Fitness to drive and cannabis: Validation of two blood THCCOOH thresholds to distinguish occasional users from heavy smokers.

Many studies based on either an experimental or an epidemiological approach, have shown that the ability to drive is impaired when the driver is under the influence of cannabis. Baseline performances of heavy users remain impaired even after several weeks of abstinence. Symptoms of cannabis abuse and dependence are generally considered incompatible with safe driving. Recently, it has been shown that traffic safety can be increased by reporting the long-term unfit drivers to the driver licensing authorities and referring the cases for further medical assessment. Evaluation of the frequency of cannabis use is a prerequisite for a reliable medical assessment of the fitness to drive. In a previous paper we advocated the use of two thresholds based on 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH) concentration in whole blood to help to distinguish occasional cannabis users (≤3μg/L) from heavy regular smokers (≥40μg/L). These criteria were established on the basis of results obtained in a controlled cannabis smoking study with placebo, carried out with two groups of young male volunteers; the first group was characterized by a heavy use (≥10 joints/month) while the second group was made up of occasional users smoking at most 1 joint/week. However, to date, these cutoffs have not been adequately assessed under real conditions. Their validity can now be evaluated and confirmed with 146 traffic offenders' real cases in which the whole blood cannabinoid concentrations and the frequency of cannabis use are known. The two thresholds were not challenged by the presence of ethanol (40% of cases) and of other therapeutic and illegal drugs (24%). Thus, we propose the following procedure that can be very useful in the Swiss context but also in other countries with similar traffic policies: if the whole blood THCCOOH concentration is higher than 40μg/L, traffic offenders must be directed first and foremost toward medical assessment of their fitness to drive. This evaluation is not recommended if the THCCOOH concentration is lower than 3μg/L and if the self-rated frequency of cannabis use is less than 1 time/week. A THCCOOH level between these two thresholds cannot be reliably interpreted. In such a case, further medical assessment and follow-up of the fitness to drive are also suggested, but with lower priority.

On Lundh's percolation diffusion

A collection of spherical obstacles in the unit ball in Euclidean space is said to be avoidable for Brownian motion if there is a positive probability that Brownian motion diffusing from some point in the ball will avoid all the obstacles and reach the boundary of the ball. The centres of the spherical obstacles are generated according to a Poisson point process while the radius of an obstacle is a deterministic function. If avoidable configurations are generated with positive probability Lundh calls this percolation diffusion. An integral condition for percolation diffusion is derived in terms of the intensity of the point process and the function that determines the radii of the obstacles.

On Lundh's percolation diffusion

A collection of spherical obstacles in the unit ball in Euclidean space is said to be avoidable for Brownian motion if there is a positive probability that Brownian motion diffusing from some point in the ball will avoid all the obstacles and reach the boundary of the ball. The centres of the spherical obstacles are generated according to a Poisson point process while the radius of an obstacle is a deterministic function. If avoidable con gurations are generated with positive probability Lundh calls this percolation di usion. An integral condition for percolation di ffusion is derived in terms of the intensity of the point process and the function that determines the radii of the obstacles.

Briefing 25: NCMP data 2008/9, East of England: Body Mass Index (BMI) thresholds

One in a series of six data briefings based on regional-level analysis of data from the National Child Measurement Programme (NCMP) undertaken by the National Obesity Observatory (NOO). The briefings are intended to complement the headline results for the region published in January 2010, at Quick Link 20510.

Absolute height-specific thresholds to identify elevated blood pressure in children.

OBJECTIVE: : Identification of children with elevated blood pressure (BP) is difficult because of the multiple sex, age, and height-specific thresholds to define elevated BP. We propose a simple set of absolute height-specific BP thresholds and evaluate their performance to identify children with elevated BP in two different populations. METHODS: : Using the 95th sex, age, and relative-height BP US thresholds to define elevated BP in children (standard criteria), we derived a set of (non sex- and non age-specific) absolute height-specific BP thresholds for 11 height categories by 10 cm increments. Using data from large school-based surveys conducted in Switzerland (N = 5207; 2621 boys, 2586 girls; age range: 10.1-14.9 years) and in the Seychelles (N = 25 759; 13 048 boys, 12 711 girls; age range: 4.4-18.8 years), we evaluated the performance of these height-specific thresholds to identify children with elevated BP. We also derived sex-specific absolute height-specific BP thresholds and compared their performance. RESULTS: : In the Swiss and the Seychelles surveys, the prevalence of elevated BP (standard criteria) was 11.4 and 9.1%, respectively. The height-specific thresholds to identify elevated BP had a sensitivity of 80 and 84%, a specificity of 99 and 99%, a positive predictive value of 92 and 91%, and a negative predictive value of 97 and 98%, respectively. Performance of sex-specific absolute height-specific BP thresholds was similar. CONCLUSION: : A simple table of height-specific BP thresholds allowed identifying children with elevated BP with high sensitivity and excellent specificity.

Outage thresholds of LDPC codes over nonergodic block-fading channels

This paper derives approximations allowing the estimation of outage probability for standard irregular LDPC codes and full-diversity Root-LDPC codes used over nonergodic block-fading channels. Two separate approaches are discussed: a numerical approximation, obtained by curve fitting, for both code ensembles, and an analytical approximation for Root-LDPC codes, obtained under the assumption that the slope of the iterative threshold curve of a given code ensemble matches the slope of the outage capacity curve in the high-SNR regime.

Investigations on hydrogen isotope ratios of endogenous urinary steroids: reference-population-based thresholds and proof-of-concept.

Carbon isotope ratio (CIR) analysis has been routinely and successfully used in sports drug testing for many years to uncover the misuse of endogenous steroids. One limitation of the method is the availability of steroid preparations exhibiting CIRs equal to endogenous steroids. To overcome this problem, hydrogen isotope ratios (HIR) of endogenous urinary steroids were investigated as a potential complement; results obtained from a reference population of 67 individuals are presented herein. An established sample preparation method was modified and improved to enable separate measurements of each analyte of interest where possible. From the fraction of glucuronidated steroids; pregnanediol, 16-androstenol, 11-ketoetiocholanolone, androsterone (A), etiocholanolone (E), dehydroepiandrosterone (D), 5α- and 5β-androstanediol, testosterone and epitestosterone were included. In addition, sulfate conjugates of A, E, D, epiandrosterone and 17α- and 17β-androstenediol were considered and analyzed after acidic solvolysis. The obtained results enabled the calculation of the first reference-population-based thresholds for HIR of urinary steroids that can readily be applied to routine doping control samples. Proof-of-concept was accomplished by investigating urine specimens collected after a single oral application of testosterone-undecanoate. The HIR of most testosterone metabolites were found to be significantly influenced by the exogenous steroid beyond the established threshold values. Additionally, one regular doping control sample with an extraordinary testosterone/epitestosterone ratio of 100 without suspicious CIR was subjected to the complementary methodology of HIR analysis. The HIR data eventually provided evidence for the exogenous origin of urinary testosterone metabolites. Despite further investigations on HIR being advisable to corroborate the presented reference-population-based thresholds, the developed method proved to be a new tool supporting modern sports drug testing procedures.

Does introduction of thresholds in decision aids benefit the patient?: Comparison between findings-based and threshold-based diagnostic decision aids.

PURPOSE: To assess how different diagnostic decision aids perform in terms of sensitivity, specificity, and harm. METHODS: Four diagnostic decision aids were compared, as applied to a simulated patient population: a findings-based algorithm following a linear or branched pathway, a serial threshold-based strategy, and a parallel threshold-based strategy. Headache in immune-compromised HIV patients in a developing country was used as an example. Diagnoses included cryptococcal meningitis, cerebral toxoplasmosis, tuberculous meningitis, bacterial meningitis, and malaria. Data were derived from literature and expert opinion. Diagnostic strategies' validity was assessed in terms of sensitivity, specificity, and harm related to mortality and morbidity. Sensitivity analyses and Monte Carlo simulation were performed. RESULTS: The parallel threshold-based approach led to a sensitivity of 92% and a specificity of 65%. Sensitivities of the serial threshold-based approach and the branched and linear algorithms were 47%, 47%, and 74%, respectively, and the specificities were 85%, 95%, and 96%. The parallel threshold-based approach resulted in the least harm, with the serial threshold-based approach, the branched algorithm, and the linear algorithm being associated with 1.56-, 1.44-, and 1.17-times higher harm, respectively. Findings were corroborated by sensitivity and Monte Carlo analyses. CONCLUSION: A threshold-based diagnostic approach is designed to find the optimal trade-off that minimizes expected harm, enhancing sensitivity and lowering specificity when appropriate, as in the given example of a symptom pointing to several life-threatening diseases. Findings-based algorithms, in contrast, solely consider clinical observations. A parallel workup, as opposed to a serial workup, additionally allows for all potential diseases to be reviewed, further reducing false negatives. The parallel threshold-based approach might, however, not be as good in other disease settings.

Water percolation estimated with time domain reflectometry (TDR) in drainage lysimeters

Due to the difficulty of estimating water percolation in unsaturated soils, the purpose of this study was to estimate water percolation based on time-domain reflectometry (TDR). In two drainage lysimeters with different soil textures TDR probes were installed, forming a water monitoring system consisting of different numbers of probes. The soils were saturated and covered with plastic to prevent evaporation. Tests of internal drainage were carried out using a TDR 100 unit with constant dielectric readings (every 15 min). To test the consistency of TDR-estimated percolation levels in comparison with the observed leachate levels in the drainage lysimeters, the combined null hypothesis was tested at 5 % probability. A higher number of probes in the water monitoring system resulted in an approximation of the percolation levels estimated from TDR - based moisture data to the levels measured by lysimeters. The definition of the number of probes required for water monitoring to estimate water percolation by TDR depends on the soil physical properties. For sandy clay soils, three batteries with four probes installed at depths of 0.20, 0.40, 0.60, and 0.80 m, at a distance of 0.20, 0.40 and 0.6 m from the center of lysimeters were sufficient to estimate percolation levels equivalent to the observed. In the sandy loam soils, the observed and predicted percolation levels were not equivalent even when using four batteries with four probes each, at depths of 0.20, 0.40, 0.60, and 0.80 m.

Estimation of water percolation by different methods using TDR

Detailed knowledge on water percolation into the soil in irrigated areas is fundamental for solving problems of drainage, pollution and the recharge of underground aquifers. The aim of this study was to evaluate the percolation estimated by time-domain-reflectometry (TDR) in a drainage lysimeter. We used Darcy's law with K(θ) functions determined by field and laboratory methods and by the change in water storage in the soil profile at 16 points of moisture measurement at different time intervals. A sandy clay soil was saturated and covered with plastic sheet to prevent evaporation and an internal drainage trial in a drainage lysimeter was installed. The relationship between the observed and estimated percolation values was evaluated by linear regression analysis. The results suggest that percolation in the field or laboratory can be estimated based on continuous monitoring with TDR, and at short time intervals, of the variations in soil water storage. The precision and accuracy of this approach are similar to those of the lysimeter and it has advantages over the other evaluated methods, of which the most relevant are the possibility of estimating percolation in short time intervals and exemption from the predetermination of soil hydraulic properties such as water retention and hydraulic conductivity. The estimates obtained by the Darcy-Buckingham equation for percolation levels using function K(θ) predicted by the method of Hillel et al. (1972) provided compatible water percolation estimates with those obtained in the lysimeter at time intervals greater than 1 h. The methods of Libardi et al. (1980), Sisson et al. (1980) and van Genuchten (1980) underestimated water percolation.

Potts fully frustrated model: Thermodynamics, percolation and dynamics in two dimensions

We consider a Potts model diluted by fully frustrated Ising spins. The model corresponds to a fully frustrated Potts model with variables having an integer absolute value and a sign. This model presents precursor phenomena of a glass transition in the high-temperature region. We show that the onset of these phenomena can be related to a thermodynamic transition. Furthermore, this transition can be mapped onto a percolation transition. We numerically study the phase diagram in two dimensions (2D) for this model with frustration and without disorder and we compare it to the phase diagram of (i) the model with frustration and disorder and (ii) the ferromagnetic model. Introducing a parameter that connects the three models, we generalize the exact expression of the ferromagnetic Potts transition temperature in 2D to the other cases. Finally, we estimate the dynamic critical exponents related to the Potts order parameter and to the energy.