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Concept: Percentile rank


BACKGROUND: The clinical course of Cystic Fibrosis (CF) is usually measured using the percent predicted FEV1 and BMI Z-score referenced against a healthy population, since achieving normality is the ultimate goal of CF care. Referencing against age and sex matched CF peers may provide valuable information for patients and for comparison between CF centers or populations. Here, we used a large database of European CF patients to compute CF specific reference equations for FEV1 and BMI, derived CF-specific percentile charts and compared these European data to their nearest international equivalents. METHODS: 34859 FEV1 and 40947 BMI observations were used to compute European CF specific percentiles. Quantile regression was applied to raw measurements as a function of sex, age and height. Results were compared with the North American equivalent for FEV1 and with the WHO 2007 normative values for BMI. RESULTS: FEV1 and BMI percentiles illustrated the large variability between CF patients receiving the best current care. The European CF specific percentiles for FEV1 were significantly different from those in the USA from an earlier era, with higher lung function in Europe. The CF specific percentiles for BMI declined relative to the WHO standard in older children. Lung function and BMI were similar in the two largest contributing European Countries (France and Germany). CONCLUSION: The CF specific percentile approach applied to FEV1 and BMI allows referencing patients with respect to their peers. These data allow peer to peer and population comparisons in CF patients.

Concepts: Median, Quantile, Cystic fibrosis, Peer-to-peer, Quartile, Reference, Percentile rank, File sharing


Objective The objective of this study was to use two-dimensional (2D) ultrasound (US) during routine prenatal surveillance to develop normative estimated placental volume (EPV) growth curves.Study Design Patients ≥ 18 years old with singleton pregnancies were prospectively followed from 11 weeks gestational age (GA) until delivery. At routine US visits, placental width, height, and thickness were measured and EPV calculated using a validated mathematical model.Results In this study, 423 patients were scanned between 9.7 and 39.3 weeks GA to generate a total of 627 EPV calculations. Readings were clustered at 12 and 20 weeks, times of routine scanning. The mean EPV was 73 ± 47 cc at 12.5 ± 1.5 weeks (n = 444) and 276 ± 106 cc at 20 ± 2 weeks (n = 151). The data best fit a parabolic function as follows: EPV = (0.384GA - 0.00366GA2)3. Tenth and 90th percentile lines were generated with ± 1.28 SE offset. EPV readings below the 10th or above the 90th percentiles tended to be associated with either small or large newborns, respectively.Conclusion Routine 2D US created EPV growth curves, which may be useful for stratifying patients into prenatal risk groups.

Concepts: Pregnancy, Childbirth, Mathematics, Embryo, Fetus, Obstetrics, Gestational age, Percentile rank


One is inclined to conceptualize impact in terms of citations per publication, and thus as an average. However, citation distributions are skewed, and the average has the disadvantage that the number of publications is used in the denominator. Using hundred percentiles, one can integrate the normalized citation curve and develop an indicator that can be compared across document sets because percentile ranks are defined at the article level. I apply this indicator to the set of 58 journals in the WoS Subject Category of “Nanoscience & nanotechnology,” and rank journals, countries, cities, and institutes using non-parametric statistics. The significance levels of results can thus be indicated. The results are first compared with the ISI-impact factors, but this Integrated Impact Indicator (I3) can be used with any set downloaded from the (Social) Science Citation Index. The software is made publicly available at the Internet. Visualization techniques are also specified for evaluation by positioning institutes on Google Map overlays.

Concepts: Median, Academic publishing, Non-parametric statistics, Ranking, Science Citation Index, Bibliometrics, Google, Percentile rank


To illustrate the difficulties in optimal growth monitoring of children with severe obesity or underweight by using the Centers for Disease Control and Prevention (CDC) 2000 age- and sex-specific BMI percentile growth charts. We also aimed to examine the utility of a new modified CDC BMI z score chart to monitor growth in children with normal and extreme BMI percentiles by using real-life clinical scenarios.

Concepts: Cancer, Nutrition, Obesity, Body mass index, Body shape, Percentile rank


The cytokinesis-block micronucleus cytome (CBMN Cyt) assay was used to evaluate the baseline frequency of cytogenetic damage in peripheral blood lymphocytes of the general population (average age, 38.28 ± 12.83 years) in relation to age, sex, body mass index, seasonal variations (season of sampling, period of sampling and different meteorological parameters) and lifestyle factors (smoking habit, alcohol consumption, exposure to medications and diagnostic radiation, physical activity, and family history of cancer). The background frequency of micronuclei (MNi) for the 200 subjects assayed was 5.06 ± 3.11 per 1000 binucleated cells, while the mean frequency of nucleoplasmic bridges (NPBs) was 1.21 ± 1.46 and of nuclear buds (NBUDs) 3.48 ± 2.14. The background frequency of apoptosis and necrosis was 1.58 ± 1.50 and 1.39 ± 1.56, respectively, while the mean nuclear division index (NDI) was 1.99 ± 0.14. The cut-off value, which corresponds to the 95th percentile of the distribution of 200 individual values, was 11 MNi, 4 NPBs and 7 NBUDs. The study also confirmed an association of the above mentioned parameters with age, sex and several lifestyle factors. Moreover, significant confounders based on our results are also sampling season, sampling period and different meteorological parameters that were dependent on the CBMN Cyt assay parameters. In line with the above mentioned, several factors should be taken into account when it comes to the monitoring of exposed populations using cytogenetic biomarkers. Moreover, the normal and cut-off values obtained in this study present background data for the general population, and can later serve as baseline values for further biomonitoring studies.

Concepts: Population, Obesity, Median, Body mass index, Arithmetic mean, Season, Lymphocytes, Percentile rank


Difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning or mathematical abilities are present among persons diagnosed with learning disabilities (LDs). Previous studies suggest a significant relationship between lead (Pb) exposure and LDs. This study evaluated the potential dose-response relationship between blood Pb levels and the risk of LDs. This cross-sectional study examined 1411 children (32,788,743 weighted-persons) between 6 and 15 years old from the 2003-2004 National Health and Nutrition Examination Survey (NHANES) by analyzing demographics, health related-questions, and laboratory tests using survey logistic and frequency modeling in SAS. On a µg Pb/dL basis, a significant dose-dependent relationship between increasing blood Pb levels and increasing risk of LDs was observed (odds ratio (OR) = 1.21, 95% confidence interval (CI) = 1.03-1.43). The relationship remained significant when examining covariates such as gender and race (OR = 1.19, 95% CI = 1.00-1.40). By contrast, no dose-dependence was observed between increasing blood Pb levels and the risk of hay fever in the last year (OR = 0.77, 95% CI = 0.56-1.056), a non-plausibly biologically related outcome of blood Pb levels. Persons in the 50th-75th (12.80%) and 75th-100th (17.14%) percentiles of blood Pb were significantly more likely to have LDs than persons in the 0-50th percentile of blood Pb (8.78%). An estimated 1 million persons born in the US from 1989 to 1998 developed LDs from elevated blood Pb levels. Overall, this study revealed a significant dose-dependent association between increasing childhood blood Pb levels and the risk of a LD diagnosis, but it was not possible to ascribe a direct cause-effect relationship between blood Pb exposure and LD diagnosis. Childhood Pb exposure should be considered when evaluating children with LDs, and continuing efforts should be made to reduce Pb exposure.

Concepts: Epidemiology, Cross-sectional study, Percentile, Lead, Dose-response relationship, Percentile rank, Lead poisoning, Blood lead level


It has been reported that weather-related high ambient temperature is associated with an increased risk of work-related injury. Understanding this relationship is important because work-related injuries are a major public health problem, and because projected climate changes will potentially expose workers to hot days, including consecutive hot days, more often. The aim of this study was to quantify the impact of exposure to sustained periods of hot weather on work-related injury risk for workers in Melbourne, Australia. A time-stratified case crossover study design was utilised to examine the association between two and three consecutive days and two and three consecutive nights of hot weather and the risk of work-related injury, using definitions of hot weather ranging from the 60th to the 95th percentile of daily maximum and minimum temperatures for the Melbourne metropolitan area, 2002-2012. Workers' compensation claim data was used to identify cases of acute work-related injury. Overall, two and three consecutive days of hot weather were associated with an increased risk of injury, with this effect becoming apparent at a daily maximum temperature of 27.6 °C (70th percentile). Three consecutive days of high but not extreme temperatures were associated with the strongest effect, with a 15% increased risk of injury (odds ratio 1.15, 95% confidence interval 1.01-1.30) observed when daily maximum temperature was ≥33.3 °C (90th percentile) for three consecutive days, compared to when it was not. At a threshold of 35.5 °C (95th percentile), there was no significant association between temperature and injury for either two or three consecutive days of heat. These findings suggest that warnings to minimise harm to workers from hot weather should be given, and prevention protocol initiated, when consecutive warm days of temperatures lower than extreme heat temperatures are forecast, and well before the upper ranges of ambient daytime temperatures are reached.

Concepts: Climate, Weather, Temperature, Heat, Climate change, Maxima and minima, Percentile rank, Extreme weather


Continuous medication infusions are commonly used during surgical procedures. Alarm settings for infusion pumps are considered important for patient safety, but limits are not created in a standardized manner from actual usage data. We estimated 90th and 95th percentile infusion rates from a national database for potential use as upper limit alarm settings.

Concepts: Limit of a sequence, Percentile rank, Infusion pump, Limit of a function, Limits


Occasionally practitioners must work with single dimensions defined as combinations (sums or differences) of percentile values, but lack information (e.g. variances) to estimate the accommodation achieved. This paper describes methods to predict accommodation proportions for such combinations of percentile values, e.g. two 90th percentile values. Kreifeldt and Nah z-score multipliers were used to estimate the proportions accommodated by combinations of percentile values of 2-15 variables; two simplified versions required less information about variance and/or correlation. The estimates were compared to actual observed proportions; for combinations of 2-15 percentile values the average absolute differences ranged between 0.5 and 1.5 percentage points. The multipliers were also used to estimate adjusted percentile values, that, when combined, estimate a desired proportion of the combined measurements. For combinations of two and three adjusted variables, the average absolute difference between predicted and observed proportions ranged between 0.5 and 3.0 percentage points.

Concepts: Scientific method, Standard deviation, Statistical terminology, Percentile rank, Summary statistics


Children with chronic kidney disease (CKD) have a high risk of cardiovascular disease. Left-ventricular (LV) hypertrophy (LVH) is an early marker of cardiovascular disease in pediatric CKD, and the prevalence of LVH in pediatric CKD is approximately 20-30% in pre-dialysis CKD patients. However, there is no consensus on the ideal method of defining LVH in pediatric CKD patients. Previous studies have typically used the LV mass index (LVMI), which is calculated as LV mass in grams divided by height in meters to the 2.7th power ≥ 38 g/m2.7, to diagnose LVH in children with CKD. Recently, age-specific reference values for LVMI ≥ 95th percentile and LV wall-thickness z-score > 1.64 in children were addressed. The aim of this study was to assess the prevalence and contributing factors of LVH in pediatric CKD patients according to each measurement and evaluate the concordance between each measurement.

Concepts: Chronic kidney disease, Medicine, Disease, Medical terms, Definition, Kilogram, Division, Percentile rank