Clinical judgment to estimate pretest probability in the diagnosis of Cushing's syndrome under a Bayesian perspective

OBJECTIVE: To estimate the pretest probability of Cushing's syndrome (CS) diagnosis by a Bayesian approach using intuitive clinical judgment. MATERIALS AND METHODS: Physicians were requested, in seven endocrinology meetings, to answer three questions: "Based on your personal expertise, after obtaining clinical history and physical examination, without using laboratorial tests, what is your probability of diagnosing Cushing's Syndrome?"; "For how long have you been practicing Endocrinology?"; and "Where do you work?". A Bayesian beta regression, using the WinBugs software was employed. RESULTS: We obtained 294 questionnaires. The mean pretest probability of CS diagnosis was 51.6% (95%CI: 48.7-54.3). The probability was directly related to experience in endocrinology, but not with the place of work. CONCLUSION: Pretest probability of CS diagnosis was estimated using a Bayesian methodology. Although pretest likelihood can be context-dependent, experience based on years of practice may help the practitioner to diagnosis CS. Arq Bras Endocrinol Metab. 2012;56(9):633-7

The reduced modulus in the analysis of sharp instrumented indentation tests

In the analysis of instrumented indentation data, it is common practice to incorporate the combined moduli of the indenter (E-i) and the specimen (E) in the so-called reduced modulus (E-r) to account for indenter deformation. Although indenter systems with rigid or elastic tips are considered as equivalent if E-r is the same, the validity of this practice has been questioned over the years. The present work uses systematic finite element simulations to examine the role of the elastic deformation of the indenter tip in instrumented indentation measurements and the validity of the concept of the reduced modulus in conical and pyramidal (Berkovich) indentations. It is found that the apical angle increases as a result of the indenter deformation, which influences in the analysis of the results. Based upon the inaccuracies introduced by the reduced modulus approximation in the analysis of the unloading segment of instrumented indentation applied load (P)-penetration depth (delta) curves, a detailed examination is then conducted on the role of indenter deformation upon the dimensionless functions describing the loading stages of such curves. Consequences of the present results in the extraction of the uniaxial stress-strain characteristics of the indented material through such dimensional analyses are finally illustrated. It is found that large overestimations in the assessment of the strain hardening behavior result by neglecting tip compliance. Guidelines are given in the paper to reduce such overestimations.

A note on the local power of the LR, Wald, score and gradient tests

This paper examines the local power of the likelihood ratio, Wald, score and gradient tests under the presence of a scalar parameter, phi say, that is orthogonal to the remaining parameters. We show that some of the coefficients that define the local powers remain unchanged regardless of whether phi is known or needs to be estimated, where as the others can be written as the sum of two terms, the first of which being the corresponding term obtained as if phi were known, and the second, an additional term yielded by the fact that phi is unknown. The contribution of each set of parameters on the local powers of the tests can then be examined. Various implications of our main result are stated and discussed. Several examples are presented for illustrative purposes

Bending stiffness evaluation of Teca and Guajara lumber through tests of transverse and longitudinal vibration

The grading of structural lumber besides contributing for increasing the structure's safety, due to the reduction of the material variability, also allows its rational use. Due to the good correlation between strength and bending stiffness, the latter has been used in estimating the mechanical strength of lumber pieces since the 60's. For industrial application, there are equipment and techniques to evaluate the bending stiffness of lumber, through dynamic tests such as the longitudinal vibration technique, also known as stress wave, and the transverse vibration technique. This study investigated the application of these two techniques in the assessment of the modulus of elasticity in bending of Teca beams (Tectona grandis), from reforestation, and of the tropical species Guajara (Micropholis venulosa). The modulus of elasticity estimated by dynamic tests showed good correlation with the modulus measured in the static bending test. Meantime, we observed that the accuracy of the longitudinal vibration technique was significantly reduced in the evaluation of the bending stiffness of Teca pieces due to the knots existing in this species.

Evaluation of the Sensitivity of Freshwater Organisms Used in Toxicity Tests of Wastewater from Explosives Company

Explosives industries are a source of toxic discharge. The aim of this study was to compare organisms sensitivity (Daphnia similis, Danio rerio, Escherichia coli and Pseudomonas putida) in detecting acute toxicity in wastewater from two explosives, 2,4,6-TNT (TNT) and nitrocellulose. The samples were collected from an explosives company in the Paraiba Valley, So Paulo, Brazil. The effluents from TNT and nitrocellulose production were very toxic for tested organisms. Statistical tests indicated that D. similis and D. rerio were the most sensitive organisms for toxicity detection in effluents from 2,4,6-TNT and nitrocellulose production. The P. putida bacteria was the organism considered the least sensitive in indicating toxicity in effluents from nitrocellulose.

Local power properties of some asymptotic tests in symmetric linear regression models

In this paper we obtain asymptotic expansions, up to order n(-1/2) and under a sequence of Pitman alternatives, for the nonnull distribution functions of the likelihood ratio, Wald, score and gradient test statistics in the class of symmetric linear regression models. This is a wide class of models which encompasses the t model and several other symmetric distributions with longer-than normal tails. The asymptotic distributions of all four statistics are obtained for testing a subset of regression parameters. Furthermore, in order to compare the finite-sample performance of these tests in this class of models, Monte Carlo simulations are presented. An empirical application to a real data set is considered for illustrative purposes. (C) 2011 Elsevier B.V. All rights reserved.

Sensitivity of Eisenia andrei (Annelida, Oligochaeta) to a commercial formulation of abamectin in avoidance tests with artificial substrate and natural soil under tropical conditions

Obtaining ecotoxicological data on pesticides in tropical regions is imperative for performing more realistic risk analysis, and avoidance tests have been proposed as a useful, fast and cost-effective tool. Therefore, the present study aimed to evaluate the avoidance behavior of Eisenia andrei to a formulated product, Vertimec(A (R)) 18 EC (a.i abamectin), in tests performed on a reference tropical artificial soil (TAS), to derive ecotoxicological data on tropical conditions, and a natural soil (NS), simulating crop field conditions. In TAS tests an adaptation of the substrate recommended by OECD and ISO protocols was used, with residues of coconut fiber as a source of organic matter. Concentrations of the pesticide on TAS test ranged from 0 to 7 mg abamectin/kg (dry weight-d.w.). In NS tests, earthworms were exposed to samples of soils sprayed in situ with: 0.9 L of Vertimec(A (R)) 18 EC/ha (RD); twice as much this dosage (2RD); and distilled water (Control), respectively, and to 2RD: control dilutions (12.5, 25, 50, 75%). All tests were performed under 25 +/- A 2A degrees C, to simulate tropical conditions, and a 12hL:12hD photoperiod. The organisms avoided contaminated TAS for an EC50,48h = 3.918 mg/kg soil d.w., LOEC = 1.75 mg/kg soil d.w. and NOEC = 0.85 mg/kg soil d.w. No significant avoidance response occurred for any NS test. Abamectin concentrations in NS were rather lower than EC50, 48h and LOEC determined in TAS tests. The results obtained contribute to overcome a lack of ecotoxicological data on pesticides under tropical conditions, but more tests with different soil invertebrates are needed to improve pesticides risk analysis.

Micro-mechanical bond strength tests for the assessment of the adhesion of GIC to dentine

Background. The aim of this study is to critically evaluate the bond strength (BS) of Glass-Ionomer Cements (GIC) to dentine with microtensile (mu TBS) and microshear (mu SBS) BS tests by assessing their rankings and failure patterns. Methods. Samples were made on flat dentine surfaces and submitted to mTBS and mSBS. The materials used were: high viscosity GIC (Ketac (TM) Molar Aplicap-KM), resin-modified GIC (Fuji II-FII), nano-filled resin-modified GIC (Ketac (TM) N100-N100) and an etch-and-rinse adhesive system with a composite resin (Adper (TM) Single Bond 2 and Z100 (TM)-Z100). All tests were performed with a Universal Testing Machine (24 h water storage, crosshead speed of 1 mm/min). Debonded surfaces were examined with a stereomicroscope (x40) to identify the failure mode. The data was analyzed with two-way ANOVA (p < 0.05) and LSD test. Results. Means were statistically different regarding the tests and materials, indicating that values for BS obtained for each material depend on the test performed. Failure analysis revealed that failures produced by mTBS were mainly cohesive for KM and FII. mu SBS failures were mainly adhesive or mixed for all materials. For the mTBS, the rank was Z100 > FII > KM = N100, whereas for the mSBS it was Z100 = FII = KM > N100. Conclusion: It may be concluded that distinct micro-mechanical tests present different failure patterns and rankings depending on the material to be considered.

Reliability in kimono grip strength tests and comparison between elite and non-elite Brazilian jiu-jitsu players

Background and Study Aim: The grip strength endurance is important for Brazilian Jiu-Jitsu (BJJ). Thus, the aims of this study were: a) to test the reliability of two kimono grip strength tests named maximum static lift (MSL) and maximum number of repetitions (MNR) and b) to examine differences between elite and non-elite BJJ players in these tests. Material/Methods: Thirty BJJ players participated into two phases: "A" to test reliability and "B" to compare elite and non-elite. In phase A, twenty participants performed the MSL and, 15 min later, the MNR in two occasions with 24-h interval. In phase B, ten other BJJ practitioners (non-elite) and ten athletes (elite) performed the same tests. The intraclass correlation coefficient (ICC) two way fixed model (3,1), Bland-Altman plot and the limits of agreement were used to test reliability, correlation between the tests were evaluated by Pearson correlations and independent T test (P<0.05) was utilized to compare elite vs. non-elite. Results: The ICC was high for repeated measurements on different days of phase A (MSL: r=0.99 and MNR: r=0.97). Limits of agreement for time of suspension were -6.9 to 2.4-s, with a mean difference of -2.3 s (CI: -3.3 to -1.2-s), while for number of repetitions the limits of agreement were -2.9 to 2.3-rep, with a mean difference of -0.3-rep (CI: -0.9 to 0.3-rep). In phase B, elite presented better performance for both tests (P<0.05) compared to non-elite (56 +/- 10-s vs. 37 +/- 11-s in MSL and 15 +/- 4-rep vs. 8 +/- 3-rep in MNR). Moderate correlation were found between MSL and MNR for absolute values during test (r=0.475; p=0.034), and retest phases (r=0.489; p=0.029), while moderate and high correlations in the test (r=0.615; p=0.004) and retest phases (r=0.716; p=0.001) were found for relative values, respectively. Conclusions: These proposed tests are reliable and both static and dynamic grip strength endurance tests seem to differentiate BJJ athletes from different levels.

Water Quality Assessment in Piracicamirim Creek Upstream and Downstream a Sugar and Ethanol Industry Through Toxicity Tests With Cladocerans

An environmental impact study was conducted to determine the Piracicamirim's creek water quality in order to assess the influence of effluents from a sugar industry in this water body. For this, toxicity tests were performed with a water sample upstream and downstream the industry using the microcrustaceans Daphnia magna, Ceriodaphnia dubia and Ceriodaphnia silvestrii as test organisms, as well as physical and chemical analysis of water. Results showed that physical and chemical parameters did not change during the sampling period, except for the dissolved oxygen. No toxicity was observed for D. magna and reproduction of C. dubia and C. silvestrii in both sampling points. Thus, the industry was not negatively impacting the quality of this water body.

Motion-based wave estimation: Small-scale tests with a crane-barge model

This paper provides additional validation to the problem of estimating wave spectra based on the first-order motions of a moored vessel. Prior investigations conducted by the authors have attested that even a large-volume ship, such as an FPSO unit, could be adopted for on-board estimation of the wave field. The obvious limitation of the methodology concerns filtering of high-frequency wave components, for which the vessel has no significant response. As a result, the estimation range is directly dependent on the characteristics of the vessel response. In order to extend this analysis, further small-scale tests were performed with a model of a pipe-laying crane-barge. When compared to the FPSO case, the results attest that a broader range of typical sea states can be accurately estimated, including crossed-sea states with low peak periods. (C) 2012 Elsevier Ltd. All rights reserved.

A General Latent Class Model for Performance Evaluation of Diagnostic Tests in the Absence of a Gold Standard: An Application to Chagas Disease

We propose a new general Bayesian latent class model for evaluation of the performance of multiple diagnostic tests in situations in which no gold standard test exists based on a computationally intensive approach. The modeling represents an interesting and suitable alternative to models with complex structures that involve the general case of several conditionally independent diagnostic tests, covariates, and strata with different disease prevalences. The technique of stratifying the population according to different disease prevalence rates does not add further marked complexity to the modeling, but it makes the model more flexible and interpretable. To illustrate the general model proposed, we evaluate the performance of six diagnostic screening tests for Chagas disease considering some epidemiological variables. Serology at the time of donation (negative, positive, inconclusive) was considered as a factor of stratification in the model. The general model with stratification of the population performed better in comparison with its concurrents without stratification. The group formed by the testing laboratory Biomanguinhos FIOCRUZ-kit (c-ELISA and rec-ELISA) is the best option in the confirmation process by presenting false-negative rate of 0.0002% from the serial scheme. We are 100% sure that the donor is healthy when these two tests have negative results and he is chagasic when they have positive results.