Several fully continuous probabilistic genotyping software (PGS) use Markov chain Monte Carlo algorithms (MCMC) to assign weights to different proposed genotype combinations at a locus. Replicate interpretations of the same profile in these software are expected not to produce identical weights and likelihood ratio (LR) values due to the Monte Carlo aspect. This paper reports a detailed precision study under reproducibility conditions conducted as a collaborative exercise across the National Institute of Standards and Technology (NIST), Federal Bureau of Investigation (FBI), and Institute of Environmental Science and Research (ESR). Replicate interpretations generated across the three laboratories used the same input files, software version, and settings but different random number seed and different computers. This work demonstrates that using different computers to analyze replicate interpretations does not contribute to any variations in LR values. The study quantifies the magnitude of differences in the assigned LRs that is only due to run-to-run MCMC variability and addresses the potential explanations for the observed differences.

Probabilistic genotyping (PG) is becoming the preferred standard for evidence interpretation, amongst forensic DNA laboratories, especially those in the United States. Various groups have expressed concern about reliability of PG systems, especially for mixtures beyond two contributors. Studies involving interlaboratory testing of known mixtures have been identified as ways to evaluate the reliability of PG systems. Reliability means different things in different contexts. However, it suffices here to think about it as a mixture of precision and accuracy. We might also consider whether a system is prone to producing misleading results - for example large likelihood ratios (LRs) when the POI is truly not a contributor, or small LRs when the POI is a truly a contributor. In this paper we show that the PG system STRmix™ is relatively unaffected by differences in parameter settings. That is, a DNA mixture that is analyzed in different laboratories using STRmix™ will result in different LRs, but less than 0.05% of these LRs would result in a different, or misleading conclusion as long as the LR is greater than 50. For the purposes of this study, we define LRs assigned using different parameters for the same mixtures as similar if the LR of the true POI is greater than the LRs generated for 99.9% of the general population. These findings are based on an interlaboratory study involving eight laboratories that provided twenty known DNA mixtures of two to four contributors and their individual laboratory STRmix™ parameters. The eight sets of laboratory parameters included differences in STR kits and PCR cycles as well as the peak, stutter, and locus specific amplification efficiency variances.

The ever-increasing popularity of standardized systems for reporting cytopathology has led in part to much attention to and importance of the risk stratification schemes, especially the risks of malignancy (ROMs), which are associated with the different diagnostic categories and upon which recommendations for clinical management are based. However, it is well known that the ROM calculations are based on retrospective reviews of the existing literature, representing a heterogeneous patient population, and are plagued by significant biases and variations. Statistically, the ROM represents the post-test probability of malignancy, which changes with the test result and with the prevalence of malignancy (or pretest probability) in an individual practice setting and individual patient presentation. Therefore, the clinical utility of the ROM is questioned and likely needs a second look in the nongynecologic cytopathology reporting systems. In this communication, the authors discuss the status of the ROM estimates according to the most commonly used nongynecologic reporting systems, including for thyroid, salivary glands, and others, highlighting similarities and differences with a focus on the limitations of ROM estimates and their application in clinical practice.

In medical diagnostic research, it is customary to collect multiple continuous biomarker measures to improve the accuracy of diagnostic tests. A prevalent practice is to combine the measurements of these biomarkers into one single composite score. However, incorporating those biomarker measurements into a single score depends on the combination of methods and may lose vital information needed to make an effective and accurate decision. Furthermore, a diagnostic cut-off is required for such a combined score, and it is difficult to interpret in actual clinical practice. The paper extends the classical biomarkers\' accuracy and predictive values from univariate to bivariate markers. Also, we will develop a novel pseudo-measures system to maximize the vital information from multiple biomarkers. We specified these pseudo-and-or classifiers for the true positive rate, true negative rate, false-positive rate, and false-negative rate. We used them to redefine classical measures such as the Youden index, diagnostics odds ratio, likelihood ratios, and predictive values. We provide optimal cut-off point selection based on the modified Youden index with numerical illustrations and real data analysis for this paper\'s newly developed pseudo measures.

UNASSIGNED: As useful tools for clinical decision-making, diagnostic tests require careful interpretation in order to prevent underdiagnosis, overdiagnosis or misdiagnosis. The aim of this study was to explore primary care practitioners\' understanding and interpretation of the probability of disease before and after test results for six common clinical scenarios.
UNASSIGNED: This cross-sectional study was conducted with 414 family physicians who were working at primary care in Istanbul via face-to-face interviews held between November 2021 and March 2022. The participants were asked to estimate the probability of diagnosis in six clinical scenarios provided to them. Clinical scenarios were about three cancer screening cases (breast, cervical and colorectal), and three infectious disease cases (pneumonia, urinary tract infection, and COVID-19). For each scenario participants estimated the probability of the diagnosis before application of a diagnostic test, after a positive test result, and after a negative test result. Their estimates were compared with the true answers derived from relevant guidelines.
UNASSIGNED: For all scenarios, physicians\' estimates were significantly higher than the scientific evidence range. The minimum overestimation was positive test result for COVID-19 and maximum was pre-test case for cervical cancer. In the hypothetical control question for prevalence and test accuracy, physicians estimated disease probability as 95.0% for a positive test result and 5.0% for a negative test result while the correct answers were 2.0 and 0%, respectively (p < 0.001).
UNASSIGNED: Comparing the scientific evidence, overestimation in all diagnostic scenarios, regardless of if the disease is an acute infection or a cancer, may indicate that the probabilistic approach is not conducted by the family physicians. To prevent inaccurate interpretation of the tests that may lead to incorrect or unnecessary treatments with adverse consequences, evidence-based decision-making capacity must be strengthened.

When sampling an item or surface for DNA originating from an action of interest, one is likely to collect DNA unrelated to the action of interest (background DNA). While adding to the complexity of a generated DNA profile, background DNA has been shown to aid in resolving the genotypes of contributors in a targeted sample, and where references of donors to the background DNA are not available, strengthen the LR supporting a person of interest contributing to the targeted sample. This is possible thanks to advances in probabilistic genotyping, where forensic labs are able to deconvolute complex DNA profiles to obtain lists of genotypes and their associated weights. Coupled with DBLR™, one can then compare multiple evidentiary profiles to each other to determine the contribution of common, but unknown, contributors. Here, we consider factors associated with taking background samples and whether one should collect multiple background samples that all relate to a single target sample, or if one should collect larger background samples rather than smaller samples. Background samples consisted of DNA accumulated on the items primarily by one or both occupants of a single household, while targeted samples were generated from touch deposits, or saliva deposits that had been left to air dry. Samples were collected from areas of various sizes, consisting of only the background, the target and the background directly beneath it, and the target and additional surrounding background. A broad range of DNA quantities were recovered, with larger background samples (400 cm2) yielding significantly more DNA than smaller background samples (30 cm2). Significant differences in DNA quantities between target samples were not observed. Generated DNA profiles were interpreted using STRmix™ and DBLR™, and where there was support for a common donor between the background and target sample, pairwise comparisons were performed to observe the effect on the LR supporting the target DNA donor contributing to the targeted sample when conditioning on one (or two) common donor between the targeted sample and 1-8 background samples. Multiple background samples gave significantly higher LRs compared to a single background sample, the larger sampled background area resulted in larger LR gains than the smaller areas, and four or more background samples reduced LR variability considerably. Here we provide recommendations for the minimum and ideal number of additional background samples that should be collected, and that several smaller samples may be more beneficial than a single larger sample.

UNASSIGNED: Specific IgE (sIgE) is merely a sensitization marker that cannot be used for allergy diagnosis if there are no associated clinical symptoms. As of 2023, there is still no evidence regarding the quantity of sIgE necessary to confirm or exclude clinical disease. Therefore, this study aimed to calculate cut-offs for sIgE, allowing us to effectively diagnose olive or grass pollen allergy and select allergenic immunotherapy (AIT) candidate patients in a region under high olive and grass allergenic pressure.
UNASSIGNED: An observational retrospective study consisting of the review of electronic medical records from 1,172 patients diagnosed with seasonal rhino-conjunctivitis and suspected allergy to olive or grass pollen. Symptoms correlated with sIgE to Poaceae and Oleaceae whole extracts and sIgE to genuine allergenic components were evaluated. Optimal cut-off values were calculated using receiver operating characteristic curves. Relevant clinical symptoms and AIT indications were taken into consideration when determining the clinical allergy diagnosis.
UNASSIGNED: sIgE to Lolium showed the best area under the curve (AUC) for both diagnosis (0.957) and an indication of AIT (0.872). The optimal cut-off values for grass diagnosis and AIT indication were 1.79 kUA/L and 8.83 kUA/L, respectively. A value of 5.62 kUA/L was associated with a positive likelihood ratio (LR) of 10.08 set for grass allergy. Olea sIgE showed the best AUC for the diagnosis (0.950). The optimal cut-off for diagnosis was 2.41 kUA/L. A value of 6.49 kUA/L was associated with a positive LR of 9.98 to confirm olive pollen allergy. In regard to immunotherapy, Ole e 1 sIgE showed the best AUC (0.860). The optimal cut-off was 14.05 kUA/L. Ole e 1 sIgE value of 4.8 kUA/L was associated with a 0.09 negative LR to exclude olive AIT indication.
UNASSIGNED: The sIgE cut-offs found in this population under high olive and grass allergenic pressure reduce the gap between sensitization and clinical allergy, providing a new tool for the diagnosis of seasonal allergic rhinitis/asthma and helping to discriminate patients who will benefit from AIT.

The medical field commonly employs post-test measures such as predictive values and likelihood ratios to assess diagnostic accuracy. Predictive values, including positive and negative values (PPV and NPV), indicate the probability that individuals have a target health condition based on test results. On the other hand, likelihood ratios, including positive and negative ratios (LR+ and LR- respectively), compare the probability of a particular test result between the diseased and non-diseased groups. While predictive values are useful in evaluating diagnostic test accuracy in populations with varying disease prevalence, likelihood ratios provide a direct link between pre-test and post-test probabilities in specific patients. In this study, we introduce and analyze a new approach called generalized predictive values and likelihood ratios, using a tree ordering of disease classes. We evaluate the effectiveness of these methods through simulation studies and illustrate their use with real data on lung cancer.

DNA unrelated to an action of interest (background DNA) is routinely collected when sampling an area for DNA that may have originated from an action of interest. Background DNA can add to the complexity of a recovered DNA profile and could impact the discrimination power when comparing it to the reference profile of a person of interest. Recent advances in probabilistic genotyping and the development of new tools, now allow for the comparison of multiple evidentiary profiles to query for a common DNA donor. Here, we explore the additional discrimination power that can be gained by having an awareness of the background DNA present on a surface prior to the deposition of target DNA. Samples with varying number of contributors and DNA quantities were generated on cleaned plastic pipes (where ground truth was known) and items used by occupants of a single household (where ground truth was not known). The background consisted of deposits made by hands (touch) while target deposits were both touch and saliva. Samples were collected from areas consisting of only the background (A), the target and the background directly beneath it (B), and the target and additional surrounding background (B+C). Samples B and B+C yielded similar DNA amounts when the target consisted of saliva, but when the target consisted of touch, significantly more DNA was recovered from B+C. Subsequently generated DNA profiles were interpreted using STRmix™ and DBLR™. The first approach involved no conditioning while the second approach involved conditioning on the reference profiles of the known background DNA donors. The third approach involved conditioning on one common DNA donor between A and B or A and B+C. The fourth and final approach involved conditioning on two common DNA donors between A and B or A and B+C. As more information was applied to the analysis, the greater the increase in the LR for the comparison of the target sample to the POI. Conditioning on two common donors between the target and the background provided almost the same amount of information as conditioning on the references of the known background DNA donors. This resulted in an increase in the LR that was over 10 orders of magnitude for known donors in the target sample. Here we have demonstrated the value in collecting additional background samples from an area adjacent to a targeted sample, and that this has the potential to improve discrimination power.

Simple propositions are defined as those with one POI and the remaining contributors unknown under Hp and all unknown contributors under Ha. Conditional propositions are defined as those with one POI, one or more assumed contributors, and the remaining contributors (if any) unknown under Hp, and the assumed contributor(s) and N unknown contributors under Ha. In this study, compound propositions are those with multiple POI and the remaining contributors unknown under Hp and all unknown contributors under Ha. We study the performance of these three proposition sets on thirty-two samples (two laboratories × four NOCs × four mixtures) consisting of four mixtures, each with N = 2, N = 3, N = 4, and N = 5 contributors using the probabilistic genotyping software, STRmix™. In this study, it was found that conditional propositions have a much higher ability to differentiate true from false donors than simple propositions. Compound propositions can misstate the weight of evidence given the propositions strongly in either direction.