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Modern Applied Statistics With S

admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Large-Scale Exome Sequencing Study Implicates Both Developmental and Functional Changes in the Neurobiology of Autism

Epidemiology of cardiovascular disease in chronic renal disease

PURPOSE\nTo measure macular choroidal thickness in normal eyes at different points using enhanced depth imaging (EDI) optical coherence tomography (OCT) and to evaluate the association of choroidal thickness and age.\n\n\nDESIGN\nRetrospective, observational case series.\n\n\nMETHODS\nEDI OCT images were obtained in patients without significant retinal or choroidal pathologic features. The images were obtained by positioning a spectral-domain OCT device close enough to the eye to acquire an inverted image. Seven sections were obtained within a 5 x 30-degree area centered at the fovea, with 100 scans averaged for each section. The choroid was measured from the outer border of the retinal pigment epithelium to the inner scleral border at 500-microm intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea. Statistical analysis was performed to evaluate variations of choroidal thickness at each location and to correlate choroidal thickness and patient age.\n\n\nRESULTS\nThe mean age of the 30 patients (54 eyes) was 50.4 years (range, 19 to 85 years), and 14 patients (46.7%) were female. The choroid was thickest underneath the fovea (mean, 287 microm; standard deviation, +/- 76 microm). Choroidal thickness decreased rapidly in the nasal direction and averaged 145 microm (+/- 57 microm) at 3 mm nasal to the fovea. Increasing age was correlated significantly with decreasing choroidal thickness at all points measured. Regression analysis suggested that the subfoveal choroidal thickness decreased by 15.6 microm for each decade of life.\n\n\nCONCLUSIONS\nChoroidal thickness seems to vary topographically within the posterior pole. The thickness of the choroid showed a negative correlation with age. The decrease in the thickness of the choroid may play a role in the pathophysiologic features of various age-related ocular conditions.

Enhanced Depth Imaging Optical Coherence Tomography of the Choroid in Normal Eyes

Assessing the assumption of multivariate normality is required by many parametric mul- tivariate statistical methods, such as MANOVA, linear discriminant analysis, principal component analysis, canonical correlation, etc. It is important to assess multivariate normality in order to proceed with such statistical methods. There are many analytical methods proposed for checking multivariate normality. However, deciding which method to use is a challenging process, since each method may give different results under certain conditions. Hence, we may say that there is no best method, which is valid under any condition, for normality checking. In addition to numerical results, it is very useful to use graphical methods to decide on multivariate normality. Combining the numerical results from several methods with graphical approaches can be useful and provide more reliable decisions. Here, we present an R package, MVN, to assess multivariate normality. It contains the three most widely used multivariate normality tests, including Mardia's, Henze-Zirkler's and Royston's, and graphical approaches, including chi-square Q-Q, perspective and contour plots. It also includes two multivariate outlier detection methods, which are based on robust Mahalanobis distances. Moreover, this package offers functions to check the univariate normality of marginal distributions through both tests and plots. Furthermore, especially for non-R users, we provide a user-friendly web application of the package. This application is available at http://www.biosoft.hacettepe.edu.tr/MVN/.

/pdf/mvn-an-r-package-for-assessing-multivariate-normality-49478mtulc.pdf

MVN: An R Package for Assessing Multivariate Normality

ROC curve analysis is a fundamental tool for evaluating the performance of a marker in a number of research areas, e.g., biomedicine, bioinformatics, engineering etc., and is frequently used for discriminating cases from controls. There are a number of analysis tools which are used to guide researchers through their analysis. Some of these tools are commercial and provide basic methods for ROC curve analysis while others offer advanced analysis techniques and a command-based user interface, such as the R environment. The R environmentg includes comprehensive tools for ROC curve analysis; however, using a command-based interface might be challenging and time consuming when a quick evaluation is desired; especially for non-R users, physicians etc. Hence, a quick, comprehensive, free and easy-to-use analysis tool is required. For this purpose, we developed a user-friendly webtool based on the R language. This tool provides ROC statistics, graphical tools, optimal cutpoint calculation, comparison of several markers, and sample size estimation to support researchers in their decisions without writing R codes. easyROC can be used via any device with an internet connection independently of the operating system. The web interface of easyROC is constructed with the R package shiny. This tool is freely available through www.biosoft.hacettepe.edu.tr/easyROC.

/pdf/easyroc-an-interactive-web-tool-for-roc-curve-analysis-using-4fgeirnl9v.pdf

easyROC: An Interactive Web-tool for ROC Curve Analysis Using R Language Environment

Background

Blood neutrophil-to-lymphocyte (N/L) ratio is an indicator of the overall inflammatory status of the body, and an alteration in N/L ratio may be found in ulcerative colitis (UC) patients. The aims of this study were to investigate the utility of N/L ratio as a simple and readily available predictor for clinical disease activity in UC. J. Clin. Lab. Anal. 27:72–76, 2013. © 2012 Wiley Periodicals, Inc.



Methods

Twenty-six patients and 28 healthy controls were enrolled in the study. The neutrophil and lymphocyte counts were recorded, and the N/L ratio was calculated from these parameters. The extent of disease classified according to the Montreal classification, clinical disease activity was evaluated using a modified Truelove–Witts severity index, and endoscopic disease activities were classified according to Schroder et al.



Results

The serum N/L ratios of active patients were significantly higher than those of inactive UC and controls (P < 0.001). The optimum N/L ratio cut-off point for active UC was 2.47. There was no significant difference between inflammation parameters, disease extension, and disease activity.



Conclusion

Our results demonstrate that N/L ratio is higher in patients with active UC compared with controls and UC patients in remission and a cut-off value of 2.47 can be used to identify patients with active ulcerative colitis.

/pdf/neutrophil-lymphocyte-ratio-as-a-predictor-of-disease-3ctooydtsi.pdf

Neutrophil–Lymphocyte Ratio as a Predictor of Disease Severity in Ulcerative Colitis

Background
Inflammation plays a role in the pathogenesis of carotid atherosclerosis. Although previous data demonstrated an association between inflammatory biomarkers and stroke, there is no publication reporting the relation of neutrophil to lymphocyte (N/L) ratio with ischemic stroke. We aimed to analyze the predictive ability of N/L ratio in acute ischemic cerebrovascular disease.

Methods
A total of 190 patients including 70 patients with first-ever atherothrombotic acute ischemic stroke (AAIS), 50 patients with transient ischemic attack, and 70 healthy subjects were enrolled in this study. We analyzed the values of white blood cell (WBC), N/L ratio, C-reactive protein (CRP), gamma-glutamyltransferase (GGT), homocysteine (HCY), mean platelet volume (MPV) in patients with ischemic group and compared those with control individuals.

Results
WBC, CRP, HCY, N/L ratio were found to increase significantly in AAIS patients than the controls (P 0.05). A cut-off value of 4.1 for N/L ratio was detected in predicting mortality with a sensitivity of 66.7% and a specificity of 74.1% (κ = 0.299, P = 0.006).

Conclusions
These findings support the role of N/L ratio as a simple inexpensive and readily available marker of prognosis in acute ischemic stroke.

/pdf/neutrophil-to-lymphocyte-ratio-predicts-poor-prognosis-in-4abjrtxx9f.pdf

Neutrophil to Lymphocyte Ratio Predicts Poor Prognosis in Ischemic Cerebrovascular Disease

AIM: To identify novel non-invasive biomarkers for non-alcoholic fatty liver disease (NAFLD).

METHODS: Twenty patients with histologically proven NAFLD and 20 controls were included. All NAFLD cases were scored using the NAFLD activity score. The relative expressions of miR-197, miR-146b, miR-10b, miR-181d, miR-34a, miR-122, miR-99a and miR-29a were analyzed using real-time polymerase chain reaction.

RESULTS: Serum levels of miR-181d, miR-99a, miR-197 and miR-146b were significantly lower in biopsy-proven NAFLD patients than in the healthy controls. Serum levels of miR-197 and miR-10b were inversely correlated with degree of inflammation and miR-181d and miR-99a were inversely correlated with serum gamma glutamyl transferase levels in non-alcoholic steatohepatitis patients.

CONCLUSION: NAFLD is associated with altered serum miRNA expression pattern. This study provides clues for defining the non-invasive diagnosis of NAFLD.

Gokmen Zararsiz

Papers

MVN: An R Package for Assessing Multivariate Normality

easyROC: An Interactive Web-tool for ROC Curve Analysis Using R Language Environment

Neutrophil–Lymphocyte Ratio as a Predictor of Disease Severity in Ulcerative Colitis

Neutrophil to Lymphocyte Ratio Predicts Poor Prognosis in Ischemic Cerebrovascular Disease

Circulating microRNAs in patients with non-alcoholic fatty liver disease.