who failed to take the test, both predictors of mortality remained independent predictors of long-term mortality (average of 31 months of follow-up) after controlling for each other. Moreover, subgroups with an approximate 15-fold difference in mortality were defined using both variables (CLV less than 50 ms, did not take test had a 54% mortality; CLV greater than 100 ms, completed the test had a mortality of 3.5%). CLV is a measure of autonomic tone; it is not strongly related to exercise ability and using the results of both stress testing and CLV results in the identification of subgroups of postinfarction patients with markedly disparate risks of mortality.

Blood Pressure↗

Use of suprathreshold test data to predict the results of quantitative testing in the nasal periphery.

We compared the results of suprathreshold testing of the nasal periphery with those of quantitative assessment of the same area. One eye each from 81 patients in four categories (normal [21 subjects], low-risk ocular hypertensive [20 subjects], high-risk ocular hypertensive [20 subjects] and early glaucoma [20 subjects]) was tested with the nasal suprathreshold points of the Octopus G1 program and the Sargon peripheral field-nasal (PFN) program. Simple algorithms were developed to generate from the nasal suprathreshold points of the G1 program two "qualitative indices", mean defect-qualitative (MD-Q) and loss variance-qualitative (LV-Q); these are analogous to the indices mean defect and loss variance respectively, which were calculated from the PFN program data. MD-Q and LV-Q were found to be well correlated with their quantitative counterparts. They provide a uniform method for interpreting the nasal suprathreshold points of the G1 program and help identify patients in whom further quantitative testing is likely to yield useful information.

Adult↗

Attitudes of German persons at risk for Huntington's disease toward predictive and prenatal testing.

Huntington's disease is an autosomal dominant neurodegenerative disorder characterized by involuntary movements, psychological deterioration and dementia. Indirect predictive testing by linkage analysis has been possible since 1983; direct predictive testing by detecting the instable CAG-repeat has been possible since 1993. Persons at risk were asked, by questionnaire, about their motivation and regarding attitude taking part in indirect and direct predictive and prenatal diagnostics. About half of the interrogated German persons at risk wish to undertake DNA analysis, whereas 32.7% do not want to take part in a direct predictive test. Motives for taking the test are the same as those mentioned in the literature (certainty of carrier status, decisions concerning marriage and further children, planning a career). Motives for not taking the test mostly involve psychological problems in coping with the test result. 45.7% wish to undergo a direct prenatal test (main cause: certainty of the gene status of the child), whereas 27% would not take this test (because of non-toleration of abortion). Only statistical trends could be seen between the intention to take the predictive or prenatal test and some social and demographic variables. The at-risk persons would not change their attitudes regarding indirect or direct predictive and prenatal DNA analysis; they seem to have a confirmed opinion about molecular genetics, mostly depending on familial and social background.

Adolescent↗

Evaluation of a treadmill test for predicting the aerobic capacity of firefighters.

BACKGROUND: As part of a comprehensive occupational medical program for fire departments in the USA, the National Fire Protection Association and The Fire Service Joint Labor Management Wellness/Fitness Initiative endorse a standardized submaximal test that uses the Gerkin treadmill protocol for predicting the maximal oxygen uptake (VO(2max)) of firefighters. AIMS: To test the validity of the Gerkin treadmill protocol in healthy men and women. METHODS: Fifty-four healthy men and women (age range 19-58 years) performed the Gerkin test and a treadmill run test to maximal exhaustion. Their heart rates were monitored continuously with an electrocardiogram during each test. During the VO(2max) test, the subjects' VO(2) was measured continuously using indirect calorimetry. RESULTS: Although the predicted and observed VO(2max) values correlated (r = 0.70, P < 0.001 and standard error of estimate = 5.98 ml/kg/min), the mean values differed (49.8 +/- 8.3 and 41.8 +/- 5.8 ml/kg/min, respectively) (P < 0.001). The VO(2max) value was overestimated in 50 (93%) participants. The overestimation was >25% in 18 (33%) participants. Gender, age and VO(2max) did not affect the Gerkin protocol's predictability of VO(2max). CONCLUSIONS: The Gerkin treadmill protocol overpredicts VO(2max) in healthy men and women and, therefore, should not be used for predicting VO(2max) in individual firefighters, particularly if VO(2max) is a criterion for inclusion or exclusion from duty. At this time, a valid treadmill running test is needed for predicting the VO(2max) value of individual firefighters.

Adult↗

The value of the new interpretation of the insulin test in predicting duodenal ulcer relapse after treatment with cimetidine.

Twenty-one patients with duodenal ulcer were treated with cimetidine. After 2 weeks they were submitted to an insulin test and the results were compared with a range of secretion previously established in untreated duodenal ulcer patients (1). The secretion of 13 patients fell within this range and so they were predicted to have a high risk of relapse. The patients whose secretion was below the range had a predicted low risk of relapse. After 4 weeks' treatment repeat endoscopy showed that 4 ulcers had failed to heal. The secretion of 3 of the patients was within the range of the high risk group. The remaining 17 patients were followed up (range 20-23 months): 9 relapsed and 8 remained symptom-free. Eight of the 9 were in the high risk group and 6 of the 8 symptom-free patients were in the low risk group. In all, 11 out of 13 were correctly predicted in the high risk group and 6 out of 8 in the low risk group. The performance of the insulin test in predicting liability to relapse following cimetidine treatment was significant (P = 0.0225).

Cimetidine↗

Early prediction of neonatal hyperbilirubinemia.

The study aim was to predict, using serum bilirubin level measured 18 to 24 hours (SB, 18-24) after birth, the occurrence of peak serum bilirubin level > 15 mg/dL (hyperbilirubinemia) or the requirement of phototherapy, any time from the second to fifth postnatal day. The study was conducted on a prospective cohort of 274 neonates born in north India. The main outcome measures were (a) hyperbilirubinemia and (b) phototherapy. Serum bilirubin level was estimated at 18-24 hours of age and then daily from second to fifth postnatal day. Exclusion criteria were Rh incompatibility, asphyxia and life threatening congenital malformations; and neonates of women with gestational diabetes or history intake of drugs affecting the fetal liver. Hyperbilirubinemia was found in 12.8%; and 19.3% neonates received phototherapy. Dichotomous SB 18-24, using a cut-off of > 3.99 mg/dL, as the "prediction test" had the following sensitivity and specificity for predicting (a) hyperbilirubinemia: 67% and 67%, respectively, and (b) the treatment with phototherapy: 64% and 68%, respectively. We concluded that by using SB 18-24 as the "prediction test", approximately two-thirds of neonates were test negative and had about one in ten chances of re-admission for treatment of hyperbilirubinemia, if discharged. After further validation, our results will be of benefit to neonates delivered in developing countries.

Adult↗

A population-based study of human papillomavirus deoxyribonucleic acid testing for predicting cervical intraepithelial neoplasia.

OBJECTIVE: Our purpose was to determine the predictive values of primary or secondary screening for cervical human papillomavirus infection for cytologic detection of cervical intraepithelial neoplasia. STUDY DESIGN: Most of the 254 women referred for colposcopy in Västerbotten County in Sweden during October 1993 through December 1995 and 320 age-matched women from the general population were screened for human papillomavirus deoxyribonucleic acid by nested general-primer polymerase chain reaction. RESULTS: Ninety-six percent of women with high-grade cervical intraepithelial neoplasia had human papillomavirus, compared with 4% of women with normal findings (odds ratio 606; 95% confidence interval 137 to 5607). Thirty-seven percent of referred women and 48% of referred women >39 years old had mostly minor cytologic abnormalities with no human papillomavirus. The human papillomavirus-associated positive predictive value for cervical intraepithelial neoplasia was 76% in the colposcopy group and 11% in the general population, whereas the negative predictive value was >97% in both populations. CONCLUSION: Testing for human papillomavirus deoxyribonucleic acid seems diagnostically useful among women referred for colposcopy.

Adult↗

Testing a predictive regression model for response in adult acute myeloid leukemia comparing two induction regimens of the E.O.R.T.C. -AML-5 and AML-6 trial.

Pretreatment characteristics of 295 adults with acute myeloid leukemia who were treated in a large cooperative group of the E.O.R.T.C. between 1976 and 1982 (AML-5) have been evaluated to assess their value as prognostic indicators. Logistic regression methods were applied to derive a model for prediction of achievement of CR. The model was tested prospectively in an independent group of 274 subsequent patients treated with a different but similar induction regimen (AML-6), who were matched in all eligibility criteria. The concordance between the observed percentage of response in the AML-6 trial population and the expected response given by the model built on the AML-5 study was very close for the good response subgroups (WBC less than 50,000/mm3 and age less than 60 yrs), while the discrepancies in the poor prognostic groups were considerable. Furthermore, our study shows that the prognostic value of factors may shift as treatment strategies change and that caution is necessary in applying conclusions from a preceding trial to a current patient population.

Adolescent↗

Predictive washing test for evaluation of individual eczema risk.

It was the aim of our studies to estimate predictively the individual eczema risk for persons due to repetitive contact with washing-active substances, by a barrier function test on clinically healthy skin over 2 weeks. Within the scope of the study 3 groups with different atopy scores were compared. As washing solutions, 0.1 m SLS and a slightly acid soap-free washing emulsion were used in comparison to tap water. Prior to the 1st washing procedure, on days 3, 5, 8, 10, and 12, the transepidermal water loss, the horny layer moisture, and the skin blood flow were measured as parameters of barrier function, as well as the inflammatory reaction. The results prove that the atopy score has only limited validity as a predictive method for the acceptance of washing-active substances. The repetitive washing test, however, seems to be more adequate for evaluating the individual barrier function as well as the eczema risk. Irritation by a washing procedure may be greatly influenced by choice of the washing solution.

Adult↗

Use of the exercise test to predict prognosis after coronary artery bypass grafting.

The objective of this study was to predict the prognosis of patients who become symptomatic after having undergone coronary artery bypass grafting (CABG) using clinical and exercise test responses. A retrospective analysis was performed of all veterans referred for clinical indications to a Veterans Administration Medical Center for a treadmill test after having undergone CABG. Of 2,044 patients who were exercise tested from April 1984 to May 1987, 296 had previously undergone CABG. Clinical data considered included age, sex, medication and symptom status, history of myocardial infarction, type of myocardial infarction and time from CABG. The exercise test responses considered were MET level, maximal heart rate, maximal systolic blood pressure, chest pain pattern and ST-segment response. During a 2-year follow-up after exercise testing, there were 15 deaths, 11 nonfatal myocardial infarctions, 6 repeat CABGs and 3 percutaneous transluminal coronary angioplasties. Although MET level and maximal heart rate were significantly related to prognosis and no patient who exceeded 8 METs died, the predictive power of these exercise test responses was low and ST-segment depression was not predictive at all. The inability of the exercise electrocardiogram to predict cardiac events in patients after CABG requires the use of other methods of testing to identify those who need invasive studies and intervention.

Angiography↗

Application of the PKCYP-test to predict the amount of in vivo CYP2C11 using tolbutamide as a probe.

Previous reports have shown that the determination of drug metabolism capacity can be made by the pharmacokinetic estimation of the quantity of cytochrome P450 (CYP) in vivo (PKCYP-test), in which an apparent liver-to-blood free concentration gradient in vivo (qg) is introduced, which is useful for evaluating fluctuations of CYPIA2 in rats. The aim of the present study was to examine the application of the PKCYP-test to evaluate the quantity of in vivo CYP2C11 by using tolbutamide as a probe, to confirm its validity using a physiologically-based pharmacokinetic rat model. Rats treated with carbon tetrachloride (CCl4-treated rats) were used as a model for low levels of CYP2C11 in the liver. In CCl4-treated rats, the total body clearance (CLtot) of tolbutamide and the amount of CYP2C11 fell to about a quarter and a third of that in control rats, respectively. The time-course of tolbutamide concentrations in serum in control rats could be simulated by a physiologically-based pharmacokinetic model. In CCl4-treated rats, take into consideration the qg value of control rats, the level of CYP2C11 was accurately predicted by the PKCYP-test, and the time-course of tolbutamide concentrations in serum could be predicted by the same physiologically-based pharmacokinetic model. In conclusion, we have shown that the PKCYP-test can be used to predict levels of CYP2C11. It was also demonstrated that the qg and amount of CYP are useful parameters in the PKCYP-test by constructing a physiologically-based pharmacokinetic model which was applied to the PKCYP-test.

Animals↗