Pathophysiology Of Heart Failure

Pathophysiology Of Heart Failure
Heart failure (HF) is defined as a chronic progressive disease in which the cardiac muscle is not able
to pump an adequate amount of blood to fulfill the body's requirement for blood and oxygen.
(American heart association, 2016 sep 28) In the United State of the America, Near to 5.7 million
people are diagnosed with heart failure (Mozzafarian D, Benjamin EJ, Go AS, et al), with overall
estimated heart failure costs exceeding $30 billion each year (Heidenreich PA, Trogdon JG, Khavjou
OA, Butler J, Dracup K, Ezekowitz MD, et al.). In the United States, Heart failure is one of the
leading causes of hospitalization in elderly people. Because of improvement in health care services
such as diagnosis and treatment options, the number of people living ... Show more content on
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The study concluded that BNP had very high negative predictive value at a cut–off value of 100
pg/ml. Subsequently making it appropriate as a rule‐out test for heart failure. The measurement of
BNP level provided high accuracy in diagnosis of heart failure as compared to clinical assessment.(
Maisel A S, Krishnaswamy P, Nowak R M. et al ) In the N‐terminal proBNP Investigation of
Dyspnoea in the Emergency department (PRIDE) study and in the International Collaboration of
NT‐proBNP (ICON) study established the role of NT–proBNP in detecting of heart failure. An NT–
proBNP level < 40% NT–BNP 357 pmol/l 73 82 24 98
... Get more on HelpWriting.net ...

Case Study Of Acute Appendicitis
–
Out of 100 patients studied in this research, the age incidence varies between 12 to 47 years, the
maximum incidence of acute appendicitis was found in age group of 21– 40 years [56 patients
(56%)], followed by age group of ≤20 years [28 patients (28%)] and lastly the age group of 41–60
years [16 patients (16%)]. Regarding to sex, males were more than females [68 males (68%) vs 32
females (32%) with a ratio of 2.13:1 respectively]. Married patients were suffering from acute
appendicitis more than single patients (52% vs 48% respectively). Regarding to job, students were
the maximum job suffering from acute appendicitis (32%) followed by workers (28) then house wife
(20%). Acute appendicitis were more prevalent among ... Show more content on Helpwriting.net ...
This concurs with our results, the incidence of acute appendicitis were more in males than females
(68% vs 32%) with a ratio of 2.13:1. But other investigators, documented different results in which
that male: female ratio was 1: 1.66 [Mardan et al., 2007]. Ultrasonography is an affordable,
noninvasive tool whose results can be obtained more quickly than for C T scans [Incesu et al.,
1997]. Many studies proved that, ultrasound has a high sensitivity ranged from 55% to 98% and
specificity ranged from 50% to 100%, PPV ranged from 80.48% to 97.4, NPV ranged from 19.51%
to 89.19% and accuracy ranged from 70.91% to 81%.. These results emphasize that appositive
ultrasonographic findings for appendicitis is strongly in favor of a diagnosis of acute appendicitis.
However a negative ultrasound findings is not sufficient to rule out the diagnosis and discharge the
patient [Singh et al., 2014; Incesu et al., 1997; Flum et al., 2002; Nasiri et al., 2012]. But in our
study, ultrasound sensitivity= 60%, specificity= 0%, PPV= 70.59%, NPV= 0% and accuracy= 30%,
comparing our results with the previous results reveals that the ultrasound provides less reliable
findings for the diagnosis of acute appendicitis in our study. These variations in reported data may
be due to that, the ultrasound is an operator– dependent technique and the results vary depending on
how is performing

What Is Next Generation Sequencing And Liquid Biopsy?
Next–generation sequencing and liquid biopsy:
Next–generation sequencing (NGS) has lately been adapted to diagnostic prerequisites and a
growing number of diagnostic facilities offer an assortment of NGS–based services. However,
variable NGS–based methodologies ranging from amplicon–based (targeted) NGS, whole exome
(WGS) or whole genome NGS (WES) exist and are suited for different applications. As regards to
tumor diagnostics in molecular pathology amplicon–based NGS predominantly is usually applied
this is due to the facts that
 Most of sequence information produced by WGS and WES cannot be converted into clinical
intervention,
 WGS and WES are not prepared for FFPE based NGS,
 the yield of WGS and WES appears to be too low ... Show more content on Helpwriting.net ...
While, Predictive biomarkers identifies the possible benefit of a particular treatment to a particular
patient, and subsequently are used to make clinical choices. Pharmacodynamic biomarkers measure
the impact of a medication on the disease, whereas diagnostic biomarkers are used to set up the
particular disease present in the patient sample. Yet, the "prognostic" and "predictive" biomarkers
are responsible for patient outcome. (Bentzen et al. 2008) As indicated by a U.S. NIH Consensus
Conference, "a clinical valuable prognostic biomarker must be demonstrated as independent,
significant factor that is easy to determine and interpret and that has therapeutic consequences".
Prognostic biomarker provides data about the patients overall outcome irrespective of the treatment
response (Nicholas et al. 2011).
In contrast, a predictive biomarker provides data about the impact of a therapeutic intervention as it
enables screening of a subset of patients that are receptive to a specific therapy where response is
defined. (Nicholas et al. 2011).
Some biomarkers work as both prognostic and predictive. For instance, patients with breast cancer
that is estrogen receptor (ER) and/or progesterone receptor

Case Mix Based Funding For Patients
(A) Statements:–1
Firstly case mix distributes a fixed state budget based on the type and number of patients treated and
the average of patients treated and the average cost of treating patients as reported by hospitals.
Case mix based funding is used to purchase an agreed services at an agreed patients.
It is based on the average cost of treating patients.
Case mix provides incentive to treat patients for the fewest inputs.
This type of funding helps determine hospital budgets and hospital management allocate resources
within organization.
Case mix influences each hospitals fair share of a fixed state budget.
Case mix allocates funds in way that promotes health funding objectives particular hospital.
Example: ... Show more content on Helpwriting.net ...
WIES (weighted inliers equivalent separation) co payments are in addition to base allocation
determined by the patients DRG and length of stay.
Cost data supplied to director of health is accurate as possible.
Various block funding used to support hospital activity such as incentive schemes, teaching and
research, new technology patient complexity, compensation grants. (B) Statements: – 2
Australian Institute of health and welfare
ARDRG modifications to the preferred option that outperformed their inclusion would not be
consistent with decisions made about other ADRGs across the classification.
It should be noted that, for two of these ADRGs, the vote was very nearly equally divided between
two option For two ADRGs the statistical criteria for splitting were not adequately satisfied in the
preferred option.
In addition,, a modification to the preferred option that out–performed those presented to the DTG
was found after the meeting. In both cases, this involved adding a same day split to the preferred
patient complication and co morbidity level (PCCL) split.
This was consistent with suggestions that were made by DTG members for other ADRGs. In these
cases, further analysis had been circulated after the meeting and the suggested modification accepted
by the members.
(C) Statements: – 3
ICD is vital for the correct coding & interoperation of cause of death information by codes and
statisticians.

Essay On Ultrasound
RESULTS
A total of 194 patients were symptomatic and had screen detected abnormalities. All of the breast
lesions who underwent ultrasound guided diagnostic procedures were sonographically visible and
were classified according to BI–RADS as 3, 4 or 5.
Among 194 patients who underwent needle core biopsy for diagnosis of breast lesions 79 were
reported to be BI–RADS –3, 20 were reported to be BI–RADS –4 and 32 were reported to be BI–
RADS –5 [Table 1]. Out of the 194 patients biopsied, 65 were for screen detected non–palpable
abnormalities and 129 were symptomatic patients.
Table 1: The number of patients in the symptomatic and screen detected cases in each category
Patient category BIRADS3 BIRADS4 BIRADS5
Symptomatic 79 20 32
Screen ... Show more content on Helpwriting.net ...
Among the total of 197 patients with a benign diagnosis 115 patients were recommended surgical
excision based on the radiological and histopathological discordance. Ten patients with non–
diagnostic biopsies were also offered excision.
COMPLICATIONS
There was no core biopsy related infections or pneumothorax in our study
STATISTICAL ANALYSIS
The contingency table analysis (χ2 test) shows that there is a highly statistically significant
association between assessments made on the mammograms and ultrasound of the breast and the
core biopsy results.
Table 3: Histopathological correlation with BIRADS category
PATHOLOGY BI–RADS–3 BI–RADS–4 BI–RADS–5
Cancer 2 12 18
Not cancer 59 3 0
The positive predictive value for BI–RADS–5 is 100%. The negative predictive value for BI–RADS
3 is 97%.HPE–Histopathological examination; BIRADS–Breast imaging reporting and data system.
DISCUSSION
FNAC is preferred over core needle biopsy in developing countries is because of the supposed
reduced cost of the procedure and the relative ease with, which procedure is performed.[2,3,4,5,6,7]
Histological processing is not

A Research Study On Alcohol Abuse
In the proposed study, analyzes of several potential distal and proximal determinants of 8th and 10th
graders' alcohol abuse would be conducted using a nationally representative sample from the
Monitoring the Future study to understand its pathways. It is expected that Bandura's concept of
"reciprocal determinism" related to Social Learning Theory (1978) and Life Course Theory (Elder,
1998) as developmental theory will help explain that victimization (a risk factor) as a direct or
indirect predictor of adolescents' alcohol abuse, as well as interpersonal relationship with family and
peers as a protective factor, which can moderate the predictive effect of victimization on self–
perception, perception towards alcohol, and alcohol abuse. In the proposed path analysis, all
statements related to each path are based on some evidence in the literature. As a result, it is
expected to the proposed path analysis will help evaluate victimization as the direct and indirect
predictor of interpersonal relationship, self–perception, and perception towards alcohol, and alcohol
abuse among adolescents in the United States. On the other hand, it is expected that interpersonal
relationship of adolescents will moderate the effect of victimization. Additionally, it is also expected
that self–perception as moderated by interpersonal relationships, or influenced by victimization, will
mediate the outcome measure, alcohol abuse. Similarly, perception towards alcohol influenced by
victimization or

Ceervical Cancer Case Study
Good Evening Dr. Anttila and Class, Based on Shelby's age, smoking, and medical history, she
should be screened for cervical cancer. Women age 30–65 should have a Pap (Papanicolaous) smear
done every three years or Pap smear in combination with human papillomavirus (HPV) testing every
5 years (American Cancer Society [ACS], 2016). HPV is the leading cause of cervical cancer.
Smoking doubles a woman's risk of developing cervical cancer and it also weakens the body's
immune system to fight the HPV virus (ACS, 2017). Cervical cancer is the 4th most commonly
diagnosed cancer among women worldwide and the 14th in the U.S. (Kessler, 2017). This year the
cervical cancer prevalence was estimated to be 256,078 and incidence was 12,820 in the ... Show
more content on Helpwriting.net ...
The study was done by performing a Pap smear, followed by a visual inspection with acetic acid,
and a colposcopy on all the subjects. Biopsies were done to those who had an abnormal result. A
"histopathological diagnosis was used as gold standard for women for whom biopsies were taken"
(Saleh, 2014). A larger study involving 256,648 women in multiple clinical practices in the U.S.
comparing Pap test alone vs co–testing with HPV and HPV test alone showed that a positive co–test
result has a better sensitivity (98.8%; 4040 of 4090 co–tests) for diagnosing CIN3 than either a
positive HPV only test (94%; 3845 of 4090 HPV only tests) or a positive Pap only test (91.3%; 3734
of 4090 Pap only tests; P<.0001). A high sensitivity means that the test is capable of detecting those
who have the disease. A positive Pap only result had a slightly better specificity (26.3%; 66,145 of
251,715 Pap only tests) for diagnosing CIN3 than a positive HPV only test (25.6%; 64,625 of
252,556 HPV only tests) or a positive co–test (10.9%; 27,578 of 252,558 co–tests; P<.0001) (Blatt,
Kennedy, Luff, Austin, & Rabin, 2015). When performing a test simultaneously like a co–test, the
specificity usually decreases because both tests have to show negative results for the individual to be
considered negative and the sensitivity increases because an individual will be considered positive
when either of the tests show positive. The results of the three tests are very similar. This shows

New Predictive Model For Vaginal Birth After Cesarean
A clear objective of this study has been demonstrated in the paper: To construct a new predictive
model for vaginal birth after cesarean (VBAC), which incorporates the factors that can only be
obtained as the pregnancy progresses and compare the new model with a previous model that only
have variables available at the first prenatal visit. In this study, authors stated that in a previous
model is limited to the variables which are available at the first prenatal visit, and they want to know
whether incorporating pregnant woman's most recent circumstances can refine the predicted
probability of VBAC. Model and Variables: Logistic model has been use in this study. In previous
model, only variables at first prenatal visit have been used. In this study, Grobman et. al developed
the model by adding the variables that can only be obtained as the pregnancy progresses. Cross–
validation method was used to evaluate the predictive power of models. Dataset was equally divided
into two parts. Models were fitted on training set and tested on testing set. Results The significant
factors in the model were presented in table 1. In Fig 1 and 2, calibration curves (empirical
probabilities vs predicted probabilities) were presented. The predicted probabilities are the mid–
points of five equal intervals (0%–20%, 21%–40%, ..., etc). The empirical probabilities were
calculated by average all women in the same interval. The closer to the 45–degree line, the better the
model is. Figure 1

Support Vector Machine ( Svm )
Support Vector Machine (SVM) is primarily a classier method that performs classification tasks by
constructing hyperplanes in a multidimensional space that separates cases of different class labels.
SVM supports both regression and classification tasks and can handle multiple continuous and
categorical variables. For categorical variables a dummy variable is created with case values as
either 0 or 1. Thus, a categorical dependent variable consisting of three levels, say (A, B, C), is
represented by a set of three dummy variables: A:{1 0 0}, B: {0 1 0}, c:{0 0 1} To construct an
optimal hyperplane, SVM employs an iterative training algorithm, which is used to minimize an
error function. According to the form of the error function, SVM models can be classified into four
distinct groups: Classification SVM Type 1 (also known as C–SVM classification) Classification
SVM Type 2 (also known as nu–SVM classification) Regression SVM Type 1 (also known as
epsilon–SVM regression) Regression SVM Type 2 (also known as nu–SVM regression) C. Dataset
The dataset for ECG signals are obtained from MIT–BIH pyhsionet database. There were two
databeses present in the website, one was Normal Sinus Rhythm database(NSR), and other was
sudden cardiac death(SCD) database. In this database it had one hour of each pateints ECG record,
where 30 minutes were prior to cardiac arrest. Every 5 minutes of ECG srignal were used to record
HRV, and thus keeping a window size of 10 minutes, HRV values

Predictive Analytics Has Positive And Negative Impact
1.EXECUTIVE SUMMARY:
"Predictive analytics uses technology to predict the future and influence it." [27] It is predominantly
being used to improve business processes, which is a great opportunity for entrepreneurs to achieve
positive business outcomes [26]. The goal of this white paper is to discuss the impact of predictive
analytics in today's world and the various concerns that come along with it. The paper addresses key
research questions like what are the legal and ethical concerns that rise from predictive analytics?
And where can we use predictive analytics to get positive results? We have tried to analyze the
current market situation in order to answer these questions, focusing on the key areas where
predictive analytics has had positive and negative impact. After intense scrutiny of the facts and
details encountered by us, we have come up with some recommendations and solutions to address
the issues caused by the use of predictive analytics and how their effects can be balanced by
organizations.
2. INTRODUCTION:
"There have always been three types of analytics: descriptive, which reports on the past; predictive,
which uses models based on past data to predict the future; and prescriptive, which uses models to
specify optimal behaviors and actions" [4]. This white paper addresses predictive analytics, which is
the analysis of past and present data in order to predict future risks and opportunities. Although
reactive decision–making has been successful in the past, it

Evaluating Systematic Review
Evaluating a Systematic Review or Meta–Analysis
Overall Relevance:
1. Is the article proposing to answer a specific clinical question or questions? What are the
questions?
This article is looking to determine if it is effective practice for primary care providers to perform
routine screening for skin cancer in their patients. Effectiveness of screening is described as early
detection of melanoma and nonmelanoma skin cancer in order to reduce mortality and morbidity
rates.
2. Is the problem studied one that is common to your practice? If a therapeutic intervention or a
diagnostic test is being studied, is it feasible?
The problem studied is common to practice and it is stated that the incidence of melanoma has
increased rapidly in the United States. This study aims at examining routine skin cancer screenings.
Routine skin cancer screenings by a primary care provider are feasible, particularly if the routine
skin cancer screenings are performed on patients determined to have increased risk factors
associated with developing skin cancer.
3. What outcome(s) was (were) studied? Are the outcomes patient–oriented?
The outcomes studied were the effect of routine screening on patient morbidity and mortality and
effect on quality ... Show more content on Helpwriting.net ...
The inclusion criteria for this study was appropriate to the clinical question because it addressed
obtaining studies that focused of the effectiveness of routine skin cancer screening, as well as
addressing screening patients with risk factors for skin cancer and the effectiveness of detecting skin
cancer early because of routine skin cancer

Advantages Of Predictive Policing
Can Predictive Policing Benefit Society?
According to Times Magazine, "President Donald Trump signed three executive orders that will
intensify the criminalization of communities of color, under the false premise the need to increase
'law and order.'" Racism was bad before Trump, now it has worsened, is there anything else that
could make things worse? In "Police Program Aims to Pinpoint Those Most Likely To Commit
Crimes" by John Eligon and Timothy Williams it states that predictive policing is using math and
police awareness to stop or prevent crimes from happening. "...An experiment taking place in
dozens of police departments across the country, one in which authorities have turned to complex
computer algorithms to try to pinpoint people most likely to be involved in future crimes" (Eligon
and Williams). This means that police use predictive policing as a way to stop crimes from
happening based on data. There are benefits and disadvantages that predictive policing contain.
When looking at the issue of predictive policing, many might argue that predictive policing is
beneficial because it can reduce crime rates and prevent deaths from happening through the use of
social media. However, predictive policing has more disadvantages because of being accused guilty
of whom you associate with and the use of inaccurate data leads to unfair policing.
It may be true that previous crimes have been stopped due to predictive policing, and that predictive
policing has prevented

The Regression Model Of The United States
First of all, I would like to mention that it is more reasonable to compare the models that are based
on the same data, so I tried to use the same variables and the same missing value treatment approach
(excluding decision tree) to all of the models.
All the 3 models showed a performance of nearly the same quality, according to the various lift
charts produced and presented in the further parts of the report.
However, the difference becomes more evident on the % captured response and the most efficient
and useful model turns out to be the logistic regression model.
It is described in a greater detail in part 4 of this report.
This ROC plot indicates that the logistic regression is also efficient in terms of trade–off between ...
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2. Recommended Model – Decision Tree
The recommended decision tree model includes 2 variables : annual income and loans, both of them
are interval variables and represent the original observations. They were chosen for the final model,
because after several trials, they proved to be the key ones in determining the rules within decision
trees.
In terms of missing values, nothing particular had to be done, because decision trees conveniently
handle missing values by default.
As for the splitting criterion, after getting more knowledge about each of the criteria and performing
numerous trials , Gini was chosen, due to its ability to measure the differences between the values of
a frequency distribution.
Presented below is the model assessment graph that represents the misclassification rates at each
number of leaves.
As can be seen from the graph, the model enables to reduce the difference between the training and
actual sets compared to other situations when different settings were used and different variables
included.
Another indicator of this model's usefulness is the lift value graph. The base line represents the
nonexistence of our prediction model, while the intercept of the red line states that with this decision
tree we can identify 3,7% more bad customers than we would have done without it.
The %

Statistics Can Reduce Internet Fraud Essay
Many online auction sites help consumers bid on items they might want to possess. These sites
include eBay, WebStore, ebid, OnlineAuction, OZtion, Overstock, and a whole slew of others.
Currently there is no system to protect consumers from fraudulent sales. When someone bids for an
item, consumers trust both the seller and the online auctioneer to be both honest and ethical when
presenting items for bid. Many of the auction houses, including Sotheby's and Christie's have their
experts examine each piece to prove authenticity. However, it is not all bad news. To help protect
consumers from fraud, Joseph Gastwirth and Wesley Johnson have found that the use of statistics
answers the problem of authenticity. Joseph ... Show more content on Helpwriting.net ...
They gathered all the alleged Henry Moore
item auctioned on eBay during the period of March 2005 through November 2007. It totaled 239
items. After they completed the gathering of the data, they required the help of two independent
evaluators. "The first was Stephen Gabriel, an expert on Moore, and the second was one of the
authors (JLG)." (Gastwirth & Johnson, 2011) They had a third person, Dr. H. Hikawa download
each item. They used digital photos of each of the items. "The files were e–mailed to the first
evaluator, while the second evaluator was given a printed version." (Gastwirth & Johnson, 2011)
Neither assessor was able to talk to the other about any of the art for sale during the study period in
order to ensure the independence of the evaluations. "The results of the study were summarized in
two 2 x 2 tables reporting the matched pairs classification for the two groups of artwork." (Gastwirth
& Johnson, 2011) Figure 1 is a copy of that table.
Prints Evaluator 2 Questionable Genuine Total
Evaluator 1 Questionable 6 10 16 Genuine 1 149 150 Total 7 159 166
Sculptures and Drawings Evaluator 2 Questionable Genuine Total
Evaluator 1 Questionable 59 6 65 Genuine 2 6 8 Total 61 12 73
The second part is their specificity, which is in some ways the reverse – that they know a genuine
article when they see one. These are far from being the same thing. An evaluator

Predictive Accuracy And Modelling For Explanatory Power Essay
Through using R, we have created a set of models that help to predict the likelihood of a customer
churning. By working together in the analysis stage we were able to 'bounce' ideas off one another
and grasp a further understanding of the data and customer churn. We created two different models:
modelling for predictive accuracy and modelling for explanatory power. What is our team structure?
In the group we have four team members that consists of three males and one female; Ryan
Campion, Samuel O'Connell, Hunter Stewart, and myself, Hannah Lowe. We've all worked really
well together. Everyone has contributed and we have managed to meet the allocated times set to
doing this assignment. There has been no group issues, or any person putting in any less effort than
the other. In the analysis stage we tackled it as a group: we didn't work as individuals. We worked on
one computer and used the lab work we had done prior to aid us with our models. The reason for
this is that we were confused slightly as how to read the models from the start; by discussing it with
one another we were able to grasp a better concept of what we were looking for. In the reporting
stage we all worked independently, within our own time frame. There was a discussion on the
findings from the data, which is in our reports, but in our own words. The presentation was worked
on collectively. I organised the parts that were to be discussed, these areas were the distributed to
other members. We all wrote

Classi Cation Performance Evaluation Report
To evaluate our systems classi cation performance, i.e. the proportion of correctly classi ed tweets
for a given test set, we used four common information retrieval (IR) evaluation measures, including
recall (R), Precision (P), F1 Score, and Accuracy [73]. To explain these evaluation measures, we use
a confusion matrix depicted in gure 5.1. 1 Classified Positive Classified Negative Actual Positive
TP FN Actual Negative FP TN Figure 5.1: Confusion Matrix Where, TP (True Positive) ) Number of
correct classi cations of the positive samples FN (False Negative) ) Number of incorrect
classi cations of positive samples FP (False Positive) ) Number of incorrect classi cations of
negative samples TN (True Negative) ) Number of correct classi cations ... Show more content on
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In another way, it is the number of positive predictions divided by the total number of positive class
values predicted. It is also called the Positive Predictive Value (PPV). Precision can be thought of as
a measure of a classi ers exactness. A low precision can also indicate a large number of False
Positives. Precision, P = TP TP + FP Recall: Recall is the number of True Positives divided by the
number of True Positives and the number of False Negatives. In another way it is the number of
positive 48 5.3 Results with Supervised Feature Selection predictions divided by the number of
positive class values in the test data. It is also called Sensitivity or the True Positive Rate. Recall can
be thought of as a measure of a classi ers completeness. A low recall indicates many False
Negatives. Recall, R = TP TP + FN F1 Score: The F1 score, also called the F Score or the F
Measure, conveys the balance between the precision and the recall. The traditional F1 score (F–
measure or balanced F–score) is the harmonic mean of precision and recall: F1 Score, = 2 P R
P + R Accuracy: The accuracy is the proportion of true results (both true positives and true
negatives) among the total number of cases examined. Accuracy simply

Abstract. Objectives: To Highlight The Importance Of Cord
Abstract
Objectives: To highlight the importance of cord blood S100B protein in neonatal hypoxic–ischemic
encephalopathy (HIE)
Subjects and Methods: This study included 60 asphyxiated newborns and 40 matched controls.
Blood samples were collected from all neonates and values of S100B protein were determined using
enzyme–linked immunosorbent assay (ELISA) technique. Results: The mean serum level of S100B
protein was significantly higher in asphyxiated group than the control group with a significant
correlation between increased S100B protein level and severity of HIE among patients. We found
that at the cutoff level of serum S100B protein 0.44µg/l, sensitivity 97%, specificity91%, an
accuracy of predicting neonatal asphyxia 94% with ... Show more content on Helpwriting.net ...
In 1976 Sarnat and Sarnat carried out a score, the Sarnat score, which was a combination of
neurological symptoms as described above and the accompanying electro–encephalographic (EEG)
features. This score was, in fact, a grading of the severity of the encephalopathy. It contains three
stages, hypoxic–ischemic encephalopathy (HIE) stage 1, HIE stage 2 and HIE stage 3, the latest the
most severe stage of encephalopathy. The most severely affected infants typically progress from
stage 1 to 3 [7,8]. The S100B protein is produced and released primarily by astrocytes in the CNS
where it has trophic functions on neurons and the glia. Many molecules are asigned a role as
markers of neurological injury in cases of HIE. Glutamate, aspartate, lactate, ammonia, creatinine,
specific kinase, NSE (neuron specific enolase) and other substances have been studied in serum,
umbilical cord blood, amniotic fluid and cerebrospinal fluid (CSF) [9]. Previous studies that
measured the concentration of S100B in the CSF and blood have shown a direct relationship with
brain injury [10]. The aim of this study was to highlight the importance of cord blood S100B protein
in the diagnosis of neonatal HIE and determination of its severity.
Patients and Methods
This cross–sectional study is conducted on 60 asphyxiated full–term neonates delivered in El
Shohadaa Central Hospital and Shebeen El Kom teaching Hospital in the period

Statistics for Bi
Statistics for Business Intelligence – Hypothesis Testing
Index:
1. What is Hypothesis testing in Business Intelligence terms? 2. Define – Statistical Hypothesis
Testing – Inferences in Business – and Predictive Analysis 3. Importance of Hypothesis Testing
in Business with Examples 4. Statistical Methods to perform Hypothesis Testing in Business
Intelligence 5. Identify Statistical variables required to compute Hypothesis testing. a. Correlate
computing those variables from the data available in normalized tables arranged in row x columns.
6. Computing Statistical Hypothesis Testing for Business Decisions using Algorithms 7. User
Interface Development for Presentation of Hypothesis feature ... Show more content on
Helpwriting.net ...
Predictive analysis considers previous data and predicts future data points, but predictive analysis
fails to consider new variables to practice and judge results. In this case, hypothesis helps to analyze
old data to set benchmark and set goal to achieve the new variable modified.
Hypothesis helps in making decision by comparing benchmark values and present results with the
variables applied. If Hypothesis is used to predict the future results this will be more about decision
to conclude whether to implement/accept or reject. Again, Hypothesis also use all statistical modals
of data, outliers removal, mean of sample, mean of population and proportions.
4. Statistical methods to perform Hypothesis Testing in Business Intelligence –
Steps in Hypothesis Testing –
Step 1: Take a decision item of proposed or implemented
Step 2: Formulate testable hypothesis (In case of implemented decision hypothesis will be to judge
whether the modified variable has shown positive results or not)
Step 3: Design the experiment
Step 4: Set up a Decision Rule
Step 5: Collect Data
Step 6: Make a Decision
Step 7: Revise your decisions towards success or profits.
Hypothesis Formulation:

We formulate a pair of mutually exclusive, collectively exhaustive statements about the business
scenario.
One statement or other must be true, but they cannot both be true.
Ho = Null Hypothesis
H1 = Alternative Hypothesis
The two statements are hypothesis

Predictive Analytics : The Use Of Data Science For...
Essay Introduction To compete effectively in an era in which advantages are ephemeral, companies
need to move beyond historical, rear–view understandings of business performance and customer
behavior and become more proactive(tableau). Predictive Analytics is the use of data science for
audience profiling. Generic audience profiling involves determining specific characteristics of your
target audience and creating specific personas to represent each type of person within your target
audience. Predictive analytics is essentially the same process, but from a data perspective (koozai).
Predictive analytics can be used in wide areas in the industry, it's importance is not constrained to a
particular domain and ranges from marketing, telecommunication, retail, banking, etc. For example,
the telecommunication industry has noticed a high customer churn since the switching costs are slim
to none. So telecommunication companies operating in this industry are looking for new ways to
differentiate themselves from competitors in order to retain customers. By using predictive analytics
as a solution to this problem, they would be able to understand the customer needs, requirements
and retain them also allowing them to acquire new ones more effectively. With predictive analytics,
companies can predict trends, understand customers, improve business, drive strategic decision
making and predict behavior. A company named Cox Communications, the third largest cable
entertainment and broadband

Soft Tissue Sarcomas: A Case Study
Discussion: The objective of our study was to assess the accuracy of MRI and image guided CNB in
diagnosing the soft tissue sarcomas. Two important steps in diagnosis of soft tissue sarcomas are the
pre biopsy imaging and the biopsy. MRI has been considered the preferred imaging modality by
most of the authors. However the Sensitivity and specificity of MRI has been reported to vary from
70% –100% and 17–89% respectively (Moulton et al 1995, Ma et al 1995) . There are also articles
on limitations of MRI as a diagnostic tool (Peer S et al, Daniel et al, Devita et al ) . The sensitivity
and specificity of MRI depends on methodology (radiological parameters included) . In our study
98/100 patients had MRI as initial imaging investigation. ... Show more content on Helpwriting.net
...
Based on the above mentioned referenced and WHO guidelines all patients in our centre underwent
image guided biopsy In our study 98/100 patients underwent image–guided biopsy , and as per the
WHO guidelines the biopsy tract was chosen by the operating surgeon , and the quality of biopsy
was assessed by both MSK radiologist and pathologist. The diagnostic yield in our study was 98%,
this was comparable to diagnostic yield of an open biopsy. This yield was higher when compared to
results of other studies like Siegfried peer et al (94.6%), Adam SC et al 2010(91%), Yang et al
(89%), Taieb et al (89%), Narvani et al(94.8%) , and Demarchi et al (94.8%). Most commonly
reported cause of non diagnostic yield was myxoid/cystic lesions. In our study 2/98 patients had non
diagnostic yield of which one was a cystic lesion seated deep inside the chest wall and the other was
a intra articular lesion 3 cms . The sensitivity and specificity of CNB in our study was 94 % and
89% respectively , these

Pros And Cons Of False Positive Drug Test Background
Ana Patricia Morales
Dr. Beverly Joy
Finite Math
October 2, 2017
False Positive Drug Test Background
The random test is a drug test conducted upon a computer–generated random sampling of
Department employees, administered for the purposes of detecting the presence of drugs, controlled
substances (including anabolic steroids) or their metabolites. (Florida Department of State)
What are employees' rights in regard to random drug testing?
If an employee receives a false positive drug test, employee has different rights depending on the
policy of the organization or company and the federal laws that protect the rights of employees.
For instance at the University of Miami, if an individual test positive, the individual's sample will be
re–tested using appropriate laboratory procedures to confirm the results. If the positive results are
not confirmed in the second test, the test will be considered negative. (University of Miami
Personnel Policies Procedures Manual)
In the state of Florida, an employer is required to use a certified medical review officer (MRO)
(include name and address, telephone number in your policy). The MRO will be responsible for:
Interpreting the drug test results, Contacting the employee if the drug test is positive. The MRO is
required to contact the donor who has a confirmed positive test result before reporting the results of
the test to the employer. If the donor has a plausible explanation for the test result showing

Fluid Responsiveness Study
Introduction Prediction of fluid responsiveness has been investigated to prevent fluid overload
because excessive peri–operative fluid administration can be a contributory factor to postoperative
complications, prolonged length of hospital stay, organ failure and mortality1–4. Mini–fluid
challenge is a strategy to assess fluid responsiveness based on a fractional change in stroke volume
(SVfc) after a small loading dose of fluid. Theoretically, at a steep portion of the Frank–Starling
curve, SVfc after fluid loading would be greater than at a plateau portion. Therefore, greater SVfc
after small fluid loading could indicate positive fluid responsiveness. Several studies have shown
that a mini–fluid challenge could predict fluid responsiveness ... Show more content on
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The administration of a small amount of fluid is thought to have minimum adverse effects in even
non–responders. Muller et al reported that a rapid administration of 100 mL fluid induced a greater
than 10% increase of subaortic VTI by Doppler echocardiography, which subsequently predicted a
15% increase in VTI after a 500 mL of fluid administration in mechanically ventilated and sedated
ICU patients with acute circulatory failure5. Guinot et al demonstrated a greater than 7% SVfc
measured by thoracic impedance cardiography after 100 mL of fluid administration was a good
predictor of a subsequent increase in SVfc in response to a 500 mL fluid loading in spontaneously
breathing patients under spinal anaesthesia6. Therefore, the mini–fluid challenge can be a clinically
useful diagnostic method to predict fluid responsiveness in either mechanically or spontaneously
ventilated patients. The present study also showed the relatively high (r = 0.77) correlation
coefficient between SVfc3 and SVfc10, suggesting that the greater the increase in SVfc3, the better
the fluid responsiveness. SVfc3 greater than 5.8% measured by transthoracic echocardiography also
predicted fluid responsiveness in mechanically ventilated anaesthetised dogs. All these results
support the ability of the mini–fluid challenge to predict fluid responsiveness based on SVfc.
However, the assessment of SVfc is challenging in routine practice because it requires special and
expensive equipment. Therefore, an alternative simple method to assess SVfc would be

Linear Regression Model Based On Recursive Feature...
last and the first 10 seconds of elbow flexion and extension task. And the number of
flexion/extension was also counted as the 31st feature. More detailed description of the features and
their calculations are provided in Figure 3 and Table 1.
We compared features between two groups, non–frail and frail, categorized by TSFI (frail was
identified when TSFI is over 0.27). One–way ANOVA was employed for comparing two groups.
And the features which have significantly difference (p 0.05) between groups were preselected for
designing a model in order to select optimum parameters.
Optimum Feature Selection Based on Recursive Feature Elimination
Algorithm for optimum selection of parameters was based on linear regression modeling including
... Show more content on Helpwriting.net ...
4) Then, the accuracy of the redesigned model was calculated to identify frailty. 5) And, this
procedure was repeated when the last feature is removed for redesigning the model. 6) All accuracy
values were compared. 7) If an accuracy value related to a feature excluded for modeling is the
lowest, the feature was eliminated. 8) After that, the same procedure was repeated without the
eliminated feature by 1) to 7) until only one feature remained after eliminating features. 9) Finally,
the number of features were selected based on the performance of the model evaluated by the
recursive feature elimination for selecting the best model to identify frailty.
Evaluation of algorithm performance
Performance of the algorithm was evaluated using the validation set. We calculated the sensitivity,
specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy as
follows:
Sensitivity (1)
Specificity (2)
Positive predictive value (3)
Negative predictive value (4)
Accuracy (5)
where true positive (TP) represents the number of correctly identified frail, false negative (FN)
indicates the number of missed frail, true negative (TN) refers to the number of correctly identified
nonfrail and false positive (FP) stands for the number incorrectly identified as nonfrail. The area
under the ROC curve (AUC) was also calculated as an additional evaluation of the performance. In
this

The Choices Among Model Assessment Statistics
Compare and contrast the choices amongst model assessment statistics
There are two factors that determine the appropriate validation assessment rating or assessment
statistics. Firstly the target measurement scale and secondly the prediction type. For a binary target
with a primary outcome(target=1) and secondary outcome(target=0) there are three types of
prediction types a.) decisions b.) ranking and c.) estimates. When the prediction type is decision for
a binary target, it works to match the primary decision with the primary outcome yielding a correct
decision called as true positive and matches the secondary decision with the secondary outcome
yielding a correct decision called as true negative. In this case the decision predictions are rated by
their accuracy in other words in order to maximize accuracy there should be agreement between the
outcome and prediction. Also, when the secondary decision mismatches with the primary outcome it
yields an incorrect decision called as false negative. Similarly, when primary decision mismatches
with secondary outcome it yields an incorrect decision called as false positive. In this case the
decision predictions can be rated by their misclassification rate wherein to minimize
misclassification there should be very less disagreement between the actual outcome and
predictions. In ranking predictions, the cases are ranked based on their likelihood of being a primary
or secondary outcome. When the primary and secondary cases are

Using The Method Of S2
Method
The method of S2 was to conduct a nested–case–control study. Utilizing a national database of civil
registration numbers, through which all databases were linked and a university prescription
database. The inclusion criteria were to have a prescription history of Met or = two years before
the diagnosis of PCa (index date). For every case in the study 10 controls were selected and those
controls were born the same year, alive, and resided in the same area two years before the index
date of the case.
Results
S2 identified 12,226 cases of PCa and selected 10 controls per case for a total of 12,260 controls.
Met users were found to have a reduced risk of PCa when compared to never users of Met (adjusted
OR [aOR]: 0.84; 95% CI, ... Show more content on Helpwriting.net ...
The study was publishes in 2015. This study determined the optimum prostate–specific antigen
(PSA) value coupled with free PSA% (FPSA%) to reduce the number of unnecessary biopsies
performed on benign prostate disease while identifying significant tumors of prostate cancer (PCa).
The study involved 2,225 Caucasian patients who experienced biopsies between the years of 1995
and 2012 and were in the Biobank. The patients were stratified into four age groups: or = 49 years,
50–60 years, 60–69 years, and or = 70 years. To determine the new PSA cutoff values, scenarios
were simulated with sensitivity and specificity calculated for all PSA cutoff values from 1.25 ng/ml
to 6 ng/ml in increments of 0.5 ng/ml and FPSA% values of 15%, 18%, and 20% were compared
and contrasted for all groups. Sensitivity was determined to be 88% in all groups, this value was
utilized as the lower limit for the new cutoff values and among that group of or = 88% those with
the highest specificity and sensitivity were utilized as the new PSA cutoff values. Statistical analysis
was calculated for the new cutoffs, including a 95% confidence interval. The receiver operating
characteristic curves with stratified FPSA% values of or = 18% vs. 18% and or = 21% vs.
21% were noted. The proposed new cutoffs for PSA, the FPSA% and the reduced number of
biopsies

Comparative Value Of Real Time And Conventional Pcr
Comparative Value of Real Time and Conventional PCR in Antenatal Gender Determination
Naglaa Ibrahim Azab1, *, Rabab Fawzi Salim1, Mohamed A. Hadi Farag2
1 Department of Medical Biochemistry, Faculty of Medicine, Benha University, Benha – Egypt.
2 Department of Gynecology and Obstetrics, Faculty of Medicine, Benha University, Benha –
Egypt.
*Corresponding author naglaa1270@yahoo.com, naglaa.azab@fmed.bu.edu.eg
ABSTRACT
Invasive procedures including chorionic villus sampling and amniocentesis in sex–linked diseases
increase the risk of fetal loss. Therefore, Noninvasive fetal gender determination using cell–free
fetal DNA (cffDNA) in maternal plasma may be promising. Fifty pregnant women with gestational
age between sixth to tenth weeks were included. cffDNA were extracted from maternal plasma and
amplified by real time PCR and conventional PCR for detection of SRY, DYS14 and DAZ genes as
specific genetic markers for male–bearing pregnancies. In general, sensitivity and specificity of real
time PCR was better than conventional PCR. However, sensitivity of DYS14 gene and specificity of
SRY gene by real time PCR was equal to those of conventional PCR. Sensitivity of DYS14 gene
was the highest and sensitivity of SRY gene was the lowest. However, combination of the three Y–
chromosome sequences in the diagnosis increased the test accuracy, which is suitable for clinical
application.
Keywords: Fetal gender determination, cell free fetal DNA, SRY gene, DYS14 gene, DAZ gene,

Social Cost Of Cancer
Cancer is the second leading cause of death in the United States, exceeded only by heart disease. In
2011, more than 575,000 people died of cancer, and more than 1.5 million people had a diagnosis of
cancer. Millions more have been affected by cancer directly post diagnosis or indirectly by taking
care of a loved one that had been diagnosed with cancer. The actual cost of such a disease extends
well beyond the number of lives lost and new diagnoses each year. Cancer survivors, as well as their
family members, friends, and caregivers, may face physical, emotional, social, and spiritual
challenges as a result of their cancer diagnosis and treatment. The financial costs of cancer also are
overwhelming. According to the National Institutes of Health,

Rma Care Case Study
Introduction Based on the data 22,000 women are diagnosed with ovarian cancer every year .If
diagnosed early the 5 year survival rate is said to be 93% .Here we do an analysis to find out the best
optimal path of care for a person , from the insurance company's perspective. Decision Maker –
Insurance Company Attributes – Cost From the given data and the decision tree we have inferred the
various costs that the insurance company would have to pay for under different circumstances. If the
Patient goes for :– a) RMI test =$ 0 b) OVA 1 test =$650 c) Surgery by a OB/GYN(Benign)=$
28,750 d) Surgery by an Oncologist(Benign)=$ 31,500 e) Surgery by an Oncologist(Malignant)=$
44,500$ For the different options available we found that the following costs are relevant. From the
perspective of Insurance Company lowest cost is assigned Utility 1 (0$) and Highest Cost is
assigned Utility 0 ... Show more content on Helpwriting.net ...
The more the insurance company pays for the treatment of a malignant tumor, higher the utility. The
utilities were calculated as follows:– u(OB/GYN –Malignant)=1 and u(Do–Nothing– Malignant)=0
For Ex :Our choice was uncertain between A: when the insurance company pay's when patient goes
to an oncologist and the tumor is benign . B : 70% chance of paying for a patient who goes to an
oncologist and the tumor is malignant and 30% chance of not paying and the tumor is malignant
U(ONC–Benign)= 0.7 * u(OB/GYN –Malignant)+0.3 * u(Do–Nothing– Malignant) U(ONC–
Benign)=0.7*(1)+0.3*(0) =0.7 Similarly we came up with the other values. The corresponding
values are as follows. Reputation Utility Do–Nothing– Malignant 0 Do–nothing– Benign 0.2 ONC–
Malignant 0.8 ONC–Benign 0.7 OB/GYN –Malignant 1 OB/GYN –Benign 0.4 [Table 2]
Alternative Policy

Characteristics And Differences Of People Behaviors
The claim being tested the individual differences in some specific personality characteristics and
differences in people behaviors. The participants in study one were one hundred and sixteen
students. Fifty five were men and sixty one women. The students received a course credit for
participating in the study. The final sample included forty men and forty eight men. The independent
variable of the study male and females. The dependent variables is questionnaire, scales, tissues and
hot sauce. The researchers provided packet of in random order. The measures consisted of global
self–esteem and forty item personality inventory. Additional measures of self–esteem that
researchers hypnotized would be predictive aggression. Social inclusion used two scales one was
nine items and other was ten item. Interpersonal support evaluation list to measure social inclusion.
This measure was reverse scored. The researchers measured components of competitive within
group self–esteem questionnaire. The questionnaire consisted of participants to rate themselves
relative to other college same age and sex. The ratings were on a ten point scale that ranged five
percent relative to same sex peer. The last measure was a twelve item that measured attractiveness to
potential mates. The survey included items such as members of opposite sex seem to like me. The
second measure was reverse scored. Then the participants were tested in groups of three to five
people at a time. The participants were

Predictive Validation Paper
While it can be difficult to find that there are processes, procedures, and business decisions in place
that may not be working as intended, for leaders, analytics are unavoidable as the insights gained
add value and drive leaders to make better evidence–based people decisions (Hirsch, Sachs
Toryfter, 2015). Analytics are used in various business practices including the validation of pre–
employment assessments. Validation is one of the most essential aspects of any legitimate pre–
employment assessment program. Predictive validity is established when the scores from a
measurement procedure generate accurate predictions about the construct it has been designed to
measure. (e.g., intelligence, achievement, burnout, etc.). In a predictive validation ... Show more
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Consider for example a university that is looking to hire 20 faculty members to fill positions within
its math and science department from an applicant pool of 125. An assessment is given to identify
the most qualified applicants. An optimal study design would use and test predictive validity
simultaneously placing the 20 applicants with the best scores in the vacant positions. After 6
months, the hires work performance would be assessed. From there the assessment and work
performances (criterion) can be correlated. The result is high reliability and high content validity.
Chances for adverse impact are also greatly reduced. This approach also provides verification of
job–relatedness of the assessment. It is also difficult for applicants to fake job proficiency which
ensures a more positive correlation in the relationship between test scores and job performance. The
validation of assessments aid managers in gaining an understanding of the market and formulating
employer branding. Assessment validation is also the key driver in objectively quantifying test
results. Through the use of predictive validation managers are able to confirm that the items
included in an assessment accurately represent the constructs being analyzed and that appraisal
based on logic and

Bipolar Disorder II ( Bpd II )
Bipolar Disorder II (BPD–II) is a relatively new disorder, first appearing in the Diagnostic and
Statistical Manual of Mental Disorders, 4th Edition (DSM–IV) as a separate condition to Bipolar
Disorder I (BPD–I), which until then was deemed as being a personality style (Parker, 2015). BPD–
II is more often than not described as being the lite version of BPD–I (Phelps, 2012) thought to
have much less incapacitating effects on the individual however; its disease burden is comparable to
that of BPD–I, if not worse (Merikangas Lamers, 2011) Of all non–communicable diseases,
Bipolar Disorder (BPD) is ranked in the top ten most debilitating with BPD–II prevalence ranging
from 0.4% (World Health Organisation, 2008) to 1.2% (Bauer Pfennig, 2005). Its suicide rates are
amongst the highest of all mental disorders with the Rihmer Pestality (1999) study indicating that
suicide risk may be greater in BPD–II when compared to BP–I and Unipolar Depression (UPD)
(12%), are more likely to use more lethal means and have greater numbers of completed suicides. As
per DSM–5 (American Psychiatric Association (APA), 2013) criteria, the two key BPD–II
symptoms are episodes of recurrent depression and an episode/s of hypomania whereby some
individuals rapid cycling between hypomanic and depressive states in short periods of time,
significantly impacting work, family and social environments. Diagnosing BPD–II is of great sleuth
work on the clinician's part as hypomanic symptoms are not easily

Accounting Information and Predicting Financial Performance
Accounting Information and Predicting Financial Performance:
Accounting information can be useful in order to help predict future performance in the short and
long term. It is important to note however that accounting information including accounting ratios
show a company's performance at a period in time. It is historical data. Trends can be identified by
comparing data in sequential periods and future forecasts can be determined using historical data.
There is no evidence or proof however, that these patterns will predict the future at a level of
complete certainty. In my opinion, it would be hard to argue that decreasing profits over an extended
period of time, or deteriorating liquid assets and increasing long term debt will have a ... Show more
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The coverage ratios use cash flow from operations in most cases. Coverage ratios are important to
long term investors and creditors because of the nature of the ratios that show the availability of
cash to pay for items that include long term debts and dividends as well calculating percentages of
cash flow from operations to shareholders equity, and average number of common shares
outstanding (Ibarra, 2009). In addition, it has been determined that the cash flow to total debt (a
coverage ratio) can be used as one of the best indicators of financial distress (Jooste, 2007). In all
coverage ratios, a high ratio and increasing trends is the best case scenario.
Regression analysis seems to be extremely useful in determining financial distress and the
bankruptcy of firms. In fact, in a particular study conducted by Bredart in 2014, it was presented that
regression analysis was able to show an 84% prediction accuracy rate in determining bankruptcy of
870 firms between the years of 2000 and 2012 (Bredart, 2014). The independent variables used in
Bredart study included profitability (net income/total assets), liquidity (current assets/current
liabilities), and solvency (equity/total assets) while the dependent variable included financial
distress.
Although cumulative research seems

Statistical Analysis On Pre-Eclampsia
Statistical analysis Statistical analysis was carried out using the software program Anova one–way
unstacked. Quantitative data were presented as mean and standard deviation. Pearson correlation for
measuring covariance of two variables divided by the product of their standard deviations measures
the strength of a linear association between two variables and is denoted by r. The Receiver Operator
Characteristic (ROC) curve was used for prediction of pre–eclampsia using sensitivity, specificity,
accuracy and the predictive values (positive and negative). Sensitivity: probability that the test
results will be positive when the disease is present (true positive rate, expressed as a percentage);
Specificity: Probability that the test results will be negative when the disease is present (true
negative rate, expressed as a percentage); Positive Predictive value (PPV: probability that the
disease is present when the test is positive); Negative Predictive value (NPV: probability that the
disease is present when the test is negative) and accuracy is the ratio of the true positive and true
negative on all patients. Result was considered significant at a P value of 400ml/24hrs). Oliguria
was found in 25% of severe preeclampsia cases as shown in Table (1). ... Show more content on
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This indicating increased intensity of proteinuria with the severity of disease (Table 3). Prediction of
preeclampsia was done on the basis of serum LCN2 using calculation of ROC curve and area under
ROC curve. Sensitivity and specificity of serum Lipocalin2 using a cut off value of 480 pg/ml, for
the diagnosis of preeclampsia was found to be 100% and 100% respectively, using 95% confidence
interval. The positive predictive value was 100%, negative predictive value was 100%, area under
curve (AUC) was 1.0 and accuracy index was 100 % (Tables 4, 5 and Fig.

Hypothetical Screening
Think of hypothetical screening programs for diseases of interest to you; find one example of a
disease where high sensitivity would be more important, and one example where high specificity
would be more important. Screening programs utilize diagnostic tests on individuals who are
asymptomatic of certain diseases and the intent of diagnostic tests are used to establish the
probability of having a certain disease (New York State, Department of Health (n.d.). As a provider,
the fundamental intention of screenings is to reduce morbidity and mortality; however, providers
must also understand the potential affect on individuals if results reveal false–positives and false–
negatives (Gates, 2001). Therefore, diagnostic accuracy is critical and making sure quality of
screenings is important in that the tests are sensitive enough to detect disease during the period in
individual who do not have symptoms of a particular disease and specific enough to lessen the
incidence of false positives (Gates, 2014). Screening the female population with Pap (Papanicolaou)
smears for cervical cancer is considered a sensitive test (Lalkhen McCluskey, 2008). ... Show
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Therefore, it is the period of time between early diagnosis with screening and the time in which
diagnosis would have been made without screening (Gates, 2001). Thus, lead time is an important
factor when evaluating the effectiveness of screening programs. According to Gates (2001),
advancing the time of diagnosis solely does not validate screenings because those diagnosed early
are not living longer per se compared to those individuals that are not screened. Therefore, the best
way to avoid lead–time bias is to compare actual mortality rates in the screened and unscreened
populations through randomized trials (Gates, 2001; Gordis,

Symptoms And Treatment Of Pediatric Patients
Hyperlactatemia is a prevalent condition in ICU patients and it occur because of the disturbance
between oxygen supply and oxygen consumption, hyperlactatemia also occurs as a result of
increased aerobic glycolysis in hypermetabolic conditions [1]. Multiple organ dysfunctions that
occurs postoperatively, following trauma, and in septic shock are often associated with increased
lactate levels [2], and it has been found that hyperlactatemia is associated with bad prognosis [3].
The PRISM III score was calculated to evaluate the disease severity in the first 24 hours after
hospital admission, it uses age–related physiological variables estimated during the first day after
admission, including: temperature, systolic blood pressure, heart rate, pupillary reflexes, mental
status, acidosis, pCO2, pO2, glucose, potassium, creatinine concentration, blood urea, white blood
cell count, platelet count, prothrombin and partial thromboplastin time [4]. Early detection of
children who are at high risk for mortality gives chance for early changes in therapy and improves
the prognosis. Although improvement in critical care in pediatric patients in the last several decades,
there is no consistent marker for predicting mortality in the critically ill children [5]. A single
elevated serum lactate measurement at the beginning of emergency department care in pediatric
sepsis is associated with a 5–fold increase in the risk of organ dysfunction, but no previous studies
have investigated the

Acute Appendicitis Case Study
Out of 100 patients studied in this research, the age incidence varies between 12 to 47 years, the
maximum incidence of acute appendicitis was found in age group of 21– 40 years [56 patients
(56%)], followed by age group of ≤20 years [28 patients (28%)] and lastly the age group of 41–60
years [16 patients (16%)]. Regarding to sex, males were more than females [68 males (68%) vs 32
females (32%) with a ratio of 2.13:1 respectively]. Married patients were suffering from acute
appendicitis more than single patients (52% vs 48% respectively). Regarding to job, students were
the maximum job suffering from acute appendicitis (32%) followed by workers (28) then house wife
(20%). Acute appendicitis were more prevalent among urban country ... Show more content on
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(1).
Table (2):– Distribution of Modified Alvarado scoring system components among studied
populations
Variable Summary statistics
Symptoms
Migrating. Rt. iliac fossa pain 68 (68.00%)
Anorexia 96 (96.00%)
Nausea/vomiting 84 (84.00%)
Signs
Tender Rt. lower quadrant 96 (96.00%)
Rebound tenderness Rt. iliac fossa 88 (88.00%)
Pyrexia 37.3 Co 68 (68.00%)
Investigation
Leucocytosis 10x10/L 80 (80.00%)
Total Modified Alvarado score Mean ± SD Median (min–max)
7.56±1.56
8 (4–9)
Total Modified Alvarado score 6 ≥6
16 (16.00%)
84 (84.00%)
Total Modified Alvarado score 7 ≥7
24 (24.00%)
76 (76.00%)
Regarding to abdominal ultrasonography, 68 patients (68%) had positive (+ve) ultrasound findings
for acute appendicitis but 32 patients (32%) had negative (–ve) findings. 80 patients (80%) were

positive for histopathological study but 20 patients (20%) were negative, as shown in table (3) and
fig. (1).
Table (3):– Investigations of studied populations
Variable Summary statistics
Laboratory
WBCs Mean ± SD Median (min–max)
13004±3809
12600 (6200–19400)
Radiology
Abdominal ultrasonography Negative Positive
32 (32.00%)
68 (68.00%)
Histopathology
Negative Positive
20 (20.00%)
80 (80.00%)
Fig. (1):– Diagnosis of appendicitis by Modified Alvarado score, Abdominal ultrasonography and
Histopathology There were insignificant difference between males and females regarding to
modified Alvarado score as a diagnostic method in

Prostate Cancer Research Paper
Prostate cancer is considered as the most commonly diagnosed cancer in men, in the U. S and most
cases of prostate cancer have a good prognosis. Some of these cases can be aggressive and the
death–rate is assessed to be 2.8%. The Prostate–specific antigen (PSA) test is used for screening for
prostate cancer, to aid early detection and treatment.
Prostate–specific antigen (PSA) test Prostate–specific antigen (PSA) is a protein produced by the
prostate gland, found in the blood. Blood sample is utilized to check PSA levels and Lab results are
reported in nanograms of PSA per milliliter (ng/mL) of blood. 4 ng/mL is considered to be the
normal level of PSA. Levels of PSA in the blood may be elevated in patients who have prostate ...
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Although PSA Screening tests can facilitate to detect prostate cancer in its early stage, there is
controversy and concern about patient being unnecessarily treated and over–diagnosed. The
reliability of prostate specific antigen (PSA) testing is very poor. PSA values could be false positive
caused by conditions such as benign prostatic hyperplasia, ejaculation, perineal trauma and PSA
value cannot be used to rule out prostate cancer. PSA–screening misses a considerable number of
patients with PCa (false–negatives) and wrongly suspects or false–positives (Hayat, Nordin and
Berglund, 2013). Sensitivity of the test is determined with the percentage of people tested with the
disease that had positive results equals the number of patients that were true positive. The cut–off
range for an abnormal PSA screening is 4.0 ng/mL. The American Cancer Society estimated that,
the sensitivity of a PSA levels cutoff of 4.0 ng/mL, was twenty one percent for detecting any
prostate cancer and fifty one percent for detecting high–grade cancers (Gleason ≥8). Validity of the
test can be determined by the ability of its screening to accurately identify, if the patient has the
disease or not. With PSA screening alone, one cannot validate if the patient has prostate cancer and
other diagnostic tests such as digital rectal exam

The Lachman Test
The Lachman Test is an important diagnostic test for detection of Anterior Cruciate Ligament (ACL)
pathology (van Eck, 2013) and is frequently used by sports therapists. Joint arthrometry, magnetic
resonance imaging (MRI), and diagnostic arthroscopy are all well–established methods to evaluate
the knee for the presence of an ACL tear. However, the clinical gold standard, with well–established
levels of accuracy for detecting this injury, is the Lachman test, which is performed with the patient
in a supine position and the knee at 20° to 30° of flexion (Benjaminse, 2006; Ostrowski, 2006). The
grading of the Lachman test is based on the amount of anterior translatory movement (translation) of
the tibia relative to the femur and on the end–feel perceived by the examiner. A positive test requires
a soft end–feel and observable translation of the tibia (Torg, 1976). ... Show more content on
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The patient's knee joint position during the Lachman's test might affect the grade given. Because
examiners do not agree on the position of the knee joint during the Lachman's test, reliability might
be affected if they do not place the knee in the same position each time they administer the test
(Donaldson 1985 ). Similarly, grading might be affected as experience of therapists differs from
each other. Hence, judgments based on the Lachman's test are inconsistent when made by
inexperienced testers, but such judgments become more reliable as testers become more
experienced (Dehaven, 1980; Noyes,

The Relationship Between Antioxidants From Diet And...
Objective The objective of Study 1 (S1) was to review the relationship between antioxidants from
diet and supplements and risk of PCa. The antioxidants included were vitamin E, selenium, vitamin
C, carotenoids, and polyphenols from coffee and tea. Combination studies were also included.
Method
The method of S1 was a literature search utilizing the database Pubmed for studies that contained
subheadings of diet, antioxidants, and prostatic neoplasms. The reference of selected studies was
reviewed to identify additional articles. Studies that only examined plasma levels were excluded.
Selected were 12 intervention studies and 32 observational studies.
Results The evidence of vitamin E was inconsistent, the majority found no benefit for the vitamin E.
Selenium was found to have some protective effect, the findings were restricted to patients with the
lowest concentration at baseline and indicated a confounding effect of selenium deficiency. Other
studies found no effect of selenium on PCa. The Initial benefits of Vitamin C was attenuated once
vegetable intake was taken into account. Carotenoids provided inconclusive evidence,
demonstrating no relationship with PCa. Three studies of green tea were performed, one each of
intervention, prospective, and case studies. After 1 year PCa was significantly less prevalent in the
green tea test group than the controls. Dietary flavonoids were not associated with PCa risk. Coffee
was inversely associated with lethal, but not low–grade

Pathophysiology Of Heart Failure

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