Do we know how to set decision thresholds for diabetes?

The diagnosis of diabetes, based on measured fasting plasma glucose level, depends on choosing a threshold level for which the probability of failing to detect disease (missed diagnosis), as well as the probability of falsely diagnosing disease (false alarm), are both small. The Bayesian risk provides a tool for aggregating and evaluating the risks of missed diagnosis and false alarm. However, the underlying probability distributions are uncertain, which makes the choice of the decision threshold difficult. We discuss an hypothesis for choosing the threshold that can robustly achieve acceptable risk. Our analysis is based on info-gap decision theory, which is a non-probabilistic methodology for modelling and managing uncertainty. Our hypothesis is that the non-probabilistic method of info-gap robust decision making is able to select decision thresholds according to their probability of success. This hypothesis is motivated by the relationship between info-gap robustness and the probability of success, which has been observed in other disciplines (biology and economics). If true, it provides a valuable clinical tool, enabling the clinician to make reliable diagnostic decisions in the absence of extensive probabilistic information. Specifically, the hypothesis asserts that the physician is able to choose a diagnostic threshold that maximizes the probability of acceptably small Bayesian risk, without requiring accurate knowledge of the underlying probability distributions. The actual value of the Bayesian risk remains uncertain.

Vibrio coralliilyticus sp. nov., a temperature-dependent pathogen of the coral Pocillopora damicornis.

Vibrio sp. YB1T (=ATCC BAA-450T =LMG 20984T), the aetiological agent of tissue lysis of the coral Pocillopora damicornis, was characterized as a novel Vibrio species on the basis of 16S rDNA sequence, DNA-DNA hybridization data (G + C content is 45.6 mol%), AFLP and GTG5-PCR genomic fingerprinting patterns and phenotypic properties, including the cellular fatty acid profile. The predominant fatty acids were 16:0 and 18:1 omega7c. The name Vibrio coralliilyticus sp. nov. is proposed for the novel coral-pathogenic species. In addition to strain YB1T, which was isolated from the Indian Ocean, five additional strains of V. coralliilyticus have been isolated, three from diseased P. damicornis in the Red Sea, one from diseased oyster larvae (Kent, UK) and one from bivalve larvae (Brazil). The six V. coralliilyticus strains showed high genotypic and phenotypic similarities and all were pathogenic to P. damicornis. The closest phylogenetic neighbours to V. coralliilyticus are Vibrio tubiashii, Vibrio nereis and Vibrio shilonii.

Inhibition of photosynthesis and bleaching of zooxanthellae by the coral pathogen Vibrio shiloi.

Vibrio shiloi is the causative agent of bleaching (loss of endosymbiotic zooxanthellae) of the coral Oculina patagonica in the Mediterranean Sea. To obtain information on the mechanism of bleaching, we examined the effect of secreted material (AK1-S) produced by V. shiloi on zooxanthellae isolated from corals. AK1-S caused a rapid inhibition of photosynthesis of the algae, as measured with a Mini-PAM fluorometer. The inhibition of photosynthesis was caused by (i) ammonia produced during the growth of V. shiloi on protein-containing media and (ii) a non-dialysable heat-resistant factor. This latter material did not inhibit photosynthesis of the algae by itself but, when added to different concentrations of NH4Cl, enhanced the inhibition approximately two- to threefold. Ammonia and the enhancer were effective to different degrees on zooxanthellae isolated from four species of coral examined. In addition to the rapid inhibition of photosynthesis, AK1-S caused bleaching (loss of pigmentation) and lysis of zooxanthellae. Bleaching was more rapid than lysis, reaching a peak (25% bleached algae) after 6 h. The factors in AK1-S responsible for bleaching and lysis were different from those responsible for the inhibition of photosynthesis, because they were heat sensitive, non-dialysable and active in the dark. Thus, the coral pathogen V. shiloi produces an array of extracellular materials that can inhibit photosynthesis, bleach and lyse zooxanthellae.

Remodeling of the calcaneus apophysis in the growing child.

Radiography and computer-aided analysis of tomography of the os calcis in 35 children with Sever's disease and of 52 control children were concurrently evaluated with histologic appearance of six calcanei of victims of road accidents, which were radiographically compatible with the same syndrome. Histology showed abrupt interruption in continuity of the apophysis of perpendicular fibrous plates with evidence of an ongoing reparative process. Computer-aided analysis of orientation of the "fragmentation" lines and histologic data both support the hypothesis of a stress remodeling process owing to excessive bending forces acting on the calcaneal apophysis.

Adaptive assay of radioactive pulmonary aerosols with an external detector.

The accuracy of the assay of radioactive pulmonary aerosols is influenced by the spatial distribution of the aerosol in the lungs. In general, there is considerable uncertainty in the spatial distribution of the aerosol beginning a few months after inhalation. This paper develops an adaptive approach for optimizing the assay of non-uniform spatial distributions of pulmonary aerosols. An adaptive assay is one in which the design of the assay system is modified during operation in response to measurements obtained on-line. Experimental results are presented which compare the performance of an adaptive assay with that of the standard measurement procedure. We study the assay of 241Am distributed in the lungs of a Lawrence Livermore realistic phantom using a NaI-CsI Phoswich detector.