Others titles
- Development of a Clinical Prediction Model
- Clinical Signs of Pneumonia, Sepsis and Meningitis in Young Infants
Keywords
- Infant
- Young Infant
- Newborn Infant
- Infant Fever
- Pneumonia
- Sepsis
- Meningitis
- Pneumonia in Children
- Meningitis in Children
- Sepsis in Children
WHO ARI Young Infant Multicenter Study
This dataset contains 4552 observations and 97 variables. This dataset is from The World Health Organization Multicentre Acute Respiratory Infection (WHO ARI) Study of Clinical Signs and Etiological Agents of Pneumonia, Sepsis, and Meningitis in Young Infants.
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Description
This dataset came from the Department of Biostatistics of Vanderbilt University. Frank E. Harrell, together with colleagues, and the World Health Organization Multicentre Acute Respiratory Infection (WHO ARI) Young Infant Multicentre Study Group conducted a study titled, “The World Health Organization Multicentre Study of Clinical Signs and Etiological Agents of Pneumonia, Sepsis, and Meningitis in Young Infants”. This study was conducted to develop a clinical prediction model to assist health workers in developing countries in the presentation of an acutely ill young infant.
One of the most difficult problems faced by health workers in all parts of the world is the presentation of an acutely ill young infant. Infants under 3 months of age face serious infections which are the main causes of morbidity and mortality, particularly in developing countries. Diagnosis proves to be difficult as in the case of meningitis, pneumonia or sepsis. The ability to detect serious bacterial infection early in young infants is important in defining appropriate prevention and treatment strategies hence a better clinical prediction rule to be used by health workers both in developing and industrialized countries is needed in order to accurately predict which combination of clinical signs of infant determine meningitis, sepsis or pneumonia.
This study was undertaken in Ethiopia, The Gambia, Papua New Guinea and the Philippines where data was collected and used to come up with better screening criteria for finding infants at high risk of serious infection. There are 47 clinical signs collected from this study and a single variable was coded 0—3 representing sign not present, mild, moderate, severe.
From this study, researchers were able to develop a clinical prediction model for an ordinal scale to determine the combinations of clinical signs of infant that determine meningitis, sepsis or pneumonia.
For more information about this study, see related studies: Frank E. Harrell, Peter A. Margolis, Sandy Gove, Karen E. Mason, E. Kim Mulholland, Deborah Lehmann, Lulu Muhe, Salvacion Gatchalian, and Heinz F. Eichenwald. Development of a clinical prediction model for an ordinal outcome: The World Health Organization ARI Multicentre Study of clinical signs and etiologic agents of pneumonia, sepsis, and meningitis in young infants. Stat Med, 17:909-944, 1998 and Peter Margolis, E. Kim Mulholland, Frank E. Harrell, Sandy Gove, and the WHO Young Infants Study Group. Clinical prediction of serious bacterial infections in young infants in developing countries. Pediatric Infectious Disease Journal, 18S:S23-S31, 1999.
About this Dataset
Data Info
Date Created | 2008-01-17 |
---|---|
Last Modified | 2008-01-17 |
Version | 2008-01-17 |
Update Frequency |
Never |
Temporal Coverage |
1998 |
Spatial Coverage |
Ethiopia, The Gambia, Papua New Guinea, Philippines |
Source | John Snow Labs; Department of Biostatistics, Vanderbilt University; |
Source License URL | |
Source License Requirements |
N/A |
Source Citation |
N/A |
Keywords | Infant, Young Infant, Newborn Infant, Infant Fever, Pneumonia, Sepsis, Meningitis, Pneumonia in Children, Meningitis in Children, Sepsis in Children |
Other Titles | Development of a Clinical Prediction Model, Clinical Signs of Pneumonia, Sepsis and Meningitis in Young Infants |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
Sticker_Number | Sticker number of young infants | string | - |
Weight_Criteria_Met | Infants in the study sample meeting the inclusion criteria for weight where an infant with a birth weight <1500 g and less than 48 hours old is excluded, either Yes, No, or Maybe | string | - |
Laboratory_Evaluation_Criteria_Met | Infants in the study sample meeting the prescribed criteria for laboratory evaluation and underwent blood culture and chest radiography, either No, Refused, Sampled, Yes | string | - |
White_Blood_Cell_Result | White blood cell result | integer | level : Ratio |
Lumbar_Puncture_Cell_Count | Cell count from a lumbar puncture culture | integer | level : Ratio |
Number_Days_Ill | Number of days ill | integer | level : Nominal |
Birthweight | Birthweight of infants | number | level : Ratio |
Head_Circumference | Head circumference of infants | number | level : Ratio |
Weight_in_Grams | Weight in grams of infants | integer | level : Ratio |
Length_in_Centimeters | Length in centimeters of infants | number | level : Ratio |
Temperature | Temperature of infants | number | level : Ratio |
Chronic_Inflammatory_Demyelinating_Polyneuropathy | Cdip, either Yes, No, or S | string | - |
Heart_Rate_Oximeter | Heart rate | number | level : Ratio |
Country | Country either Ethiopia, Gambia, Manila or Papua New Guinea | string | - |
Age_in_Days | Age in days of infants | number | level : Ratio |
Adjusted_Respiratory_Rate | Adjusted respiratory rate | integer | level : Ratio |
Chest_Radiograph_Protocol | Chest radiograph either None, Cold,cough, Pneumonia, Severe pneumonia or Very severe disease | string | - |
Mother_Report_Respiratory_Problems | Mother report respiratory problems, either No problem, Hy respir/no chest, Hy respir/chest | string | - |
Implications | Implications, either No Pneumonia, Sepsis or Meningitis, No Pneunomia, Sepsis, Meningitis - other, Pneumonia only, Sepsis only, Meningitis only, Pneumonia and Sepsis, Pneumonia and Meningitis, Meningitis and Sepsis, and Pneumonia, Meningitis and Sepsis | string | - |
Arterial_Oxygen_Saturation | Arterial oxygen saturation where the adjusted oxygen saturation measurements used placed infants into three risk categories equivalent to SaO2 values of <90%, 90 to 94% and >94%. | string | - |
Polymorphonuclear_Cell_Ratio | Polymorphonuclear cell ratio | number | level : Ratio |
Days_to_Death_or_Discharge | Days to death or discharge | integer | level : Ordinal |
Blood_Culture_Rank | Blood culture rank | integer | level : Ordinal |
Weight_for_Age_Zscore | Weight for age Zscore | number | level : Ratio |
Weight_for_Age_Percent_Median | Weight for age in percent median | number | level : Ratio |
Dead | If infant died, either L, N, P, or Y | string | - |
Is_Omphalitis_Present | Presence or absence of omphalitis as a clinical sign | boolean | - |
Is_Conjunctivitis_Present | Presence of absence of conjunctivitis as a clinical sign | boolean | - |
Is_Disease_Present_or_Absent | Primary study outcome measure which indicates the presence or absence of disease, as well as its severity. | boolean | - |
Total_Number_of_Xray_Readings | Total number of xray readings | integer | level : Ordinal |
Pneumonia | Number of pneumonia | integer | level : Ordinal |
Number_of_Definite_Pneumonia | Number of definite pneumonia | integer | level : Ordinal |
Number_Normal | Number of normal | integer | level : Ordinal |
Number_of_Probable_Pneumonia | Number of probable pneumonia | integer | level : Ordinal |
Is_Associated_with_Death | Diagnoses ranked in a hierarchic fashion based on their association with the most severe outcome which is death. | boolean | - |
Is_Associated_with_Bacterial_Infection | Diagnoses not strongly related to death examined with respect to their association with the presence of a positive blood culture or CSF result. This measure was selected because it would allow infants to be included in the clinical prediction rule who might have negative cultures (e.g. those with low oxygen saturation and positive radiographs), but who still might benefit from treatment because they were at increased risk of bacterial infection. | boolean | - |
Is_No_Abnormality | Primary study outcome measure on an ordinal scale that summarized the presence or absence of disease, as well as its severity where first level of disease severity is no abnormality | boolean | - |
Is_Mild_Hypoxemia | Primary study outcome measure on an ordinal scale that summarized the presence or absence of disease, as well as its severity where second level of disease severity is mild hypoxemia (90% ≧ SaO2 < 95%) or radiologic pneumonia | boolean | - |
Is_Severe_Hypoxemia | Primary study outcome measure on an ordinal scale that summarized the presence or absence of disease, as well as its severity where third level of disease severity is severe hypoxemia (SaO2 < 90%) or bacteremia or meningitis | boolean | - |
Is_Sleep_More | Sleeping more as a clinical sign | boolean | - |
Is_Sleep_Less | Sleeping less as a clinical sign | boolean | - |
Is_Wake_Less_Easy | Wakes less easy as a clinical sign | boolean | - |
Is_Convulsion | Presence or absence of convulsion as a clinical sign | boolean | - |
History_of_Abnormal_Feeding | History of abnormal feeding where 0=sign no present, 1=mild, 2=moderate, 3=severe as clinical sign | string | - |
Is_Fast_Breathing | Fast breathing as a clinical sign | boolean | - |
Is_History_of_Fever | History of fever as a clinical sign | boolean | - |
Is_History_of_Stop_Breathing | History of stop breathing as a clinical sign | boolean | - |
Is_Less_Activity | Less activity as a clinical sign | boolean | - |
Is_More_Cry | More crying as a clinical sign | boolean | - |
Is_Less_Cry | Less crying as a clinical sign | boolean | - |
Is_History_of_Diarrhea | History of diarrhea as a clinical sign | boolean | - |
Is_Vomit_More | Vomitting more as a clinical sign | boolean | - |
Is_Birth_Preterm | Birth preterm as a clinical sign | boolean | - |
Is_Fever_at_Delivery | Fever at delivery as a clinical sign | boolean | - |
Is_History_of_Child_Death | History of child death as a clinical sign | boolean | - |
Is_Engorged_Breasts | Engorged breasts as a clinical sign | boolean | - |
Is_Water_Broke | Water breaking as a clinical sign | boolean | - |
Days_in_Labour | Days in labour | number | level : Ratio |
Respiratory_Distress | Respiratory distress, where 0=sign no present, 1=mild, 2=moderate, as clinical sign | string | - |
State_Respiratory_1 | State of respiratory distress (1) where 0=sign no present, 1=mild, 2=moderate, 3=severe as clinical sign | string | - |
State_Respiratory_2 | State of respiratory distress (2) where 0=sign no present, 1=mild, 2=moderate, 3=severe as clinical sign | string | - |
Is_Apnea | Apnea as a clinical sign | boolean | - |
Lower_Chest_Indrawing | Lower chest indrawing where 0=sign no present, 1=mild, 2=moderate, 3=severe as clinical sign | string | - |
Nasal_Flare | Nasal flare where 0=sign no present, 1=mild, 2=moderate, 3=severe as clinical sign | string | - |
Stridor | Stridor where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Grunt | Grunt where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Is_Cough_Heard | Cough heard as a clinical sign | boolean | - |
Is_Central_Cyanosis | Central cyanosis as a clinical sign | boolean | - |
Is_Jaundice | Jaundice as a clinical sign | boolean | - |
Drowsy_State | Drowsy state where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Is_Agitated_State | Agitated state as a clinical sign | boolean | - |
Arousal | Arousal where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Quality_of_Crying | Quality of crying where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Consolability | Consolability where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Attentive | Attentive where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Amount_of_Movement | Amount of movement where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Drinking_Ability | Drinking ability where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Sucking_Ability | Sucking ability where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Skin_Turgor | Skin turgor where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Dehydrate | Dehydration where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Digital_Capillary_Refill | Digital capillary refill where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Crepitation | Crepitation where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Skin_Rash | Skin rash where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Is_Bulging_Fontanelle | Bulging fontanelle as a clinical sign | boolean | - |
Is_Sunken_Fontanelle | Sunken fontanelle as as clinical sign | boolean | - |
Hypotonia | Hypotonia where 0=sign no present, 1=mild, 2=moderate, 3=severe as clinical sign | string | - |
Is_Wheeze | Wheeze as a clinical sign | boolean | - |
Is_Difficult_Breathing | Difficulty breathing as a clinical sign | boolean | - |
Smile_Adjust_for_Age | Smile adjustability for age where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Is_Pustular_Skin_Rash | Pustular skin rash as a clinical sign | boolean | - |
Abdominal_Distention_Score | Abdominal distention score where 0=sign no present, 1=mild, 2=moderate, 3=severe, 4=very severe as clinical sign | string | - |
Nutritional_Status_Score | Nutritional status score where 0=sign no present, 1=mild, 2=moderate, 3=severe as clinical sign | string | - |
Otoscopy_Impression | Otoscopy where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Severity_Illness | Severity of illness where 0=sign no present, 1=mild, 2=moderate, 3=severe, 4=very severe as clinical sign | string | - |
Is_Sclerema_or_Hypertonicity | Sclerema or hypertonicity as a clinical sign | boolean | - |
Is_Positive_Lumbar_Puncture | Positive lumbar puncture as a clinical sign | boolean | - |
Treatment_Indicated | Treatment indicated where 0=sign no present, 1=mild, 2=moderate as clinical sign | string | - |
Data Preview
Sticker Number | Weight Criteria Met | Laboratory Evaluation Criteria Met | White Blood Cell Result | Lumbar Puncture Cell Count | Number Days Ill | Birthweight | Head Circumference | Weight in Grams | Length in Centimeters | Temperature | Chronic Inflammatory Demyelinating Polyneuropathy | Heart Rate Oximeter | Country | Age in Days | Adjusted Respiratory Rate | Chest Radiograph Protocol | Mother Report Respiratory Problems | Implications | Arterial Oxygen Saturation | Polymorphonuclear Cell Ratio | Days to Death or Discharge | Blood Culture Rank | Weight for Age Zscore | Weight for Age Percent Median | Dead | Is Omphalitis Present | Is Conjunctivitis Present | Is Disease Present or Absent | Total Number of Xray Readings | Pneumonia | Number of Definite Pneumonia | Number Normal | Number of Probable Pneumonia | Is Associated with Death | Is Associated with Bacterial Infection | Is No Abnormality | Is Mild Hypoxemia | Is Severe Hypoxemia | Is Sleep More | Is Sleep Less | Is Wake Less Easy | Is Convulsion | History of Abnormal Feeding | Is Fast Breathing | Is History of Fever | Is History of Stop Breathing | Is Less Activity | Is More Cry | Is Less Cry | Is History of Diarrhea | Is Vomit More | Is Birth Preterm | Is Fever at Delivery | Is History of Child Death | Is Engorged Breasts | Is Water Broke | Days in Labour | Respiratory Distress | State Respiratory 1 | State Respiratory 2 | Is Apnea | Lower Chest Indrawing | Nasal Flare | Stridor | Grunt | Is Cough Heard | Is Central Cyanosis | Is Jaundice | Drowsy State | Is Agitated State | Arousal | Quality of Crying | Consolability | Attentive | Amount of Movement | Drinking Ability | Sucking Ability | Skin Turgor | Dehydrate | Digital Capillary Refill | Crepitation | Skin Rash | Is Bulging Fontanelle | Is Sunken Fontanelle | Hypotonia | Is Wheeze | Is Difficult Breathing | Smile Adjust for Age | Is Pustular Skin Rash | Abdominal Distention Score | Nutritional Status Score | Otoscopy Impression | Severity Illness | Is Sclerema or Hypertonicity | Is Positive Lumbar Puncture | Treatment Indicated |
A0001 | No | 60 | 2595.88 | 31.0 | 5250 | 55.0 | 37.5 | 160 | Ethiopia | 62 | 44 | Cold, cough | No problem | No Pneumonia, Sepsis or Meningitis | <90% | -1 | 0.04 | 100.53 | N | False | False | False | False | False | False | False | False | False | False | False | False | sign not present | True | False | False | True | False | False | False | False | False | False | False | False | True | 1 | mild | mild | mild | False | sign not present | sign not present | sign not present | mild | False | False | False | sign not present | False | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | False | False | sign not present | False | False | sign not present | False | sign not present | sign not present | sign not present | mild | False | False | sign not present | |||||||||||
A0002 | No | 1 | 2225.55 | 34.0 | 2350 | 48.0 | 37.0 | 160 | Ethiopia | 25 | 48 | Very severe disease | No problem | No Pneumonia, Sepsis or Meningitis | <90% | -1 | -2.58 | 61.04 | N | False | True | False | False | False | False | False | False | False | True | False | False | moderate | True | True | False | False | True | False | False | True | False | True | False | False | False | 1 | sign not present | sign not present | sign not present | False | sign not present | sign not present | sign not present | sign not present | False | False | False | sign not present | False | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | False | False | sign not present | False | False | sign not present | False | sign not present | mild | sign not present | sign not present | False | False | sign not present | |||||||||||
A0003 | No | 1 | 2298.37 | 34.0 | 2650 | 47.0 | 37.0 | 160 | Ethiopia | 25 | 48 | Very severe disease | No problem | No Pneumonia, Sepsis or Meningitis | <90% | -1 | -2.28 | 64.36 | N | False | False | False | False | False | False | False | False | False | True | False | False | mild | True | True | False | False | False | True | False | True | False | True | False | False | False | 1 | sign not present | mild | mild | False | sign not present | sign not present | sign not present | sign not present | False | False | False | sign not present | False | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | False | False | sign not present | False | False | sign not present | False | sign not present | sign not present | sign not present | sign not present | False | False | sign not present | |||||||||||
A0004 | No | Yes | 20000.0 | 1 | 2411.95 | 32.5 | 2400 | 44.0 | 38.0 | 151 | Ethiopia | 6 | 98 | Very severe disease | Hyrespir/no chest | No Pneumonia, Sepsis or Meningitis | <90% | 0.0 | 0.0 | 0 | -1.9 | 71.04 | Y | False | False | True | 3.0 | 1.0 | 0.0 | 2.0 | 1.0 | True | False | False | False | False | False | False | False | True | sign not present | True | True | False | True | False | False | False | False | False | False | False | False | False | 1 | sign not present | mild | mild | False | moderate | moderate | sign not present | moderate | False | False | True | sign not present | False | sign not present | mild | sign not present | moderate | mild | moderate | moderate | mild | mild | sign not present | sign not present | sign not present | True | True | sign not present | False | True | sign not present | False | moderate | sign not present | sign not present | very severe | True | False | moderate | ||
A0005 | No | 4 | 3500.0 | 33.0 | 3000 | 52.0 | 37.5 | 128 | Ethiopia | 50 | 44 | Cold, cough | No problem | No Pneumonia, Sepsis or Meningitis | <90% | -1 | -2.33 | 61.45 | N | False | False | False | False | False | False | False | False | False | False | False | False | sign not present | False | False | False | False | False | False | False | True | False | False | True | False | True | 1 | sign not present | mild | mild | False | sign not present | sign not present | sign not present | sign not present | False | False | False | sign not present | False | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | False | False | sign not present | False | False | moderate | False | sign not present | sign not present | sign not present | mild | False | False | sign not present | |||||||||||
A0006 | No | Yes | 10400.0 | 5 | 3500.0 | 36.0 | 3550 | 53.0 | 37.5 | Yes | 170 | Ethiopia | 30 | 60 | Very severe disease | Hyrespir/chest | Pneumonia only | 90 to 94% | 0.13 | 2.0 | 0 | -0.71 | 89.37 | N | False | False | True | 3.0 | 1.0 | 0.0 | 2.0 | 1.0 | True | True | True | True | True | False | True | False | False | sign not present | True | True | True | False | False | True | False | True | False | False | True | False | False | 1 | moderate | sign not present | sign not present | False | moderate | mild | sign not present | mild | True | False | False | sign not present | False | mild | sign not present | mild | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | False | False | sign not present | False | True | sign not present | False | sign not present | sign not present | sign not present | moderate | False | False | moderate | |
A0007 | No | Yes | 14600.0 | 2.0 | 1 | 2645.37 | 39.0 | 4300 | 54.0 | 38.3 | 115 | Ethiopia | 73 | 48 | Very severe disease | Hyrespir/no chest | Meningitis only | <90% | 0.07 | 14.0 | 0 | -1.35 | 77.92 | N | False | False | True | False | False | False | False | False | False | True | True | True | moderate | True | True | True | True | True | False | False | True | False | False | False | False | True | 1 | moderate | mild | mild | False | mild | mild | sign not present | moderate | False | False | False | mild | False | mild | moderate | sign not present | moderate | moderate | mild | mild | sign not present | sign not present | sign not present | sign not present | sign not present | True | False | sign not present | False | True | moderate | False | sign not present | sign not present | sign not present | severe | True | False | moderate | ||||||
A0008 | No | Yes | 10400.0 | 0.0 | 3 | 2150.0 | 34.0 | 2300 | 50.0 | 35.0 | 136 | Ethiopia | 34 | 44 | Very severe disease | No problem | Sepsis only | <90% | 1.0 | 1.0 | 0 | -2.91 | 56.52 | Y | False | False | True | 3.0 | 1.0 | 0.0 | 2.0 | 1.0 | True | True | True | True | True | False | False | False | False | sign not present | False | False | False | True | False | False | True | False | False | False | False | False | True | 1 | moderate | mild | mild | False | sign not present | sign not present | sign not present | sign not present | False | False | False | sign not present | False | mild | mild | mild | moderate | mild | moderate | moderate | sign not present | sign not present | mild | sign not present | sign not present | False | False | moderate | False | False | sign not present | False | sign not present | moderate | sign not present | severe | False | False | moderate | |
A0009 | No | Yes | 14800.0 | 8 | 3446.64 | 41.0 | 5500 | 61.5 | 37.4 | Yes | 160 | Ethiopia | 58 | 60 | Very severe disease | Hyrespir/chest | Pneumonia only | 90 to 94% | 0.04 | 4.0 | 0 | 0.5 | 107.62 | False | False | True | 3.0 | 1.0 | 0.0 | 2.0 | 1.0 | True | True | True | True | True | False | False | True | False | sign not present | True | True | False | True | False | False | True | True | False | False | True | False | True | 3 | moderate | mild | mild | False | severe | mild | sign not present | sign not present | False | False | False | mild | False | mild | mild | mild | moderate | moderate | moderate | moderate | sign not present | sign not present | sign not present | moderate | sign not present | False | False | sign not present | False | True | moderate | False | sign not present | sign not present | sign not present | severe | False | False | moderate | ||
A0010 | No | 1 | 1650.0 | 36.0 | 3150 | 51.0 | 37.0 | 170 | Ethiopia | 80 | 48 | Cold, cough | Hyrespir/no chest | No Pneumonia, Sepsis, Meningitis - other | <90% | -1 | -2.76 | 55.26 | N | False | False | False | False | False | False | False | False | False | True | False | False | sign not present | False | False | False | False | True | False | False | False | True | False | True | False | False | 1 | sign not present | mild | mild | False | sign not present | sign not present | sign not present | sign not present | False | False | False | sign not present | False | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | sign not present | False | False | sign not present | False | True | moderate | False | sign not present | sign not present | sign not present | mild | False | False | mild |