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The Turkish version of the Bath Ankylosing Spondylitis Functional Index: reliability and validity.

The purpose of this study was to investigate the reliability and validity of the Turkish version of the Bath Ankylosing Spondylitis (AS) Functional Index (BASFI). The Turkish version of the BASFI was obtained after a process of translation and back-translation. Eighty-one consecutive patients meeting the 1984 New York criteria for AS were enrolled. Patients were evaluated and requested to complete the questionnaire at days 1 and 2 and on a third occasion between days 15-90. Reliability, reproducibility, validity and sensitivity to change of the Turkish version of the index were assessed. Each score correlated closely with the index score, with coefficients between 0.727 and 0.844. Reliability analysis showed a Cronbach's alpha score of 0.926. Correlations were found between all items of the BASFI and Schober's test (r=-0.258 to -0.531, p<0.001-0.05), occiput-to-wall distance (r=0.284 and 0.589, p<0.001-0.05), and finger-to-floor distance (r=0.334 to 0.613, p<0.001-0.01). The total index score was correlated with the number of nocturnal awakenings (r=0.515, p<0.001), Schober's test (r=-0.444, p<0.001), finger-to-floor distance (r=0.567, p<0.001), occiput-to-wall distance (r=0.535, p<0.001), chest expansion (r=-0.403, p<0.001), and the Dougados articular index (r=0.371, p<0.01). A good correlation was found between day 0 and 1 BASFI indices (r=0.765-0.917, p<0.001), showing good reproducibility of the index. The Turkish version of the BASFI showed reliability, reproducibility, and validity, confirming its utility in the research of AS in Turkey. However, sensitivity to changes due to drug therapy and/or rehabilitation remains to be determined.

Activities of Daily Living↗

A special vegetation index for the weed detection in sensor based precision agriculture.

Many technologies in precision agriculture (PA) require image analysis and image- processing with weed and background differentiations. The detection of weeds on mulched cropland is one important image-processing task for sensor based precision herbicide applications. The article introduces a special vegetation index, the Difference Index with Red Threshold (DIRT), for the weed detection on mulched croplands. Experimental investigations in weed detection on mulched areas point out that the DIRT performs better than the Normalized Difference Vegetation Index (NDVI). The result of the evaluation with four different decision criteria indicate, that the new DIRT gives the highest reliability in weed/background differentiation on mulched areas. While using the same spectral bands (infrared and red) as the NDVI, the new DIRT is more suitable for weed detection than the other vegetation indices and requires only a small amount of additional calculation power. The new vegetation index DIRT was tested on mulched areas during automatic ratings with a special weed camera system. The test results compare the new DIRT and three other decision criteria: the difference between infrared and red intensity (Diff), the soil-adjusted quotient between infrared and red intensity (Quotient) and the NDVI. The decision criteria were compared with the definition of a worse case decision quality parameter Q, suitable for mulched croplands. Although this new index DIRT needs further testing, the index seems to be a good decision criterion for the weed detection on mulched areas and should also be useful for other image processing applications in precision agriculture. The weed detection hardware and the PC program for the weed image processing were developed with funds from the German Federal Ministry of Education and Research (BMBF).

Agriculture↗

Genetic uptake in BRCA-mutation families is related to emotional and behavioral communication characteristics of index patients.

INTRODUCTION: Carriers of a hereditary mutation in BRCA are at high risk for breast and ovarian cancer. The first person from a family known to carry the mutation, the index person, has to share genetic information with relatives. This study is aimed at determining the number of relatives tested for a BRCA mutation, and the exploration of facilitating and debilitating factors in the transmission of genetic information from index patient to relatives. METHODS: The study includes 50 female index patients, with a germline mutation in either BRCA1 or BRCA2. RESULTS: The percentage of first- and second-degree relatives tested for the BRCA-mutation was 36%. Uptake levels for predictive BRCA-mutation testing could not be explained by demographic or counseling characteristics, nor by cancer-related history. In 14 families, fewer than 20% of first- and second-degree relatives were tested. These families were compared with the other families. In retrospect, the index patients of families with few BRCA-mutation tests more often asked for support in the communication with family members (62% vs. 27%). A psychosocial worker had been absent more often during counseling (39% vs. 9%). Emotional factors debilitating the information transmission were only reported by index patients from families with few BRCA-mutation tests (18% vs. 0%), who also informed their parents less often (21% vs. 67%) and did so less often personally (38% vs. 71%). CONCLUSION: Uptake of predictive BRCA-mutation testing by first- and second-degree relatives is low. Emotional and behavioral factors of index patients are related to this uptake.

Adolescent↗

Characterization of brain tumors by MRS, DWI and Ki-67 labeling index.

With the advent of fast imaging hardware and specialized software, additional non-invasive magnetic resonance characterization of tumors has become available through proton magnetic resonance spectroscopy (MRS), hemodynamic imaging and diffusion-weighted imaging (DWI). Thus, patterns could be discerned to discriminate different types of tumors and even to infer their possible evolution in time. The purpose of this study was to investigate the correlation between MRS, DWI, histopathology and Ki-67 labeling index in a large number of brain tumors. Localized proton spectra were obtained in 47 patients with brain tumors who subsequently underwent surgery (biopsy or tumor removal). We performed MRS with short echo-time (30 ms) and metabolic values in spectra were measured using an external software with 25 peaks. In all patients who had DWI, we measured apparent diffusion coefficients (ADC) in the same region of interest (ROI) where the voxel in MRS was located. In most tumors the histological diagnosis and Ki-67 labeling index had been determined on our original surgical specimen. Cho/Cr, (Lip+Mm)/Cr, NAA/(Cho+Cr) and Glx/Cr indexes in MRS allowed discriminating between low- and high-grade gliomas and metastases (MTs). Likewise, absolute ADC values differentiated low- from high-grade gliomas expressed by Ki-67 labeling index. A novel finding was that high Glx/Cr in vivo MRS index (similar to other known indexes) was a good predictor of tumor grading.

Adult↗

Docosahexaenoic acid supplementation in vegetarians effectively increases omega-3 index: a randomized trial.

Low red blood cell (RBC) membrane content of EPA + DHA (hereafter called omega-3 index) has recently been described as an indicator for increased risk of death from coronary heart disease. The relationship between plasma and RBC FA, focusing on omega-3 index, and the response to DHA supplementation were investigated in a double-blind, randomized, placebo-controlled, intervention study. Healthy vegetarians (87 f, 17 m) consumed daily a microalgae oil from Ulkenia sp. (0.94 g DHA/d) or olive oil (placebo) for 8 wk. DHA supplementation significantly increased DHA in RBC total lipids (7.9 vs. 4.4 wt%), in RBC PE (12.1 vs. 6.5 wt%), in RBC PC (3.8 vs. 1.4 wt%), and in plasma phospholipids (PL) (7.4 vs. 2.8 wt%), whereas EPA levels rose to a much lesser extent. Microalgae oil supplementation increased the omega-3 index from 4.8 to 8.4 wt%. After intervention, 69% of DHA-supplemented subjects (but no subject of the placebo group) reached an omega-3 index above the desirable value of 8 wt%. Omega-3 index and EPA + DHA levels in RBC PE, RBC PC, and plasma PL were closely correlated (r always > 0.9). We conclude that an 8-wk supplementation with 0.94 g DHA/d from microalgae oil achieves a beneficial omega-3 index of > or =8% in most subjects with low basal EPA + DHA status. RBC total FA analyses can be used instead of RBC lipid fraction analyses for assessing essential FA status, e.g., in clinical studies.

Adolescent↗

An ischemic index from the electrocardiogram to select patients with low left ventricular ejection fraction for coronary artery bypass grafting.

Patients who have a decreased left ventricular (LV) ejection fraction (EF) may be denied coronary by-pass grafting (CABG) because it is assumed that improvement in function is unlikely. If the low LVEF were due to myocardial necrosis, this assumption would be valid. If the dysfunction were due to both necrosis and ischemia, however, then improvement may be possible with CABG. A method capable of identifying such patients would be useful. In this study, an "ischemic index" was determined for 37 patients based on the difference between the presurgical LVEF estimated from the standard 12-lead electrocardiogram by the Selvester QRS score (indicating the extent of dysfunction due to necrosis) and the presurgical LVEF measured from resting multigated radionuclide angiography (indicating dysfunction due to both necrosis and ischemia). It was hypothesized that a high ischemia index, that is, a large discrepancy between estimated and measured LVEF, would be associated with an improved post-surgical measured LVEF. The results showed that patients with an ischemic index of less than or equal to 0 had a mean decrease in LVEF of 8% (p = 0.02) and those with an index between 0 and 10 had no mean change. Patients with an index greater than or equal to 11, however, had a mean increase of 5% (p = 0.02), suggesting that depressed LVEF may improve following CABG among patients whose low function is due primarily to reversible ischemia as indicated by a high ischemic index.

Adult↗

Accuracy of ST/heart rate index in the diagnosis of coronary artery disease.

The accuracy of ST/heart rate (ST HR) index was evaluated in patients presenting for exercise electrocardiography with suspected coronary disease. In all, 420 patients (235 men and 185 women) with normal electrocardiograms at rest underwent exercise testing, followed within 3 months by coronary angiography. The sensitivity and specificity for standard ST criteria (greater than or equal to 1 mm horizontal or downsloping depression) were 48% (78 of 162) and 81% (208 of 258), respectively. An ST HR-index threshold of 1.86 microV/beta/min had the exact same specificity with a sensitivity of 44% (71 of 162; p = not significant). Consideration of greater than or equal to 1.5 mm upsloping depression had no significant impact on the aforementioned results. Using multivariate logistic regression analysis, age, sex, symptoms, cigarette smoking, diabetes mellitus, qualitative ST slope, rate-pressure product, METs achieved and exercise angina were evaluated with and without ST HR index and ST depression. According to this analysis, age, sex, symptoms and ST slope were good predictors of presence or absence of disease. Neither ST HR index nor ST depression had significance in the multivariate analysis. However, when a separate analysis was performed in men and women, the 2 quantitative ST variables showed significance in men, but not in women. Comparisons of discriminative accuracy using receiver-operating characteristic curves demonstrated differences between men and women, but no difference between ST HR index and ST depression. Therefore, concerning questions of coronary disease diagnosis, consideration of ST HR index was not better than standard ST criteria, and added nothing to multivariate analysis of other available variables.

Adult↗

Analysis of heart rate and beat-to-beat variability: Interval difference index.

The relationshp between the RR interval length (RR) and the RR interval-to-interval differences (RR differences) was investigated. Data on heart rate were obtained from 11 newborn infants in well-defined behavioral states undergoing polygraphy. It was found that the RR differences were strongly dependent on the RR interval length in all behavioral states. The relationship between the RR differences (y) and the interval length (RR) could be described by the equation y = alpha (RR-320)1.5 for the interval length in the investigated range from 375 to 605 msec. On the basis of this relationship the interval difference index (ID index) was constructed for the quantification of beat-to-beat heart rate variability. The ID index showed good independence from the long-term irregularity index (LTI index). Other statistical parameters proposed for the quantification of beat-to-beat heart rate variability are discussed and compared with the ID index.

Electrocardiography↗

Efficacy of the fetal-pelvic index as a predictor of fetal-pelvic disproportion in women with abnormal labor patterns that require labor augmentations.

The fetal-pelvic index, which compares fetal head and abdomen circumferences with respective maternal inlet and midpelvic circumferences, was introduced in 1986 as a means of identifying the presence or absence of fetal-pelvic disproportion. In this study the efficacy of the fetal-pelvic index was evaluated in 46 patients with abnormal labor patterns that required labor augmentations and was compared with that of two other means (Colcher-Sussman x-ray pelvimetry and ultrasonographically derived estimated fetal weight greater than or equal to 4000 gm). Of the 24 women who required operative intervention (19 cesarean sections and five operative vaginal procedures), 17 had positive fetal-pelvic index values (sensitivity = 0.71). Six of the seven fetuses of patients with false-negative fetal-pelvic index values persisted in an occipitoposterior presentation, and these patients failed to progress in labor. Of the 22 patients in whom vaginal deliveries were spontaneous, 21 had negative fetal-pelvic index values (specificity = 0.95). Of the 18 women with positive fetal-pelvic index values, 17 required operative intervention (positive predictability = 0.94). In contrast, when used alone, neither x-ray pelvimetry nor ultrasonographically derived estimated fetal weight greater than or equal to 4000 gm provided accurate identification of fetal-pelvic disproportion.

Body Weight↗

Correlation of amniotic fluid index and nonstress test in patients with preterm premature rupture of membranes.

The amniotic fluid index and the nonstress test are commonly used in the expectant management of preterm premature rupture of membranes. This study was designed to investigate the interrelationship of the nonstress test and the amniotic fluid index during the preterm rupture of membranes latency period. Fifty patients with preterm premature rupture of membranes for greater than 48 hours were prospectively followed with daily 1-hour nonstress tests and blinded, daily amniotic fluid index examinations (totaling 422 evaluations). The overall average daily amniotic fluid index was statistically lower in the earlier gestations and nulliparous patients but was not influenced by the fetal position or nonlaboring uterine activity. An increased incidence of variable decelerations and nonreactive nonstress tests was associated with a significantly lower overall average daily amniotic fluid index, but these differences were beyond the standard precision of the amniotic fluid index examination. The daily nonstress test appears to identify clinically significant lower fluid volumes during the latency period and should remain the mainstay in the management of preterm premature rupture of membranes.

Adult↗

Intrapartum amniotic fluid index and its relationship to fetal distress.

Amniotic fluid index was measured in 50 consecutive laboring women after membrane rupture. The 10th percentile of the normal range was 6.2 cm. Thirty-three women had a repeat measurement by a second observer. Although there was no systematic bias between the two observers, the limits of agreement were wide: 95% of the measurements by one observer were between 0.59 and 2.07 times those of the second. Closer agreement was observed when amniotic fluid index was low (less than 6.2 cm). The relationship between intrapartum amniotic fluid index and fetal distress was then investigated in a further 60 laboring women. When compared with women with a normal intrapartum amniotic fluid index, women with a low amniotic fluid index had higher incidences of fetal heart rate abnormalities during the first stage of labor (64% vs 20%, p less than 0.01), meconium (grade II or III) at delivery (64% vs 35%, p less than 0.05), and operative delivery for fetal distress (57% vs 17%, p less than 0.01). Umbilical artery pH and Apgar scores were, however, similar for the two groups. Measurement of intrapartum amniotic fluid index may be an appropriate method for selecting women suitable for intrapartum aminoinfusion.

Amniotic Fluid↗

Longitudinal measurement of amniotic fluid index in postterm pregnancies and its association with fetal outcome.

OBJECTIVE: Our purpose was to study the association between dynamic changes in serial amniotic fluid index measurements and adverse fetal outcome in postterm pregnancies. STUDY DESIGN: Serial amniotic fluid index values were obtained semiweekly in 139 reliably dated, uncomplicated, singleton pregnancies at > 41 weeks' gestation. Adverse fetal outcome was defined by the presence of moderate or thick meconium, fetal heart rate decelerations, cesarean delivery for fetal distress, neonatal intensive care unit admission, and perinatal mortality. RESULTS: Prominent changes in the amniotic fluid index (i.e., > 50% increase or decrease) had no association with adverse fetal outcome irrespective of rate of change, provided the final value remained > 5.0 cm. A significant association with fetal heart rate decelerations and the presence of meconium was detected only in patients whose final amniotic fluid index was < or = 5.0 cm (p = 0.007 and p = 0.003, respectively). CONCLUSION: Irrespective of the rate of change in amniotic fluid index, postterm pregnancies are significantly associated with potential complications such as fetal heart rate decelerations and meconium staining when the final amniotic fluid index is < or = 5.0 cm.

Amniotic Fluid↗

A simple quantitative index of the P3 amylase isoenzyme in the diagnosis of acute pancreatitis.

Following a report (Legaz, M.E. and Kenny, M.A. (1976) Clin. Chem. 22, 57--62) that the amylase isoenzyme, P3, is elevated in acute pancreatitis but not in other conditions a new "P3 Index" is proposed. This reflects the ratio of the P3 isoenzyme to the major salivary isoenzyme, S1. The P3 Index eliminates the problems of peak overlap which prevent accurate detection or direct quantitation of P3. In acute pancreatitis a large increase in 3 produces a serum P3 Index of below 80%. Normal serum exhibits a P3 Index of above 80%. Most causes of hyperamylasaemia observed without acute pancreatitis also exhibited a P3 Index of above 80%. The P3 Index seems to be a useful aid to the diagnosis or exclusion of acute pancreatitis in patients exhibiting equivocal hyperamylasaemia.

Acute Disease↗

The intrauterine ponderal index in relation to birth weight discordance in twin gestations.

OBJECTIVE: To establish the relationship between the fetal ponderal index and birth weight discordance in twins. METHOD: The fetal ponderal index (estimated fetal weight divided by femur length3) was calculated in 86 pairs of twins delivered within 2 weeks of the last sonography and analyzed in relation to birth weight discordance. RESULTS: A weak but significant correlation between fetal ponderal index and birth weight (r = 0.26, P < 0.0007) but no correlation with gestational age (r = 0.035, P = 0.65) were found. Members of concordant pairs (< 15% birth weight difference) had a significantly higher fetal ponderal index compared with members of mildly (15-25%) discordant pairs (P < 0.02), but not as compared with members of severely discordant (> 25%) pairs. CONCLUSION: The characteristics of the fetal ponderal index in twins are similar to those in singletons. Fetal size seems to be diminished in severe but not in mild discordants. However, in its present form, the fetal ponderal index is a poor predictor of discordant growth and therefore should be employed cautiously in twin gestations.

Birth Weight↗

Linear dimensional variability and tensile strengths of three solder index materials.

This study compared the linear dimensional change and tensile strengths of three indexing materials used for aligning joints to be soldered. Sixty rods 6 mm in diameter and 18 mm in length were made from base metal. The rods were divided into three groups of 10 pairs each, and a simulated solder gap was created between the rods in each pair. Ten simulated gaps were indexed with Duralay resin, 10 were indexed with Relate resin, and 10 were indexed with ZAPIT cyanoacrylate material. Measurements were made of each pair, before and after indexing, and the tensile strength of each indexed pair was measured and recorded. Linear measurements showed no significant difference between any of the groups. However, significant differences in tensile strength were found among all the materials tested.

Acrylic Resins↗

Elevation of the free thyroxine index in psychiatric patients.

We calculated a free triiodothyronine (FT3) index on 124 patients who exhibited symptoms and signs of hyperthyroidism and elevations of the free thyroxine (FT4) index on initial screening. A thyrotropin-releasing hormone (TRH) test served as the final arbiter of thyroid function if the clinical presentation was not characteristic of hyperthyroidism or if the FT3 index was not elevated. Forty-one of the 124 patients had normal TRH tests and were thus classified as euthyroid. Of these patients with the so-called euthyroid sick syndrome, 23 had psychiatric disorders. In a separate study, we measured a FT4 index on 100 unselected admissions to the psychiatric ward. Of six patients with elevated FT4 values, only one had hyperthyroidism. We conclude that false positive FT4 index elevations occur commonly in psychiatric patients. The mechanism(s) for the FT4 index elevations remain obscure. Despite some limitations, the TRH test is a valuable diagnostic adjunct for diagnosing hyperthyroidism in the mentally ill patient when other tests and serial observations are inconclusive.

Adolescent↗

Comparison of serum procollagen III peptide concentrations and PGA index for assessment of hepatic fibrosis.

In early hepatic fibrosis, increased amounts of type III collagen are deposited. Persistently high serum concentrations of aminoterminal type III procollagen propeptide (PIIIP) correlate with the activity of the fibrogenic process. Another index for the detection of fibrosis, the PGA index, combines the prothrombin time, gamma-glutamyl transpeptidase activity, and serum apolipoprotein A1 concentration (the latter falls with progressive fibrosis). We compared PIIIP measurements and PGA index in patients with various histological forms of alcoholic liver disease (104), primary biliary cirrhosis (38), and chronic B virus hepatitis (27), and in healthy age-matched controls (30). The ability of each test to identify correctly patients with fibrosis or cirrhosis was assessed with receiver operating curves. The PGA index was much higher in all groups of patients with alcoholic liver disease than in controls (p < 0.0001). PIIIP concentrations were also substantially higher than in controls (p < 0.05 for fatty liver, p < 0.0001 for all other groups), especially in the group with alcoholic hepatitis and cirrhosis. For the detection of cirrhosis the PGA was 91% sensitive and 81% specific and the PIIIP concentration was 94% sensitive and 81% specific. The two tests combined had 85% sensitivity, but 93% specificity. Among patients with primary biliary cirrhosis, both PGA index and PIIIP concentration correlated well with the severity of the disease, determined by the Mayo score (r = 0.72 and 0.66 respectively). The combined tests were 96% sensitive for the detection of fibrosis. All patients with chronic B virus hepatitis had raised PGA and PIIIP values in comparison with controls (p < 0.0001) but there were no differences between subgroups. Substantially raised PIIIP concentrations thus identify the subgroup of alcoholic patients with both hepatitis and cirrhosis. The combination of PGA index and PIIIP concentration may be useful for targeting treatment with antifibrotic drugs and to reduce the need for liver biopsy.

Apolipoprotein A-I↗

A weighted index of bilateral brain lesions.

Attempts to correlate the amount of bilateral brain injury with behavioral changes can be complicated if the lesions are bilaterally unsymmetrical in volume. Further complications are introduced if unilateral lesions are ineffective in producing behavioral changes. An index, W%, is proposed which is based on the product of the volumes of the damage on the right and left sides. The index ranges from 0 to 100 such that conditions of no injury or unilateral injury produce an index of zero. In contrast, relatively large values of the index are generated by symmetrical lesions. Grossly unsymmetrical lesions, in which one side is nearly intact, produce very low index values. For lesions that are bilaterally equivalent in volume, the percentage of tissue destroyed on either side is equal to 10 square root of W%. Some properties of the proposed index are discussed.

Animals↗