Bayesian Estimation for Performance Measures of Two Diagnostic Tests in the Presence of Verification Bias

Sensitivity and specificity are measures that allow us to evaluate the performance of a diagnostic test. In practice, it is common to have situations where a proportion of selected individuals cannot have the real state of the disease verified, since the verification could be an invasive procedure, as occurs with biopsy. This happens, as a special case, in the diagnosis of prostate cancer, or in any other situation related to risks, that is, not practicable, nor ethical, or in situations with high cost. For this case, it is common to use diagnostic tests based only on the information of verified individuals. This procedure can lead to biased results or workup bias. In this paper, we introduce a Bayesian approach to estimate the sensitivity and the specificity for two diagnostic tests considering verified and unverified individuals, a result that generalizes the usual situation based on only one diagnostic test.

Comparing diagnostic tests with missing data

When missing data occur in studies designed to compare the accuracy of diagnostic tests, a common, though naive, practice is to base the comparison of sensitivity, specificity, as well as of positive and negative predictive values on some subset of the data that fits into methods implemented in standard statistical packages. Such methods are usually valid only under the strong missing completely at random (MCAR) assumption and may generate biased and less precise estimates. We review some models that use the dependence structure of the completely observed cases to incorporate the information of the partially categorized observations into the analysis and show how they may be fitted via a two-stage hybrid process involving maximum likelihood in the first stage and weighted least squares in the second. We indicate how computational subroutines written in R may be used to fit the proposed models and illustrate the different analysis strategies with observational data collected to compare the accuracy of three distinct non-invasive diagnostic methods for endometriosis. The results indicate that even when the MCAR assumption is plausible, the naive partial analyses should be avoided.

Critical, issues and needs in management of primary immunodeficiency diseases in Latin America

Experts from six Latin American countries met to discuss critical issues and needs in the diagnosis and management of primary immunodeficiency diseases (PIDD). The diagnosis of PIDD is generally made following referral to an immunology centre located in a major city, but many paediatricians and general practitioners are not sufficiently trained to suspect PIDD in the first place. Access to laboratory testing is generally limited, and only some screening tests are typically covered by government health programmes. Specialised diagnostic tests are generally not reimbursed. Access to treatment varies by country reflecting differences in healthcare systems and reimbursement policies. An online PIDD Registry Programme for Latin America has been available since 2009, which will provide information about PIDD epidemiology in the region. Additional collaboration across countries appears feasible in at least two areas: a laboratory network to facilitate the diagnosis of PIDD, and educational programmes to improve PIDD awareness. In total, these collaborations should make it possible to advance the diagnosis and management of PIDD in Latin America. (C) 2010 SEICAP. Published by Elsevier Espana, S.L. All rights reserved.

Electromyographic Evaluation of Neuromuscular Coordination of Subject After Orthodontic Intervention

The aim of this work was to investigate the neuromuscular changes associated with the orthodontic post-treatment using surface electromyography. One hundred (100) young, healthy adults without signs and symptoms of temporomandibular dysfunction (TMD) were divided into two groups: 60 subjects who were undergoing orthodontic intervention (Ortho Group) and 40 subjects who had no orthodontic intervention (Control Group), aged 18-25 years. EMG activity of masseter and temporalis anterior muscle was recorded during two different tests: 1. maximum voluntary clench (MVC) with cotton rolls; and 2. MVC in intercuspal position. In all subjects, both tests were performed with symmetric muscular patterns (more than 85%) and with insignificant latero-deviating of the mandible (lower than 10%). There are no statistically significant differences between the subjects of both groups evaluated. Both groups showed medium index values calculated according to the normal standards established previously.

Identification of protein-coding and intronic noncoding RNAs down-regulated in clear cell renal carcinoma

The clear cell subtype of renal cell carcinoma (RCC) is the most lethal and prevalent cancer of the urinary system. To investigate the molecular changes associated with malignant transformation in clear cell RCC, the gene expression profiles of matched samples of tumor and adjacent non-neoplastic tissue were obtained from six patients. A custom-built cDNA microarray platform was used, comprising 2292 probes that map to exons of genes and 822 probes for noncoding RNAs mapping to intronic regions. Intronic transcription was detected in all normal and neoplastic renal tissues. A subset of 55 transcripts was significantly down-regulated in clear cell RCC relative to the matched nontumor tissue as determined by a combination of two statistical tests and leave-one-out patient cross-validation. Among the down-regulated transcripts, 49 mapped to untranslated or coding exons and 6 were intronic relative to known exons of protein-coding genes. Lower levels of expression of SIN3B, TRIP3, SYNJ2BP and NDE1 (P<0.02), and of intronic transcripts derived from SND1 and ACTN4 loci (P<0.05), were confirmed in clear cell RCC by Real-time RT-PCR. A subset of 25 transcripts was deregulated in additional six nonclear cell RCC samples, pointing to common transcriptional alterations in RCC irrespective of the histological subtype or differentiation state of the tumor. Our results indicate a novel set of tumor suppressor gene candidates, including noncoding intronic RNAs, which may play a significant role in malignant transformations of normal renal cells. (C) 2008 Wiley-Liss, Inc.

Resurrection of Two Species From Synonymy of Anopheles (Nyssorhynchus) strodei Root, and Characterization of a Distinct Morphological Form From the Strodei Complex (Diptera: Culicidae)

Anopheles albertoi Unti and Anopheles arthuri Unti are revived from the synonymy with Anopheles strodei Root, and a distinct morphological form (designated in this study as Anopheles CP Form) from the Strodei Complex of Anopheles (Nyssorhynchus) is characterized. The male genitalia of An. arthuri and An. albertoi are described and illustrated for the first time. An. strodei, An. arthuri, and An. albertoi were first distinguished based on scanning electron microphotos of the eggs, and then each egg type was associated with diagnostic characters of the male genitalia. Identification of Anopheles CP Form was based on morphological characters of the male genitalia, characterized and illustrated in this study. Molecular phylogenetic analysis was most clear when an outgroup was not included, in which case using the nuclear white gene, or the white gene in combination with the mitochondrial cytochrome c oxidase subunit I (COI) gene, clearly separated these four taxa. When Anopheles quadrimaculatus Say and Anopheles stephensi Liston were included as an outgroup, combined white and COI data resolved An. strodei and An. albertoi, whereas An. arthuri was not well resolved. The single sequence of Anopheles CP Form was recovered well separated from other groups in all analyses.

Two new species of Culex subgenus Melanoconion (Diptera: Culicidae) from the Amazon forest

Two new mosquito species (Diptera: Culicidae), Culex (Melanoconion) phyllados n. sp. and Culex (Melanoconion) brachiatus n. sp. from the state of Amazonas, Brazil, are here validated and described based on morphological features of the male genitalia. Both species are morphologically more similar to both Culex coppenamensis Bonne-Wepster & Bonne and Culex alinkios Sallum & Hutchings than to any other species of the Bastagarius Subgroup of the subgenus Melanoconion. Diagnostic characters for the identification of the adult male of both species are provided.

ESTIMATING SENSORY SHELF LIFE OF CHOCOLATE AND CARROT CUPCAKES USING ACCEPTANCE TESTS

This study determined the sensory shelf life of a commercial brand of chocolate and carrot cupcakes, aiming at increasing the current 120 days of shelf life to 180. Appearance, texture, flavor and overall quality of cakes stored at six different storage times were evaluated by 102 consumers. The data were analyzed by analysis of variance and linear regression. For both flavors, the texture presented a greater loss in acceptance during the storage period, showing an acceptance mean close to indifference on the hedonic scale at 120 days. Nevertheless, appearance, flavor and overall quality stayed acceptable up to 150 days. The end of shelf life was estimated at about 161 days for chocolate cakes and 150 days for carrot cakes. This study showed that the current 120 days of shelf life can be extended to 150 days for carrot cake and to 160 days for chocolate cake. However, the 180 days of shelf life desired by the company were not achieved. PRACTICAL APPLICATIONS This research shows the adequacy of using sensory acceptance tests to determine the shelf life of two food products (chocolate and carrot cupcakes). This practical application is useful because the precise determination of the shelf life of a food product is of vital importance for its commercial success. The maximum storage time should always be evaluated in the development or reformulation of new products, changes in packing or storage conditions. Once the physical-chemical and microbiological stability of a product is guaranteed, sensorial changes that could affect consumer acceptance will determine the end of the shelf life of a food product. Thus, the use of sensitive and reliable methods to estimate the sensory shelf life of a product is very important. Findings show the importance of determining the shelf life of each product separately and to avoid using the shelf time estimated for a specific product on other, similar products.

Alternative diagnostic diagrams and the `forgotten` population of weak line galaxies in the SDSS

A numerous population of weak line galaxies (WLGs) is often left out of statistical studies on emission-line galaxies (ELGs) due to the absence of an adequate classification scheme, since classical diagnostic diagrams, such as [O iii]/H beta versus [N ii]/H alpha (the BPT diagram), require the measurement of at least four emission lines. This paper aims to remedy this situation by transposing the usual divisory lines between star-forming (SF) galaxies and active galactic nuclei (AGN) hosts and between Seyferts and LINERs to diagrams that are more economical in terms of line quality requirements. By doing this, we rescue from the classification limbo a substantial number of sources and modify the global census of ELGs. More specifically, (1) we use the Sloan Digital Sky Survey Data Release 7 to constitute a suitable sample of 280 000 ELGs, one-third of which are WLGs. (2) Galaxies with strong emission lines are classified using the widely applied criteria of Kewley et al., Kauffmann et al. and Stasinska et al. to distinguish SF galaxies and AGN hosts and Kewley et al. to distinguish Seyferts from LINERs. (3) We transpose these classification schemes to alternative diagrams keeping [N ii]/H alpha as a horizontal axis, but replacing H beta by a stronger line (H alpha or [O ii]), or substituting the ionization-level sensitive [O iii]/H beta ratio with the equivalent width of H alpha (W(H alpha)). Optimized equations for the transposed divisory lines are provided. (4) We show that nothing significant is lost in the translation, but that the new diagrams allow one to classify up to 50 per cent more ELGs. (5) Introducing WLGs in the census of galaxies in the local Universe increases the proportion of metal-rich SF galaxies and especially LINERs. In the course of this analysis, we were led to make the following points. (i) The Kewley et al. BPT line for galaxy classification is generally ill-used. (ii) Replacing [O iii]/H beta by W(H alpha) in the classification introduces a change in the philosophy of the distinction between LINERs and Seyferts, but not in its results. Because the W(H alpha) versus [N ii]/H alpha diagram can be applied to the largest sample of ELGs without loss of discriminating power between Seyferts and LINERs, we recommend its use in further studies. (iii) The dichotomy between Seyferts and LINERs is washed out by WLGs in the BPT plane, but it subsists in other diagnostic diagrams. This suggests that the right wing in the BPT diagram is indeed populated by at least two classes, tentatively identified with bona fide AGN and `retired` galaxies that have stopped forming stars and are ionized by their old stellar populations.

Two new species of Actinocephalus (Eriocaulaceae) from Minas Gerais, Brazil

We describe and illustrate two new species, Actinocephalus delicatus and A. giuliettiae (Eriocaulaceae, Paepalanthoideae), from the Espinhaco Range in Minas Gerais, Brazil, and compare them with the morphologically most similar species. Diagnostic characters, morphological variation, geographic distribution, habitat and conservation status, as well as line drawings, photos and a distribution map are provided for both species.

Consensus Statement: Chromosomal Microarray Is a First-Tier Clinical Diagnostic Test for Individuals with Developmental Disabilities or Congenital Anomalies

Chromosomal microarray (CMA) is increasingly utilized for genetic testing of individuals with unexplained developmental delay/intellectual disability (DD/ID), autism spectrum disorders (ASD), or multiple congenital anomalies (MCA). Performing CMA and G-banded karyotyping on every patient substantially increases the total cost of genetic testing. The International Standard Cytogenomic Array (ISCA) Consortium held two international workshops and conducted a literature review of 33 studies, including 21,698 patients tested by CMA. We provide an evidence-based summary of clinical cytogenetic testing comparing CMA to G-banded karyotyping with respect to technical advantages and limitations, diagnostic yield for various types of chromosomal aberrations, and issues that affect test interpretation. CMA offers a much higher diagnostic yield (15%-20%) for genetic testing of individuals with unexplained DD/ID, ASD, or MCA than a G-banded karyotype (similar to 3%, excluding Down syndrome and other recognizable chromosomal syndromes), primarily because of its higher sensitivity for submicroscopic deletions and duplications. Truly balanced rearrangements and low-level mosaicism are generally not detectable by arrays, but these are relatively infrequent causes of abnormal phenotypes in this population (<1%). Available evidence strongly supports the use of CMA in place of G-banded karyotyping as the first-tier cytogenetic diagnostic test for patients with DD/ID, ASD, or MCA. G-banded karyotype analysis should be reserved for patients with obvious chromosomal syndromes (e.g., Down syndrome), a family history of chromosomal rearrangement, or a history of multiple miscarriages.

Genetic variation and population structuring in two brooding coral species (Siderastrea stellata and Siderastrea radians) from Brazil

Siderastrea stellata and S. radians are scleractinian coral species that present a remarkable overlap of diagnostic characteristics and sympatric distribution. Moreover, both are viviparous with similar reproductive strategies and with a gregarious larval behavior. Samples of both species from the Brazilian coast were analyzed using 18 isozymic loci to quantify their genetic variability and populational structure. Results confirmed species identity, high intrapopulational variability and revealed moderate genetic structuring among all samples (S. stellata: F(ST) = 0.070; S. radians: F(ST) = 0.092). Based on genotypic diversity analysis, there was evidence that local recruitment may have a minor role in the populations (mean, G(o) :G(e) = 1.00 +/- 0.0003 SD for S. stellata and 0.99 +/- 0.0023 SD for S. radians). Deviations towards heterozygote deficiencies found in both Siderastrea species could be explained by the Wahlund effect, since there was evidence that populations might be composed of colonies of different ages. In S. radians it is also likely that there is some inbreeding occurring in the studied populations. Despite the brooding pattern and the gregarious larval behavior, our data suggest the occurrence of gene flow along the Brazilian coast. This is the first study on population genetics of Brazilian reef corals.

Research on Candida dubliniensis in a Brazilian yeast collection obtained from cardiac transplant, tuberculosis, and HIV-positive patients, and evaluation of phenotypic tests using agar screening methods

The aim of this study was to research Candida dubliniensis among isolates present in a Brazilian yeast collection and to evaluate the main phenotypic methods for discrimination between C. albicans and C. dubliniensis from oral cavity. A total of 200 isolates, presumptively identified as C. albicans or C. dubliniensis obtained from heart transplant patients under immunosuppressive therapy, tuberculosis patients under antibiotic therapy, HIV-positive patients under antiretroviral therapy, and healthy subjects, were analyzed using the following phenotypic tests: formation and structural arrangement of chlamydospores on corn meal agar, casein agar, tobacco agar, and sunflower seed agar; growth at 45 degrees C; and germ tube formation. All strains were analyzed by polymerase chain reaction (PCR). In a preliminary screen for C. dubliniensis, 48 of the 200 isolates on corn meal agar, 30 of the 200 on casein agar, 16 of the 200 on tobacco agar, and 15 of the 200 on sunflower seed agar produced chlamydoconidia; 27 of the 200 isolates showed no or poor growth at 45 degrees C. All isolates were positive for germ tube formation. These isolates were considered suggestive of C. dubliniensis. All of them were subjected to PCR analysis using C. dubliniensis-specific primers. C. dubliniensis isolates were not found. C. dubliniensis isolates were not recovered in this study done with immunocompromised patients. Sunflower seed agar was the medium with the smallest number of isolates of C. albicans suggestive of C. dubliniensis. None of the phenotypic methods was 100% effective for discrimination between C. albicans and C. dubliniensis. (C) 2011 Elsevier Inc. All rights reserved.

Comparison of Two Rotary Systems in Root Canal Preparation Regarding Disinfection

Introduction: The aim of the present study was to determine the disinfection of preparations carried out by using the Protaper or MTwo system in canals infected with Enterococcus faecalis. Methods: Twenty-eight distobuccal canals of upper molars were used, in which the canals were sterilized after being enlarged to #20 file and then contaminated with an inoculation of a culture of E. faecalis. After the incubation period, bacterial samples were collected and were seeded on plates for analysis of colony-forming units (CFU)/mL. The teeth were divided into 2 groups according to the rotary system used for instrumentation; 2 noninstrumented teeth served as the control group. Then bacterial samples were collected and were seeded on plates for analysis of CFU/mL again. The data obtained were evaluated by the Wilcoxon and Mann-Whitney U tests. Results: Bacterial reduction was 81.94% and 84.29%, respectively, in Pro Taper and Mtwo systems, and there was no statistically significant difference (P > .05). Conclusions: Both systems, Pro Taper and Mtwo, reduced the amount of bacteria in the mechanical disinfection of the root canal system, demonstrating that they are suitable for this purpose. (J Endod 2010;36:1238-1240)

Orthodontic brackets removal under shear and tensile bond strength resistance tests - a comparative test between light sources

We have investigated if a new LEDs system has enough efficient energy to promote efficient shear and tensile bonding strength resistance under standardized tests. LEDs 470 +/- 10 nm can be used to photocure composite during bracket fixation. Advantages considering resistance to tensile and shear bonding strength when these systems were used are necessary to justify their clinical use. Forty eight human extracted premolars teeth and two light sources were selected, one halogen lamp and a LEDs system. Brackets for premolar were bonded through composite resin. Samples were submitted to standardized tests. A comparison between used sources under shear bonding strength test, obtained similar results; however, tensile bonding test showed distinct results: a statistical difference at a level of 1% between exposure times (40 and 60 seconds) and even to an interaction between light source and exposure time. The best result was obtained with halogen lamp use by 60 seconds, even during re-bonding; however LEDs system can be used for bonding and re-bonding brackets if power density could be increased.