Clinical validity, such as sensitivity and specificity, may vary depending on different cutoffs among laboratories. In an Australian program, a quite low overall false-positive rate of 0.18% and five false-negative cases in 343,244 newborns were reported. In the North Carolina Newborn Screening Program, an overall abnormal rate of 0.64% in 320,503 newborns was reported, although a majority of abnormal samples were due to tyrosine (0.30%) and propionylcarnitine (0.15%). In our study, an overall false-positive rate of 0.58% in 102,200 newborns included that of 0.39% because of the use of pivalic acid-containing antibiotics.
Clinical utility and cost-effectiveness may also vary depending on the sensitivity and the severity of the diseases. It is reported that MS-MS screening for MCAD deficiency alone appears to be cost-effective; adding the incremental costs for the 13 other disorders still yields a result well within accepted norms for cost-effectiveness in Wisconsin. This report is based on the assumption that, in MS-MS screening for MCAD deficiency, 10% of patients are missed and the false-positive rate is 0.1%. A report from California based on the screening of 32,000 newborns plus other published data indicated that the cost of MS-MS screening per quality-adjusted year of life compared favorably with costs of other accepted screening procedures. However, in this report, discounted treatment costs per case for MCAD deficiency were not calculated. Based on the assumption of a low rate of clinical presentations leading to death and handicap and on the assumption of a 0.25% rate of false-positive results for MCAD deficiency, the cost of false-positive results was estimated as quite high owing to hospital visits, laboratory tests, consultations, and admission.
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The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.