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In vitro cytotoxicity testing for prediction of acute human toxicity.

This study was designed to compare the cytotoxic concentrations of chemicals, determined with three independent in vitro cytotoxicity testing protocols, with each other and with established animal LD50 values, and against human toxic concentrations for the same chemicals. Ultimately, these comparisons allow us to evaluate the potential of in vitro cell culture methods for the ability to screen a variety of chemicals for prediction of human toxicity. Each laboratory independently tested 50 chemicals with known human lethal plasma concentrations and LD50 values. Two of the methods used monolayer cell cultures to measure the incorporation of radiolabeled amino acids into newly synthesized proteins and cellular protein content, while the third technique used the pollen tube growth test. The latter is based on the photometric quantification of pollen tube mass production in suspension culture. Experiments were performed in the absence or presence of increasing doses of the test chemical, during an 18- to 24-h incubation. Inhibitory concentrations were extrapolated from concentration-effect curves after linear regression analysis. Comparison of the cytotoxic concentrations confirms previous independent findings that the experimental IC50 values are more accurate predictors of human toxicity than equivalent toxic blood concentrations (HETC values) derived from rodent LD50s. In addition, there were no conclusive statistical differences among the methods. It is anticipated that, together, these procedures can be used as a battery of tests to supplement or replace currently used animal protocols for human risk assessment.

Animals↗

Evaluation of the sensitizing potential of eugenol and isoeugenol in mice and guinea pigs.

The sensitizing properties of the fragrances eugenol and isoeugenol have been investigated experimentally. The potential of these materials to induce sensitization of the respiratory tract was examined using the mouse IgE test, a novel but as yet unvalidated method for the predictive identification of chemical respiratory allergens. Comparisons were made with the activity of eugenol and isoeugenol in two predictive tests for contact sensitization potential: the murine local lymph node assay and the guinea pig maximization test. Both chemicals elicited positive responses in these tests, isoeugenol exhibiting a greater potential for contact sensitization than eugenol. Isoeugenol was negative at all concentrations examined in the mouse IgE test. In the same assay, exposure to eugenol was associated with a statistically significant increase in serum IgE concentrations when initial application concentrations of 2.5% were used. However, at higher test concentrations eugenol was negative in the mouse IgE test. It is concluded that neither eugenol nor isoeugenol have a significant potential to cause sensitization of the respiratory tract, a conclusion that is apparently consistent with the lack of evidence for occupational respiratory allergy associated with exposure to these chemicals. The evidence for isoeugenol lacking respiratory sensitization activity is particularly strong and it is proposed that this chemical may be of value as a negative control in the development and validation of new predictive test methods for the identification of chemical respiratory allergens.

Allergens↗

Evaluation of preoperative blood tests for predicting deep vein thrombosis after total hip replacement.

Determinations of the total calcium content and aggregability of the platelets as well as tests of coagulation and fibrinolysis were carried out on 93 patients before undergoing total hip replacement. All patients received low dose heparin, solely or combined with dihydroergotamine. Twenty-six patients developed deep vein thrombosis (DVT) detected by the labelled fibrinogen uptake test and confirmed by ascending phlebography. Only a few tests, among them the total calcium content of platelets, showed a statistical difference between the patients who subsequently developed DVT and those who did not. Combination of several tests by a multivariate statistical analysis programme proved to have more predictive value than the analysis of single tests.

Adult↗

The nadir growth hormone after an octreotide test dose predicts the long-term efficacy of somatostatin analogue therapy in acromegaly.

OBJECTIVE: In the treatment of acromegaly, a 'test dose' of octreotide is recommended prior to the use of depot somatostatin analogue (SSA) therapy. However, there remains no consensus regarding the criteria that predict a response to treatment. The ability to select patients who may benefit most from medical therapy is potentially of great value in clinical practice. The aim of the study was to determine the predictive value of both the nadir GH and the mean GH following an octreotide test dose in identifying patients who subsequently achieved disease remission with depot SSA therapy. Remission was defined as a mean GH < 5 mU/l (< 2 microg/l). DESIGN: Retrospective case-control study. PATIENTS: A group of 41 patients with acromegaly underwent an octreotide test dose where GH was measured hourly for a total of 6 h following an injection of octreotide 50 microg subcutaneously. Nadir GH and mean GH following the octreotide test dose were determined. Thirty-three patients were subsequently treated with depot SSA therapy and mean GH and IGF-I levels were determined at follow-up. RESULTS: The nadir GH demonstrated superior predictive power to that of mean GH across a range of GH cut-off values. A nadir GH < 5 mU/l demonstrated 80% sensitivity and 83% specificity in predicting remission with depot SSA therapy. A nadir GH < 10 mU/l demonstrated 100% sensitivity and 56% specificity. CONCLUSIONS: The nadir GH following an octreotide test dose is a useful predictive marker of achieving disease remission with depot SSA therapy used as either a primary or an adjuvant agent.

Acromegaly↗

Preoperative blood tests in prediction of postoperative deep vein thrombosis.

Fifty six patients undergoing elective abdominal surgery were investigated preoperatively with tests of coagulation, platelet function and fibrinolysis. Ten patients developed postoperative deep vein thrombosis, detected by the labelled fibrinogen uptake test and confirmed by ascending phlebography. None of the tests showed a statistically significant difference between the group mean of patients who developed DVT and of those who did not. Potential discriminators were used to derive a prognostic index for prediction of patients who would develop postoperative DVT. An index based on two preoperative blood tests i.e. three hour fibrin digestion and APTT had a successful prediction rate of 59 percent.

Blood Coagulation Tests↗

Evaluation of four in vitro genetic toxicity tests for predicting rodent carcinogenicity: confirmation of earlier results with 41 additional chemicals.

The effectiveness of four in vitro short-term tests (STT) for genetic toxicity, induction of mutations in Salmonella (SAL) and mouse lymphoma L5178Y cells (MLA), and induction of sister chromatid exchanges (SCE) and chromosome aberrations (ABS) in Chinese hamster ovary cells that are used for predicting rodent carcinogenicity were examined. The in vitro results were compared with the results from 41 rodent carcinogenicity studies performed by the National Toxicology Program. The predictive values of, and interrelationships among, the STT for these 41 chemicals were similar to those previously reported for 73 chemicals and confirm those earlier results [Tennant RW, Margolin BH, Shelby MD, Zeiger E, Haseman JK, Spalding J, Caspary W, Resnick M, Stasiewicz S, Anderson B, Minor R (1987): Science 236:933-941]. Because of this similarity among the two datasets, the chemicals were combined into a single dataset of 114. The results with 114 chemicals show that SAL had the lowest sensitivity (.48) and the highest specificity (.91), whereas MLA had the highest sensitivity (.72) and the lowest specificity (.40). The concordances of the test results with rodent carcinogenicity were .66, .61, .59, and .59, for SAL, ABS, SCE, and MLA, respectively. Salmonella was the most predictive for carcinogenicity; 89% of the chemicals mutagenic in SAL were carcinogenic in rodents, however a negative result in any or all of the STT was not indicative of noncarcinogenicity. The STT results reported here show good agreement with the potential electrophilicity of the chemicals, and the majority of carcinogens that are undetected by the STT do not have an electrophilic structure. There was no complementarity among the tests and no combination of the four tests was more effective than any single test for predicting carcinogenicity.

Animals↗

Predicting skin test sensitivity and total serum IgE levels in family members.

A total of 278 individuals in 42 randomly ascertained nuclear families were studied to determine correlations among family members for skin test response and total serum IgE levels. The major aim was to determine whether these measures of allergic response in family members could be used to predict whether the last child in the family would be skin test positive. There were significant correlations in total log[IgE] levels between parents and their children and an even higher correlation between siblings. For the measurement of skin test response (allergy index), the only significant correlation was between siblings. Discriminant analysis was performed with the fourth child in the family as the index case. This was done to determine how many of the index cases could be correctly predicted to be skin test positive or negative based on family information. With just the skin test results on the parents, only three of the 13 positive index cases were correctly predicted. However, when the mean value for the skin test results in the siblings (mean allergy index) was used, eight of the 13 skin test positive index cases were correctly predicted. These results suggest that, although there is a high degree of concordance for allergic disease within families, information from other siblings may be the most useful predictor of allergic status in another child.

Adolescent↗

Controlled test for predictive power of Lyapunov exponents: their inability to predict epileptic seizures.

Lyapunov exponents are a set of fundamental dynamical invariants characterizing a system's sensitive dependence on initial conditions. For more than a decade, it has been claimed that the exponents computed from electroencephalogram (EEG) or electrocorticogram (ECoG) signals can be used for prediction of epileptic seizures minutes or even tens of minutes in advance. The purpose of this paper is to examine the predictive power of Lyapunov exponents. Three approaches are employed. (1) We present qualitative arguments suggesting that the Lyapunov exponents generally are not useful for seizure prediction. (2) We construct a two-dimensional, nonstationary chaotic map with a parameter slowly varying in a range containing a crisis, and test whether this critical event can be predicted by monitoring the evolution of finite-time Lyapunov exponents. This can thus be regarded as a "control test" for the claimed predictive power of the exponents for seizure. We find that two major obstacles arise in this application: statistical fluctuations of the Lyapunov exponents due to finite time computation and noise from the time series. We show that increasing the amount of data in a moving window will not improve the exponents' detective power for characteristic system changes, and that the presence of small noise can ruin completely the predictive power of the exponents. (3) We report negative results obtained from ECoG signals recorded from patients with epilepsy. All these indicate firmly that, the use of Lyapunov exponents for seizure prediction is practically impossible as the brain dynamical system generating the ECoG signals is more complicated than low-dimensional chaotic systems, and is noisy.

Cerebral Cortex↗

Hypothesis testing and earthquake prediction.

Requirements for testing include advance specification of the conditional rate density (probability per unit time, area, and magnitude) or, alternatively, probabilities for specified intervals of time, space, and magnitude. Here I consider testing fully specified hypotheses, with no parameter adjustments or arbitrary decisions allowed during the test period. Because it may take decades to validate prediction methods, it is worthwhile to formulate testable hypotheses carefully in advance. Earthquake prediction generally implies that the probability will be temporarily higher than normal. Such a statement requires knowledge of "normal behavior"--that is, it requires a null hypothesis. Hypotheses can be tested in three ways: (i) by comparing the number of actual earth-quakes to the number predicted, (ii) by comparing the likelihood score of actual earthquakes to the predicted distribution, and (iii) by comparing the likelihood ratio to that of a null hypothesis. The first two tests are purely self-consistency tests, while the third is a direct comparison of two hypotheses. Predictions made without a statement of probability are very difficult to test, and any test must be based on the ratio of earthquakes in and out of the forecast regions.

Journal Article↗

A comparison of small-scale, pilot-scale and large-scale tests for predicting leaching behaviour of landfilled wastes.

Landfills generate emissions over long periods, often longer than a lifetime. The longest lasting emission is leachate. In order to estimate the future requirements for leachate treatment, different kinds of leaching tests may be applied. In this paper, shaking leaching tests (SLT), landfill-simulator leaching tests and a field-cell leaching test performed with ash, municipal solid waste (MSW) and MSW+ash are evaluated. The tests are compared and the factors influencing leaching are identified and discussed. The factors are: liquid to solid (L/S) ratio, water withdrawal, recirculation rate, presence or absence of biological processes, size of particles, duration of experiment, temperature and pre-treatment of the waste. The presence of biological processes has the greatest impact on leaching and is the main reason why SLT is less useful for long-term predictions. The landfill simulator tests were found to be useful for several different kinds of predictions. However, they are not reliable for predicting the L/S required for reaching a certain concentration. The possibilities for reliable long-term predictions would be facilitated by a better knowledge of the influence of various factors on leaching. Such an increased knowledge would make it possible to enhance waste stabilisation in leaching tests as well as in full-scale landfills.

Forecasting↗

Use of follicle-stimulating hormone test to predict poor response in in vitro fertilization.

OBJECTIVE: Optimized ovarian stimulation protocols are required for the success of in vitro fertilization (IVF). The purpose of this study was to estimate whether the ovarian reserve test using exogenous follicle-stimulating hormone (FSH) could predict ovarian response in IVF. METHODS: This was a prospective observational study of 110 patients who underwent their first IVF cycle. The FSH test was administered as 150 IU of urinary FSH daily from day 3 to day 6 of the menstrual cycle preceding the IVF cycle for evaluation of the plasma estradiol level. Outcomes of IVF, including ovarian response, were analyzed. RESULTS: A negative correlation was observed between the duration of stimulation and the result of the FSH test (r = -.238, P = .014) and between the dose of FSH per retrieved mature oocyte (metaphase II oocyte) and the result of the FSH test (r = -.308, P < .001). In addition, our results showed that the result of the FSH test was significantly lower in poor responders defined by FSH of 400 IU/metaphase II oocyte or greater (207 +/- 149 compared with 293 +/- 174 pg/mL, P = .007). CONCLUSION: The FSH test can be a useful tool for determining the conditions of individualized clinical management plans and optimizing stimulation protocols in IVF.

Adult↗

Relevance of aquatic biodegradation tests for predicting degradation of polymeric materials during biological solid waste treatment.

The aquatic biodegradability of cellulose and cellulose acetate with degrees of substitution (d.s.) in the range of 1.5 to 3.0, was compared with the mineralization under laboratory controlled composting conditions. In line with previous observations, it was found that cellulose acetates with d.s. < or = 2.5 were readily mineralized to CO2 in the controlled composting test. The degradation rate was clearly affected by the degree of substitution (d.s. 1.5 > d.s. 2.5 > d.s. 3.0). Surprisingly, however, biodegradation of cellulose acetate materials was not observed in the aquatic Strum test. Modifications of the pH and the inoculum source in an attempt to improve the activity of fungi and actinomycetes in the aquatic environment, did not increase CO2-evolution. It is concluded that the relevance of modified Strum tests is limited for predicting complete biodegradation of polymeric materials during biological waste processing. For evaluation of the compostability of polymeric products or packaging materials, more relevant laboratory controlled composting tests should be used.

Actinomycetaceae↗

Comparison and validation of simple noninvasive tests for prediction of fibrosis in chronic hepatitis C.

Liver biopsy is recommended before antiviral treatment, particularly for patients with hepatitis C virus (HCV) genotype 1 infection, but it may cause complications and is limited by sampling error. Several non-invasive tests comprising routine laboratory parameters (simple fibrosis tests) have been proposed to predict fibrosis in chronic HCV. The aim of the current study was to validate and compare the diagnostic accuracies of the simple fibrosis tests, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), cirrhosis discriminant score (CDS), age-platelet (AP) index, Pohl score, AST-to-platelet ratio index (APRI), and platelet count per se. Staging was performed in liver biopsy specimens of 194 treatment-naive patients with chronic HCV according to Ishak et al. by two independent pathologists. Receiver operating characteristic curve analysis showed comparable diagnostic accuracies of CDS, AP index, APRI, and platelet count for prediction of significant fibrosis (F3-F6) (area under the ROC curve [AUROC], 0.71, 0.74, 0.80, and 0.71, respectively; pathologist A) and for prediction of cirrhosis (F5-F6) (AUROC, 0.91, 0.91, 0.90, and 0.89, respectively; pathologist A). Diagnostic accuracy of APRI for prediction of significant fibrosis was superior to that of AAR (P < .05). Significant fibrosis was reliably predicted by APRI > or = 1.5 and platelet count <150 x10(9)/L in 24% and 22% of the patients, respectively, whereas cirrhosis was reliably excluded by APRI <2.0 and platelet count > or = 150 x10(9)/L in 85% and 78% of the patients, respectively. In conclusion, simple fibrosis tests may render liver biopsy unnecessary only in a minority of patients with chronic HCV. Improved serum fibrosis markers with greater sensitivity for severe fibrosis or cirrhosis are needed.

Adult↗

Value of skin testing for predicting reactions to equine rabies immune globulin.

The high cost of postexposure prophylaxis for rabies is one reason that treatment is inadequate in developing countries. This problem has kindled interest in the use of equine rabies immune globulin, which is a less expensive, yet effective, substitute for human rabies immune globulin. Fatal anaphylaxis is a feared complication of the administration of heterologous serum; therefore, authoritative sources recommend prior skin testing. However, recommendations for methods of administering such a skin test and for its interpretation vary greatly. We embarked on a long-term study to develop guidelines for administration and interpretation of skin test results and to eventually determine a cost-benefit ratio. The skin test is not predictive of serum sickness. Anaphylaxis is rare with modern purified and pepsin-digested equine rabies immune globulins. We consider a skin test to be positive only if a wheal of > 10 mm in diameter, with or without flare, or a wheal of 5-10 mm in diameter with a flare of > 20 mm develops. Long-term studies will be required to answer the remaining questions regarding test criteria and cost benefits.

Adolescent↗

Economic evaluation of the familial cancer programme in Western Australia: predictive genetic testing for familial adenomatous polyposis and hereditary non-polyposis colorectal carcinoma.

AIM: To evaluate costs and outcomes of genetic testing for familial colorectal cancer through services provided by Genetic Services of Western Australia (GSWA). METHODS: Costs and outcomes of predictive DNA-based testing for inherited colorectal cancers (CRC) were assessed, specifically for familial adenomatous polyposis (FAP) and hereditary non-polyposis CRC (HNPCC) using a decision-analysis model. Costs were assigned according to standards of care in Western Australia (WA). Cancer risks and the efficacy of surveillance on long-term outcomes were derived from the published literature. RESULTS: The cost-effectiveness of genetic testing was compared in first-degree relatives of known mutation carriers who have a 50% risk of carrying the mutated gene (intervention group) to individuals with the same risk but who do not undergo a genetic test (control subjects). Compared with control subjects undergoing the same high-level surveillance and surgery, the FAP and HNPCC intervention groups provided total savings of 13,390 US dollars and 14,783-15,460 per person (males-females), respectively. HPNCC mutation carriers also gained 1 CRC-free year. Compared to control subjects having only population surveillance, individuals in the FAP intervention group delayed the onset of CRC by 40 years for a net cost of 9,042 US dollars. Individuals in the HNPCC intervention group delayed the onset of CRC by 8 years at a net cost of 12,141 US dollars for males and 12,596 US dollars for females. CONCLUSIONS: Genetic testing for familial CRC in WA allows targeted surveillance for mutation carriers, which ensures the efficient use of resources and reduces cancer-related morbidity, if clinical recommendations for intervention are adopted.

Adenomatous Polyposis Coli↗