Evaluation of urine-based rapid tests for smoking and isoniazid treatment monitoring in adult patients
Bibliographic record
Abstract
Background: Globally, tuberculosis (TB) affects 9.4 million people every year, with an estimated 2 million deaths. Effective treatment of latent TB infection with isoniazid (INH) as a TB control strategy has been hampered by poor adherence to therapy. Research has shown that smoking is a risk factor for TB and that adherence to TB therapy may be lower among smoking individuals. Rapid tests are now available to detect smoking status as well as isoniazid treatment adherence in a clinic setting. Objective: The objective was to validate IsoScreen and SmokeScreen, two new point-of-care urine-based tests for INH metabolites and cotinine metabolites. The results from each of the two tests were compared with the corresponding reference standard algorithm developed in this study for measuring INH intake and smoking status. Methods: The main outcomes measured were accuracy and reliability of IsoScreen and SmokeScreen. Accuracy was measured using sensitivity and specificity values for each test against the corresponding reference standard: INH Intake Reference Standard Scale and the Smoking Status Reference Standard. Reliability was measured using kappa statistic for inter-rater and intra-rater agreement. Results: In this study, we recruited 200 adult outpatients attending the tuberculosis clinic and/or the smoking cessation clinic at the Montreal Chest Institute. The patients recruited were a combination of patients on or not on INH medication and smokers or non-smokers. IsoScreen had a sensitivity of 93.2% (95% confidence intervals [CI] 80.3, 98.2) and specificity of 98.7% (94.8, 99.8). IsoScreen had intra-rater agreement of 0.75 (0.48, 0.94) and inter-rater agreement of 0.61 (0.27, 0.90). SmokeScreen had a sensitivity of 69.2% (56.4, 79.8) and specificity of 81.6% (73.0, 88.0). SmokeScreen had intra-rater agreement of 0.77 (0.56, 0.94) and inter-rater agreement of 0.66 (0.42, 0.88).Conclusion: IsoScreen had high accuracy and reliability, whereas SmokeScreen had modest accuracy and modest reliability in tuberculosis and smoking cessation clinic settings. Further research should be conducted in various clinic settings with a focus on the impact of the tests on patient management.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".