Sequential measurements, disturbance and property testing

Evaluation of the Pre-Test Scoring System (4Ts) for the Evaluation and Management of Heparin Induced Thrombocytopenia

Low Pre-Test Probability Scores Are Not Sufficient to Exclude Heparin-Induced Thrombocytopenia in Critically Ill Patients

Evaluation of the SAMe-TT2R2 score to predict the quality of anticoagulation control in patients with venous thromboembolism treated with vitamin K antagonists: Findings from the RIETE registry

A general depth-first backtracking algorithm for graph isomorphism with the vertex partition and refinement technique is presented in this paper. The time complexity of this nondeterministic polynomial algorithm is O(nα+3) where nα is the number of backtracking points and (h-1)/2α (h+1)/2 for h=logn in the worst cases. The tests on many types of graphs validated the efficiency of this algorithm for graph isomorphism.

Are We Doing Too Many HIT Tests? II

The goal of this investigation was to understand clinicians' perceptions of the probability of pulmonary embolism as a function of V/Q scan results of normal, low, intermediate, and high probability. A questionnaire was developed and distributed to 429 clinicians at a single academic medical center. The response rate was 44% (188 of 429). The questions included level of training, specialty, probability of PE given 1 of the 4 V/Q scan results, and estimations of the charges for V/Q scanning and pulmonary angiography, and estimations of the risks of pulmonary angiography. The medians and ranges for the probability of pulmonary embolism given a normal, low, intermediate, and high probability V/Q scan result were 2.5% (0-30), 12.5% (0.5-52.5), 41.25% (5-75), and 85% (5-100), respectively. Eleven percent (21 of 188) of the respondents listed the probability of PE in patients with a low probability V/Q scan as being 5% or less, and 33% (62 of 188) listed the probability of PE given an intermediate probability scan as 50% or greater. The majority correctly identified the rate of serious complications of pulmonary arteriography, but many respondents underestimated the charge for V/Q scans and pulmonary arteriography. A substantial minority of clinicians do not understand the probability of pulmonary embolism in patients with low and intermediate probability ventilation-perfusion scans. More quantitative reporting of results is recommended. This could be particularly important because VQ scans are used less frequently but are still needed in certain clinical situations.

Retained products of conception (RPOC) occur in approximately 1% of term deliveries and may result in bleeding, infection, and reproductive complications. However, early postpartum symptoms and ultrasound findings are often nonspecific, making diagnosis challenging. This study evaluated whether transvaginal sonography performed 6 weeks postpartum can effectively stratify RPOC risk in suspected cases and guide follow-up and management. In this prospective study, 116 hemodynamically stable women with risk factors for RPOC and without significant symptoms underwent transvaginal ultrasound 6 weeks postpartum. Findings were classified as high, moderate, or low probability based on the presence of an intrauterine mass, endometrial thickness, and vascularity. Low probability cases required no further evaluation, whereas those in the moderate and high probability groups were referred for diagnostic or operative hysteroscopy, respectively. Patients were categorized into high (19%), moderate (28%), and low (53%) probability groups. The prevalence of histologically confirmed RPOC in these groups was 50, 12.5, and 0%, respectively. Compared with prior studies that performed earlier postpartum assessments, evaluation at 6 weeks improved diagnostic accuracy, particularly in moderate probability cases, while predictive values in high and low probability groups remained comparable. Sonographic assessment at 6 weeks postpartum provides reliable risk stratification for RPOC and supports a more conservative management approach in hemodynamically stable women without significant symptoms by deferring imaging and potential interventions until completion of the postpartum period. This approach improves diagnostic accuracy in the moderate probability group while reducing false positives and unnecessary interventions.

Previous studies using the precuing paradigm to determine the advanced programming of movements have required subjects to perform in conditions with high probability of movement. This study determined how two levels of response probability affected the advanced programming of movements. Eight subjects participated in four consecutive days of testing under both high (100%) probability and low (50%) probability of executing movement. A precue paradigm was employed for each probability. Subjects received advance directional information (movement right or left) in the precued conditions and no advanced information in the noncued conditions. Test trials were performed utilizing the precue paradigm to determine the degree to which information would be preprogrammed when the probability of executing a response varied. Analysis indicated that subjects utilized advanced information in both conditions. When performing under high probability, individuals benefitted more from the precue than when performing under low probability.

Comparison of the Unstructured Clinician Gestalt, the Wells Score, and the Revised Geneva Score to Estimate Pretest Probability for Suspected Pulmonary Embolism

Modal gating of GluN1/GluN2D NMDA receptors

Artificial Intelligence-Augmented Electrocardiogram in Determining Sex: Correlation with Sex Hormone Levels

BackgroundDiagnosing acute heart failure in the Emergency Department remains challenging. CoDE-HF (Collaboration for the Diagnosis and Evaluation of Heart Failure) is a previously developed machine learning algorithm that predicts an individualised probability of acute heart failure using NT-proBNP as a continuous variable in combination with routinely available clinical variables.(1)PurposeTo externally validate the CoDE-HF algorithm in a prospective cohort of patients presenting with acute breathlessness.MethodsPatients presenting to the Emergency Department with acute breathlessness in whom acute heart failure was suspected were enrolled in this study. CoDE-HF integrates NT-proBNP with age, estimated glomerular filtration rate, haemoglobin, body mass index, heart rate, systolic blood pressure, peripheral oedema, chronic obstructive pulmonary disease and ischaemic heart disease. Diagnosis was adjudicated by two independent cardiologists, with disagreements resolved by a third. Performance was assessed using the area under the receiver operating characteristic curve (AUC), Brier score, and diagnostic accuracy at pre-specified thresholds.ResultsOverall, 1,030 patients (mean age 73±14, 49% female) were included in this study, of whom, 29% (294/1,030) had a prior diagnosis of heart failure. Acute heart failure was adjudicated in 374 of 1,030 patients (36%). In patients without prior heart failure, the NT-proBNP rule-out threshold of 300 pg/mL identified 32% as low probability, with sensitivity 95.9% (91.9–97.9) and negative predictive value (NPV) 96.6% (93.3–98.3). The age-specific rule-in thresholds identified 47% as high probability, with specificity 65.4% (61.3–69.3) and positive predictive value (PPV) 45.8% (40.6–51.1). In the same group, CoDE-HF had an AUC of 0.839 (95% CI 0.809–0.869) and Brier score of 0.152. A rule-out threshold of 5.7 identified 30% as low probability, with sensitivity 98.4% (95.3–99.5) and NPV 98.6% (95.7–99.5). A rule-in threshold of 69.2 identified 19% as high probability, with specificity 90.1% (87.2–92.3) and PPV 61.7% (53.4–69.3).In patients with prior heart failure, the NT-proBNP age-specific rule-in thresholds identified 75% as high probability, with specificity 33.6% (25.5–42.8) and PPV 65.9% (59.4–71.9). The CoDE-HF rule-in threshold of 85.0 identified 36% as high probability, with specificity 80.5% (72.2–86.8) and PPV 80.2% (71.7–86.6).ConclusionsIn this prospective cohort, CoDE-HF provided improved, individualised diagnostic accuracy, especially in patients without prior heart failure. It offers a consistent, data-driven tool to support clinical decision-making.

The Graph Isomorphism (GI) problem has been extensively studied due to its significant applications. The most effective class of GI algorithms, i.e., canonical labeling algorithms, are suitable for either graphs with high randomness or symmetry, or graphs for which both of them are not strongly held. Also, the core operations of canonical labeling algorithms, i.e., individuation-refinement (IR) and certificate comparison, usually occupy more than 70% of the total running time. How to weaken the limitations of structures and improve the efficiency of these operations are challenges. In this paper, we present an efficient GI algorithm called PEACE, which is particularly suitable for graphs with high randomness or symmetry. We present a parallel implementation of our algorithm on GPUs. We design some new techniques and also use some existing methods to speed up calculations under CUDA. More importantly, these techniques can be applied to all IR-based GI algorithms. We evaluate the proposed algorithm on various graphs to make comprehensive comparison with currently the most efficient canonical labeling algorithms on CPUs. Experimental results show that PEACE is superior to other algorithms on graphs with high symmetry or many automorphisms, and up to 50% performance increase can be achieved in the best case. We also apply our parallel techniques on these algorithms, and compare the performance on CPU and multiple GPU devices. The results show that the techniques make all algorithms gain 15~55 speedup.

Constant-time algorithms are powerful tools, since they run by reading only a constant-sized part of each input. Property testing is the most popular research framework for constant-time algorithms. In property testing, an algorithm determines whether a given instance satisfies some predetermined property or is far from satisfying the property with high probability by reading a constant-sized part of the input. A property is said to be testable if there is a constant-time testing algorithm for the property. This chapter covers property testing on graphs and games. The fields of graph algorithms and property testing are two of the main streams of research on discrete algorithms and computational complexity. In the section on graphs in this chapter, we present some important results, particularly on the characterization of testable graph properties. At the end of the section, we show results that we published in 2020 on a complete characterization (necessary and sufficient condition) of testable monotone or hereditary properties in the bounded-degree digraphs. In the section on games, we present results that we published in 2019 showing that the generalized chess, Shogi (Japanese chess), and Xiangqi (Chinese chess) are all testable. We believe that this is the first results for testable EXPTIME-complete problems.

4079 Background: Microvascular invasion (MVI) is the strongest prognostic factor following surgery of hepatocellular carcinoma (HCC). However, it is usually not available on the preoperative setting. A predictive model of MVI in patients scheduled for hepatic resection (HR) or liver transplantation (LT) would thus help guiding treatment strategy. The aim of this study was to develop a predictive model for MVI of HCC before either HR or LT. Methods: HCC patients who consecutively performed HR or LT from January 1994 to June 2016 at a single institution were subdivided into a training and validation cohort. Risk factors for MVI in the training cohort were used to develop a predictive model for MVI, to be validated in the validation cohort. The outcomes of the HR and LT patients with high or low MVI probability based on the model, were compared using propensity score matching (PSM). Cut-off values for continuous factors were determined based on ROC curve analysis. Results: A total of 910 patients (425 HR, 485 LT) were included in the training (n = 637) and validation (n = 273) cohorts. In the training cohort, multivariate analysis demonstrated that alpha-fetoprotein ≥100ng/ml ( p < 0.0001), largest tumor size ≥40mm ( p = 0.0002), non-boundary HCC type on contrast-enhanced CT ( p = 0.001), neutrophils-to-lymphocytes ratio ≥3.2 ( p = 0.002), aspartate aminotransferase ≥62U/l ( p = 0.02) were independently associated with MVI. Combinations of these 5 factors varied the MVI probability from 15.5% to 91.1%. This predictive model achieved a good c-index of 0.76 in the validation cohort. In PSM (109 HR, 109 LT), there was no difference in survival between HR and LT patients among the high MVI probability (≥50%) patients, (5y-OS; 46.3% vs 42.2%, p = 0.77, 5y-RFS; 54.0% vs 28.8%, p = 0.21). Among the low probability ( < 50%), survival was significantly decreased following HR compared with LT (5y-OS; 54.1% vs 78.8%, p = 0.007, 5y-RFS; 17.3% vs 86.1%, p< 0.0001). Conclusions: This model developed from preoperative data allows reliable prediction of MVI, and may thus help with preoperative decisions about the suitability of HR or LT in patients with HCC.