Comparing two diagnostic tests against the same "gold standard" in the same sample

Methods are proposed for comparing two diagnostic tests for the same data where a threshold for positive for each test is specified. One method contrasts the diagnostic tests' estimated risks. A second method compares the two tests' kappa coefficients. When thresholds for positive test results are specified a priori, maximum likelihood estimators and their asymptotic variances are derived and test statistics are presented for both case-control and naturalistic methods of sampling. The bootstrap is proposed as a method to assess differences in risk estimators when thresholds for positive test results are chosen by scanning the data. Examples are given to illustrate the methods.     

Outcome of patients with haemorrhagic shock: an indicator of performance in a trauma centre

The survival rate of patients admitted to the Royal Prince Alfred Hospital (RPAH) from the central Sydney area with a major injury has improved since regionalization of trauma services in early 1992. This improvement has been attributed to education, better hospital care and changing trauma epidemiology. This study was conducted to assess whether the outcome of patients admitted with haemorrhagic shock had improved. This is proposed as a more subtle indicator of hospital performance than overall survival rates. A prospective before and after study was carried out comparing outcome in the 18 months preceding 1 January 1992 with that in the subsequent 18 months. Entry criteria to the study included all primary retrievals from the central Sydney area to RPAH with injury severity scores (ISS) > 15. Outcomes were compared generally and in those who were in a state of haemorrhagic shock (systolic blood pressure < or = 90 mmHg) on arrival at the emergency department. Three hundred and eight patients were entered into the study. Stratification showed similar numbers, demographic features and mechanisms of injury in the two groups. Forty patients were in a state of haemorrhagic shock on admission. The overall mortality was reduced from 31% to 11% (P < 0.001) over the two phases of the study. The mortality from blood loss in the 40 shocked patients fell from 10/25 in the first period to 2/15 (P = 0.07) in the latter. These improved survival rates were felt to reflect the value of the educational and organizational initiatives introduced following designation of the hospital as a trauma centre.     

Regeneration studies on nickel molybdate catalysts used for the upgrading of coal-derived liquids

Nickel molybdate catalysts used in several different upgrading reactions of coal-derived materials from low-rank Australian coals have been regenerated and their activity assessed using a number of physical and chemical techniques. Regeneration of spent coked catalysts for 20 hours in air at 450°C was sufficient to restore chemical hydrogenation activity to catalyst used for pre-asphaltene, asphaltene and oil upgrading, provided poisoning of the catalyst surface by other impurities, principally chlorine-containing molecules, had not occurred.     

Expression and circular dichroism studies of the extracellular domain of the alpha subunit of the nicotinic acetylcholine receptor

To provide material suitable for structural studies of the nicotinic acetylcholine receptor, we have expressed and purified the NH2-terminal extracellular domain of the mouse muscle alpha subunit. Several constructs were initially investigated using Xenopus oocytes as a convenient small scale expression system. A fusion protein (alpha210GPI) consisting of the 210 NH2-terminal amino acids of the alpha subunit and a glycosylphosphatidylinositol anchorage sequence conferred surface alpha-bungarotoxin binding in oocytes. Coexpression of alpha210GPI with an analogous construct made from the delta subunit showed no evidence of heterodimer formation. The alpha210GPI protein was chosen for large scale expression in transfected Chinese hamster ovary cells. The alpha210GPI protein was cleaved from these cells and purified on an immunoaffinity column. Gel and column chromatography show that the purified protein is processed as expected and exists as a monomer. The purified protein also retains the two distinct, conformation-specific binding sites expected for the correctly folded alpha subunit. Circular dichroism studies of alpha210GPI suggest that this region of the receptor includes considerable beta-sheet secondary structure, with a small proportion of alpha-helix.