Diagnostic accuracy of the magnetocardiograph for patients with suspected acute coronary syndrome

Background We aimed to estimate the diagnostic accuracy of the VitalScan magnetocardiograph (MCG) for suspected acute coronary syndrome (ACS). Methods We undertook a prospective cohort study evaluating the diagnostic accuracy of the MCG in adults with suspected ACS. The reference standard of ACS was determined by an independent adjudication committee based on 30-day investigations and events. The cohort was split into a training sample, to derive the MCG algorithm and an algorithm combining MCG with a modified Manchester Acute Coronary Syndrome (MACS) clinical probability score, and a validation sample, to estimate diagnostic accuracy. Results We recruited 756 participants and analysed data from 680 (293 training, 387 validation), of whom 96 (14%) had ACS. In the training sample, the respective area under the receiver operating characteristic (AUROC) curves were the following: MCG 0.66 (95% CI 0.58 to 0.74), MACS 0.64 (95% CI 0.54 to 0.73) and MCG+MACS 0.70 (95% CI 0.63 to 0.77). MCG specificity was 0.16 (95% CI 0.12 to 0.21) at the threshold achieving acceptable sensitivity for rule-out (>0.98). In the validation sample (n=387), the respective AUROCs were the following: MCG 0.56 (95% CI 0.48 to 0.64), MACS 0.69 (95% CI 0.61 to 0.77) and MCG+MACS 0.64 (95% CI 0.56 to 0.72). MCG sensitivity was 0.89 (95% CI 0.77 to 0.95) and specificity 0.15 (95% CI 0.12 to 0.20) at the rule-out threshold. MCG+MACS sensitivity was 0.85 (95% CI 0.73 to 0.92) and specificity 0.30 (95% CI 0.25 to 0.35). Conclusion The VitalScan MCG is currently unable to accurately rule out ACS and is not yet ready for use in clinical practice. Further developmental research is required

Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid: single biomarker re-derivation and external validation in three cohorts.

BACKGROUND: The original Manchester Acute Coronary Syndromes model (MACS) 'rules in' and 'rules out' acute coronary syndromes (ACS) using high sensitivity cardiac troponin T (hs-cTnT) and heart-type fatty acid binding protein (H-FABP) measured at admission. The latter is not always available. We aimed to refine and validate MACS as Troponin-only Manchester Acute Coronary Syndromes (T-MACS), cutting down the biomarkers to just hs-cTnT. METHODS: We present secondary analyses from four prospective diagnostic cohort studies including patients presenting to the ED with suspected ACS. Data were collected and hs-cTnT measured on arrival. The primary outcome was ACS, defined as prevalent acute myocardial infarction (AMI) or incident death, AMI or coronary revascularisation within 30 days. T-MACS was built in one cohort (derivation set) and validated in three external cohorts (validation set). RESULTS: At the 'rule out' threshold, in the derivation set (n=703), T-MACS had 99.3% (95% CI 97.3% to 99.9%) negative predictive value (NPV) and 98.7% (95.3%-99.8%) sensitivity for ACS, 'ruling out' 37.7% patients (specificity 47.6%, positive predictive value (PPV) 34.0%). In the validation set (n=1459), T-MACS had 99.3% (98.3%-99.8%) NPV and 98.1% (95.2%-99.5%) sensitivity, 'ruling out' 40.4% (n=590) patients (specificity 47.0%, PPV 23.9%). T-MACS would 'rule in' 10.1% and 4.7% patients in the respective sets, of which 100.0% and 91.3% had ACS. C-statistics for the original and refined rules were similar (T-MACS 0.91 vs MACS 0.90 on validation). CONCLUSIONS: T-MACS could 'rule out' ACS in 40% of patients, while 'ruling in' 5% at highest risk using a single hs-cTnT measurement on arrival. As a clinical decision aid, T-MACS could therefore help to conserve healthcare resources

The cool core state of Planck SZ-selected clusters versus X-ray selected samples: evidence for cool core bias

We characterized the population of galaxy clusters detected with the SZ effect with Planck, by measuring the cool core state of the objects in a well-defined subsample of the Planck catalogue. We used as indicator the concentration parameter Santos et al. (2008). The fraction of cool core clusters is $29 \pm 4 \%$ and does not show significant indications of evolution in the redshift range covered by our sample. We compare the distribution of the concentration parameter in the Planck sample with the one of the X-ray selected sample MACS (Mann & Ebeling, 2011): the distributions are significantly different and the cool core fraction in MACS is much higher ($59 \pm 5 \%$). Since X-ray selected samples are known to be biased towards cool cores due to the presence of their prominent surface brightness peak, we simulated the impact of the "cool core bias" following Eckert et al. (2011). We found that it plays a large role in the difference between the fractions of cool cores in the two samples. We examined other selection effects that could in principle bias SZ-surveys against cool cores but we found that their impact is not sufficient to explain the difference between Planck and MACS. The population of X-ray under-luminous objects, which are found in SZ-surveys but missing in X-ray samples (Planck Collaboration 2016), could possibly contribute to the difference, as we found most of them to be non cool cores, but this hypothesis deserves further investigation.Comment: Accepted for publication in MNRA

Improving Visual Field Examination of the Macula Using Structural Information

Purpose: To investigate a novel approach for structure-function modeling in glaucoma to improve visual field testing in the macula. Methods: We acquired data from the macular region in 20 healthy eyes and 31 with central glaucomatous damage. Optical coherence tomography (OCT) scans were used to estimate the local macular ganglion cell density. Perimetry was performed with a fundus-tracking device using a 10-2 grid. OCT scans were matched to the retinal image from the fundus perimeter to accurately map the tested locations onto the structural damage. Binary responses from the subjects to all presented stimuli were used to calculate the structure-function model used to generate prior distributions for a ZEST (Zippy Estimation by Sequential Testing) Bayesian strategy. We used simulations based on structural and functional data acquired from an independent dataset of 20 glaucoma patients to compare the performance of this new strategy, structural macular ZEST (MacS-ZEST), with a standard ZEST. Results: Compared to the standard ZEST, MacS-ZEST reduced the number of presentations by 13% in reliable simulated subjects and 14% with higher rates (≥20%) of false positive or false negative errors. Reduction in mean absolute error was not present for reliable subjects but was gradually more important with unreliable responses (≥10% at 30% error rate). Conclusions: Binary responses can be modeled to incorporate detailed structural information from macular OCT into visual field testing, improving overall speed and accuracy in poor responders. Translational Relevance: Structural information can improve speed and reliability for macular testing in glaucoma practice

Normal Mastoid Air Cell System Geometry: Has Surface Area Been Overestimated?

Objectives The aim of this study was to emphasize the necessity of a standard in segmentation threshold and algorithm for measuring volume and surface area of mastoid air cell system (MACS). Methods First, we obtained axial computed tomography scans of 54 normal temporal bones from 27 subjects. Then, we manipulated Hounsfield units (HU) image data in DICOM (digital imaging and communications in medicine) files directly using our program. The volume and surface area of MACS were computed and compared at segmentation thresholds (HU) from –700 to 0 at intervals of 50 using 2 algorithms; square pixel based (SP) algorithm and marching square (MS) algorithm. Results No significant difference was found between the volumes computed by SP and MS algorithms at each segmentation threshold. The surface area computed by SP algorithm, however, was significantly larger than that by MS algorithm. We could minimize this significant difference through a modification of the SP algorithm. As the lower HU threshold value was set, the smaller volume was measured. The surface area showed a plateau at a threshold of approximately –200 HU. The segmentation threshold had greater influence on the measured volume of MACS than the algorithm did. Conclusion A standard method for measuring volume and surface area of MACS is thought to be necessary. We suggest that the MS algorithm and –200 HU of the threshold could be a standard in the measurement of volume and surface area of MACS

Measurement of the radiative neutron capture cross section of 206Pb and its astrophysical implications

The (n, gamma) cross section of 206Pb has been measured at the CERN n_TOF facility with high resolution in the energy range from 1 eV to 600 keV by using two optimized C6D6 detectors. In the investigated energy interval about 130 resonances could be observed, from which 61 had enough statistics to be reliably analyzed via the R-matrix analysis code SAMMY. Experimental uncertainties were minimized, in particular with respect to (i) angular distribution effects of the prompt capture gamma-rays, and to (ii) the TOF-dependent background due to sample-scattered neutrons. Other background components were addressed by background measurements with an enriched 208Pb sample. The effect of the lower energy cutoff in the pulse height spectra of the C6D6 detectors was carefully corrected via Monte Carlo simulations. Compared to previous 206Pb values, the Maxwellian averaged capture cross sections derived from these data are about 20% and 9% lower at thermal energies of 5 keV and 30 keV, respectively. These new results have a direct impact on the s-process abundance of 206Pb, which represents an important test for the interpretation of the cosmic clock based on the decay of 238U.Comment: 11 pages, 8 figures, paper to be submitted to Phys. Rev.