Response Categories Research Articles

B-337 Mass Spectrometry to evaluate treatment response in patients with Multiple Myeloma. A comparative study versus Immunofixation

Abstract Background The International Myeloma Working Group (IMWG) defines treatment response categories based on monoclonal protein (MP) changes by serum protein electrophoresis (SPE) and immunofixation (sIFE). Patients that after treatment remain positive by sIFE while SPE is negative, are categorized as very good partial response (VGPR) and, if sIFE becomes negative, patients would be considered in complete remission (CR). However, the interpretation of sIFE is qualitative and subjective. In this study we evaluate the discrepancies between sIFE and Mass Spectrometry (MS) to evaluate tumor burden and the accuracy of treatment response and it´s clinical impact in terms of progression free survival (PFS). Methods Patient samples were automatically prepared on the EXENT-iP®500 liquid handler, and sample spots were analysed using the EXENT-iX®500 MALDI-TOF mass spectrometer. Light chain spectral peaks were identified by EXENT-iQ® software and then quantified indirectly in combination with total immunoglobulins concentrations by immunoturbidimetry in the Optilite® platform (The Binding Site, part of Thermo Fisher Scientific). MPs were also identified and quantified by SPE and sIFE. Results From the 430 samples from the GEM12, GEM14 and GEM-CESAR clinical trials analyzed at pre-determined time points to evaluate treatment response (post-Induction, post-ASCT, post-cons, 1st and 2nd year after maintenance), MS identified the M protein in 45% of cases (193/430) and sIFE was positive in 32% (137/430). Combining the results of both methods, we found that MS and sIFE were concordant in 76% of cases (326/430), 26.28% IFE+/ MS+ and 49.53% IFE-/ MS-. Considering sIFE as a reference, the negative predictive value (NPV) of MS was 0.8987, with a sensitivity and a specificity of 0.8248 and 0.7270, respectively (p<0.0001). Nevertheless, the positive predictive value (PPV) was 0.5855 which could be explained by the discordances observed between IFE and MS techniques (5.58% of patients IFE+/MS- and 18.6% of patients IFE-/MS+). Indeed, when the 137 patients in VGPR (IFE+ patients) were analyzed according to MS status we found that patients IFE+/ MS+ had a trend to an inferior mPFS in comparison to IFE+/MS- (5.96 years vs not reached). These discordances were even more noticeable when comparing the 293 patients in CR (IFE- patients) with MS status, since IFE-/ MS+ patients had a mPFS of 4.65 years vs mPFS not reached for IFE-/ MS- patients (p=0.0001). Conclusions Our data confirms that IFE sensitivity limitations can affect the evaluation of treatment response in patients with MM, being more noticeable when the presence of MP band in sIFE is not clear because is very fuzzy or oligoclonal bands appear. Consequently, heterogeneity in interpretation practices across labs is a major cause of misattributed response categories, especially on those patients achieving treatment responses >VGPR. In an era of highly effective MM treatments that induce quick and deep responses, we believe IMWG response criteria should be updated with an MS response category.

The Adolescent Patient Perspective on Activity Limitations After Sport-Related Concussion.

Assessment of sport-related concussion (SRC) has begun to include patient-reported outcome measures. However, understanding of which health limitations are most meaningful to adolescents after SRC is limited. To explore patient-perceived activity limitations after SRC and throughout recovery to return to play and mapped according to the International Classification of Functioning, Disability, and Health (ICF) model. Longitudinal study. Secondary school athletic training facilities. Fifty patients (41 males, 5 females, 4 sex not reported, age = 14.9 ± 3.5 years, grade = 10.2 ± 0.93 level) with a medically diagnosed SRC. The Patient Specific-Functional Scale (PSFS) was used to assess changes in the patient's condition and the effect the injury posed on their ability to perform activities. The PSFS is a self-reported assessment of health used to identify activity limitations and rate the difficulty of performing those tasks. The PSFS was administered to patients on days 3 (D3) and 10 (D10) after SRC and at return to play. Activities affected by injury were coded into common categories and themes by a 3-person research team for subsequent analysis. The coded themes were also mapped to the ICF domains, chapters, and categories. The dependent variables were the PSFS themes, number of activities endorsed, PSFS scores, ICF domains, chapters, and categories. Descriptive analyses and frequencies were reported for the dependent variables. A total of 157 different activities were identified at D3 and coded into 28 categories that fit into 6 themes: activities of daily living, cognitive and school (COG), sports and physical activity (SPA), screen time, sleep, and social. On D3, all patients (50/50) identified at least 1 activity limitation. Most related to SPA (37.6%) and COG (31.2%). Sixty percent of patients endorsed activity limitations at D10, primarily in COG (38.6%) and SPA (36.6%). All (100%) response categories were mapped to the ICF, with most (75%) fitting the activities and participation domain. Our primary findings suggest that SRC influences many facets of the lives of adolescent athletes. Specifically, adolescent athletes identified activity restrictions primarily related to physical activity and sports participation.

Association between treatment resistance and cognitive function in schizophrenia.

Treatment-resistant schizophrenia (TRS) affects around 30% of individuals with schizophrenia. About half of the patients with TRS who are treated with clozapine do not show a meaningful clinical response, that is, clozapine resistance. To date, the relationship between cognitive function and treatment response categories is not entirely clear. This study evaluated the cognitive performance across subgroups stratified by treatment response, and we hypothesised that cognitive impairment increases with increased treatment resistance. This study was conducted at the Institute of Mental Health, Singapore, and included healthy controls and people with schizophrenia categorised into these groups: antipsychotic-responsive schizophrenia (ARS), clozapine-responsive TRS (TRS-CR) and clozapine-resistant TRS (ultra-treatment-resistant schizophrenia [UTRS]). Cognitive function was assessed using the Brief Assessment of Cognition-Short Form. Symptoms were measured with the Positive and Negative Syndrome Scale (PANSS). The planned statistical analyses included adjustments for covariates such as age, sex, PANSS scores and antipsychotic dose, which might affect cognitive function. There were significant differences in overall cognitive performance between the groups: ARS had the least impairment, followed by TRS-CR and UTRS. Antipsychotic dose, and PANSS negative and disorganisation/cognitive factors were significant predictors of overall cognitive function in all patient groups. Our study found differences in cognitive function that aligned with levels of treatment resistance: the greater the degree of treatment resistance, the poorer the cognitive function. Interventions to improve negative and disorganisation symptoms might be effective to enhance the cognitive function and treatment outcomes in schizophrenia.

Development and Validation of the Youth Back Activity Questionnaire: A Measure of Function for Adolescents with Low Back Pain.

Psychometric study. To develop a reliable and valid patient-reported outcome measure to assess functional ability in adolescents with low back pain (LBP) using the Rasch model. LBP is quite common in adolescence. Currently, no method adequately measures the functional ability of adolescents with LBP. Widely used outcome measures for LBP are problematic in adolescents, with significant ceiling/floor effects. Two hundred adolescents (15.4 ± 1.9 years; 56% female) with LBP. This study was comprised of two parts: Part 1: Development of the Youth Back Activity Questionnaire (YouthBAQ) (n = 75), and Part 2: Psychometric evaluation of the newly designed YouthBAQ using the Rasch Model (n = 125). Participants also completed the Oswestry Disability Index (ODI) and Micheli Functional Scale (MFS), Data Analysis: Reliability and construct validity of the YouthBAQ were assessed using Rasch analyses. Correlations with the ODI and MFS were used to determine the convergent validity of the YouthBAQ. Part 1: Based on the results of the Rasch analysis, 31 items were reduced to 14. Part 2. The 14-item YouthBAQ demonstrated good reliability and construct validity, with good item fit (>0.7 and <1.3), acceptable item hierarchy and spacing, response category functioning, unidimensionality (ratio >3:1), local independence (<0.30). The MFS demonstrated unacceptable reliability (person reliability = 0.62) and was not compared against the YouthBAQ. The ODI demonstrated acceptable reliability (person reliability =0.70), but poor construct validity among adolescents with LBP. The YouthBAQ demonstrated a moderate correlation with the ODI (r = 0.4). The YouthBAQ is a quick and easily understood measure of function with good validity and reliability in adolescents with LBP. The YouthBAQ is a more appropriate measure of functional ability than the ODI or MFS in this population.

Diversity, Equity, and Inclusion Initiatives from Providers of Continuing Pharmacy Education

Abstract: Although continuing education (CE) plays an important role in educating health care providers on diversity, equity, and inclusion (DEI), little is known about the DEI initiatives promoted and implemented by providers of CE. Surveys were electronically administered to accredited pharmacy continuing education providers (CEPs) from 2021 to 2023. Survey items were assessed providers' current efforts and best practices for incorporating DEI into organizational culture and educational programming. Frequencies and percentages were calculated for categorical responses, and a general interpretivist approach was used to code open-ended response items and describe themes. Overall, 50 and 33 responses were received in 2021/2022 and 2023, respectively. The most common step taken by programs to advance DEI was to engage pharmacists and/or pharmacy technicians in DEI discussions. Qualitative analysis described categories and themes as follows: best practices (CE programming DEI strategies, organizational DEI strategies), DEI goals (mission statement and DEI strategic plan, developing CE, continuing pharmacy education committee and task force, and faculty development and guidance), and accrediting body support (sharing best practices and training and technical support). Although CEPs described current efforts and best practices related to DEI in CE, organizations involved in CE accreditation can continue to explore ways to support DEI initiatives.

Neither agree nor disagree: use and misuse of the neutral response category in Likert-type scales

Neither agree nor disagree: use and misuse of the neutral response category in Likert-type scales

Abstract B156: Exploring identity-specific stressors among Black women with a family history of cancer

Abstract Background: Compared to women of other racial/ethnic groups, Black women are more likely to be diagnosed with aggressive subtypes of breast cancer (including triple-negative breast cancer), diagnosed at younger ages, diagnosed at more advanced stages, and have higher mortality rates and poorer survival outcomes. Black women also experience higher rates of breast cancer recurrence, which further exacerbates the survival disparities. These disparities are influenced by a complex interplay of genetic, environmental, and social factors, including chronic stress and discrimination. Understanding identity-specific stressors will help identify potential risk factors impacting breast cancer outcomes among Black women.Objective: This study aims to identify common stressors among Black women aged 18 to 49 with a family history of cancer, exploring potential links to breast health risk. Methods: We conducted a grounded theory study, including qualitative interviews from Black women in the Augusta, Georgia, area (N=47) discussing life as a Black woman and sources of stress. Participants with a close family history of cancer (defined as having at least one first- or second-degree relative diagnosed with cancer) were selected for this analysis (n=22). We applied the Sort &amp; Sift, Think &amp; Shift method for analysis. Results: We identified three categories in response to the research question, including healthcare access barriers and medical invalidation (particularly in rural communities), intergenerational trauma, and Strong Black Woman persona (characterized by independence, emotional suppression, and a tendency to care for others while neglecting their own needs). Participants described these categories in reference to themselves and their female family members with cancer. Participants reported stress related to jobs and caregiving responsibilities, lack of adequate social support, lack of time and finances necessary for self-care, and racial discrimination in medical settings. Conclusion: The identified stressors highlight the complex interplay between familial cancer history and daily stress experiences among Black women. These findings suggest the need for targeted interventions to mitigate stress and potentially reduce breast cancer risk. Further research is warranted to explore these themes in relation to breast cancer outcomes. Citation Format: Samantha R. Jones, Debbynie Barsh, Kathleen McIntyre, Christy J.W. Ledford. Exploring identity-specific stressors among Black women with a family history of cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B156.

Development and validation of the 5-Dimension Comprehensive Assessment Scale (5DCAS) for assessing physical function and health in axial spondyloarthritis.

To describe the development and validation of a novel patient reported scale, which is a comprehensive assessment of the physical function and health specific for patients with axial spondyloarthritis (axSpA). This is a multiphase, mixed methods study. Based on opinion collection and discussions of multidisciplinary consensus meetings and patients, an initial item pool covering all of the ranges of functioning was generated. The item optimization, model fit, response category functioning, differential item functioning, reliability, structure validity, and unidimensionality were tested by confirmatory factor analysis and Rasch measurement theory framework. After the consensus meeting and the two rounds of surveys in patients with axSpA, the initial pool of 135 items was reduced to 25 items formed in five dimensions, which exhibited preferable item reliability, item fit, and person fit to the Rasch model. The Five-Dimensional Comprehensive Assessment Scale (5DCAS) had the best reliability and validity (Kaiser-Meyer-Olkin was 0.919, and the standardized Cronbach's α coefficient was 0.932). The final version of 5DCAS had good unidimensionality, and the Person Separation Index ranged from 0.77 to 0.85. 5DCAS significantly correlated with ASAS-HI, SF-36, BASFI, and disease activity with p values of < 0.001. 5DCAS is a novel patient-reported outcome specific to axSpA, and it forms five dimensions providing a linear sum score of 25 items. 5DCAS comprehensively and significantly represents the physical function and health status of patients with axSpA, although its performance needs further validation in future clinical practices. Key Points • The primary goal in the management of axial spondyloarthritis is to maximize health-related quality of life. Except for the current instruments of ASAS-HI, BASFI, or SF-36, the heterogeneous clinical symptoms and rapid updated treat-to-target concept require a new instrument which can comprehensive and significant evaluate the changes of physical function and health-related quality of life due to disease. • 5DCAS is a novel patient-reported outcome specific to axSpA, and it forms five dimensions providing a linear sum score of 25 items, which contained aspect of pain involvement, spine mobility, global body performance and activity, social participation and environment, and mental health. All of the items were set to a 4-point semantic rating scale measuring severity, frequency, or interference from score 0 to 3. Total 5DCAS score ranges from 0 to 75; higher scores represented greater symptom burden and worse physical function. • 5DCAS is a comprehensive, multidisciplinary, and convenient disease outcome measurement specific for axSpA. It provides a new evaluation instrument in clinical trial and treat-to-target clinical remission for patients and physicians, and also provides a sensitive and accurate assessment standard for optimized health benefits.

120 Cross-validation of breeding values and future phenotypes for heifer pregnancy in Red Angus cattle using the LR method

Abstract Heifer pregnancy (HP) in beef cattle is a heritable and economically relevant trait but is challenging to predict using best linear unbiased prediction (BLUP) methodology due to the binary nature of the phenotypes. The observed categorical responses (e.g., 1 = pregnant; 0 = non-pregnant) are due to an animal either exceeding a particular threshold for pregnancy or not on an underlying genetic distribution which is why this binary trait is commonly evaluated using a threshold model (TM). However, TM are susceptible to scenarios where only 1 category of observation is predominant. In this study we compare genetic evaluations including “partial” and “whole” data to cross-validate methodologies for the prediction of HP. The objectives of this study were then to evaluate estimators of prediction accuracy, bias, and dispersion. Heifer fertility data were obtained from the Red Angus Association of America. Evaluations for HP were performed using ASREML3.0 and a univariate, BLUP, traditional TM; and a linear continuous BLUP animal model (LM) on both reference (whole) and validation (partial) datasets. Reference data included all animals with HP phenotypes, and validation data had censored the most recent 5 yr of HP phenotypes (~16% of HP phenotypes). Reference and validation estimated breeding values (EBV) were then compared using linear regression (LR) methods. Heritability estimates were 0.05 (± 0.007) and 0.15 (± 0.009) for LM and TM respectively. The average BIF accuracy of censored validation animals (n = 10,175) using a LM on whole and partial datasets were 0.07 and 0.03 respectively, and using a TM on whole and partial datasets were 0.09 and 0.04 respectively. Comparing the mean EBV from the partial and whole datasets can be a good estimator of bias in the model as the difference is expected to be 0. The difference between the mean EBV from partial and mean EBV from whole datasets were –0.003 and –0.016 for LM and TM respectively, suggesting that the TM is a slightly more biased evaluation. The regression of EBV obtained with whole data on EBV estimated with partial data has an expected value of 1 if there is no over/under dispersion which can be a useful tool in determining model correctness and gauge bias in an evaluation. The closer a regression coefficient is to 1, the less biased the evaluation is. The slope of the regression of EBV estimated from whole data on partial data for validation animals were 0.98 (P &amp;lt; 0.0001) and 0.91 (P &amp;lt; 0.0001) for LM and TM respectively. Although both regression coefficients were above 0.90 suggesting both evaluations are performing well, these results suggest that TM models may be a more biased predictor of HP than LM despite a small benefit in prediction accuracy for the trait.

Domestic and Family Violence Screening and Response: A Prospective, Cross-Sectional, Mixed Methods Survey in Private Mental Health Clients.

Most domestic and family violence (DFV) research has focused on establishing prevalence and screening rates in public health and community samples. This study sought to address a gap in the literature by evaluating DFV screening and response practices in a private mental healthcare inpatient service and determining if clients of the service had unmet DFV needs. A prospective, convenience sample, mixed methods, cross-sectional survey of adult inpatient mental health consumers was employed. Sixty-two participants completed the Royal Melbourne Hospital Patient Family Violence Survey. Quantitative Likert-type and categorical responses were collated and analysed descriptively (count and percentage). Free-text responses were analysed using qualitative description within a content analysis framework. Sixty-five percent of participants had been screened for at least one DFV issue, on at least one occasion, with 35% not being screened, to their recall. Twenty-three percent reported disclosing DFV concerns, 82% felt very supported by the clinician's response to their disclosure, and 86% were provided with information they found helpful. Unmet needs were identified in 13% of participants, who had wanted to disclose DFV concerns but not feel comfortable to do so. No unscreened respondents disclosed DFV concerns, highlighting the need to uphold best practice guidelines for direct enquiry. Most disclosing clients were positive about the support they received. Indicated areas for improvement were screening rates, active follow-up, increasing psychology support levels and safety planning.

Perceptions of government-assisted payors: a survey and analysis of American Shoulder and Elbow Surgeons current Medicare, Medicare Advantage, and Medicaid practice allocation

Significant discrepancy and variance exist in the United States health care system with regard to patient access to medical care based on a patient's insurance type, whether that be government-assisted or a private insurer. There are currently 3 major government-assisted insurance programs, Medicare, Medicare Advantage, and Medicaid, each of which has its own patient mix and regulatory processes that govern care delivery. The purpose of this study was to evaluate the current perceptions of shoulder and elbow surgeons surrounding practice patterns and barriers to access for patients whose primary insurance is a government-assisted payor. This was a national, observational study that surveyed the American Shoulder and Elbow Surgeons (ASES) society membership. This 15-question survey assessed surgeon demographics, practice types, reimbursement models, as well as rates and trends of their access to patients with government-assisted insurance. Subgroup analysis between practice type and barriers to access for patients with one of these 3 government-assisted insurance were also analyzed and compared. Pearson χ2 test or Fisher exact test was used to test association between categorical responses and categorical/binary respondent characteristics. A P value<.05 was deemed statistically significant. A total of 257 ASES members completed the survey. Mean years in practice for respondents was 14. For Medicare patients, the most common perceived barriers were reimbursement (49%) followed by administrative burden (33%) and then implant reimbursement at the surgeon's primary surgical facility (32%). For Medicare Advantage patients, the most common barrier to access was administrative burden (52%), reimbursement (50%), and the patient's ability to access perioperative services such as physical therapy and home health (40%). The most common barriers for Medicaid patients were relatively evenly distributed between reimbursement (62%), low patient engagement in their care (61%), and patient's ability to access perioperative services (60%). Among members of the ASES, barriers to patient access varied by government-assisted payor. For Medicare advantage, administrative burden was the largest barrier to access. Whereas for Medicare and Medicaid, reimbursement was the most significant barrier. Further investigation and understanding of these barriers to patient access are necessary to improve availability of shoulder and elbow subspecialized care to a broader population of patients insured by government-assisted payors.

Psychometric properties and diagnostic performance of three dry eye questionnaires in Italian: OSDI, OSDI-6, and SPEED.

Psychometric questionnaires are highly valuable instruments in clinical practice as they make subjective symptoms easier to measure. Recently, a short version of the Ocular Surface Disease Index (OSDI) questionnaire was developed, named OSDI-6. This study aimed to assess the psychometric properties and compare the diagnostic criteria of three questionnaires, available in the Italian language, designed for assessing dry eye disease: Standard Patient Evaluation of Eye Dryness (SPEED), OSDI-12, and specifically the new shortened version, OSDI-6. Psychometric evaluations were conducted on 250 adult participants aged 20 to 83 years. Classic and Rasch psychometric analyses were performed on the three questionnaires. The repeatability of the questionnaires was assessed by retesting 120 participants. The exploratory factor analysis of OSDI-6 indicated saturation on two factors. Repeatability was optimal for all three questionnaires. Based on the reference OSDI-12, the cutoff for OSDI-6 was 5 points and 7 for SPEED. Rasch analysis showed that OSDI-6 and OSDI-12 present disordered response categories and thresholds. Conversely, the SPEED questionnaire shows the optimal item characteristic curve. The OSDI-12 is a reference questionnaire used in dry eye disease studies and clinics, but OSDI-6 does not represent a perfect shortened version, primarily for the absence of one factor measured and secondarily for the same problem of category response order and thresholds. Conversely, SPEED focusing only on symptoms showed better psychometric properties.

MRI Predicts Residual Disease and Outcomes in Watch-and-Wait Patients with Rectal Cancer.

Background MRI plays a crucial role in restaging locally advanced rectal cancer treated with total neoadjuvant therapy (TNT); however, prospective studies have not evaluated its ability to accurately select patients for nonoperative management. Purpose To evaluate the ability of restaging MRI to predict oncologic outcomes and identify imaging features associated with residual disease (RD) after TNT. Materials and Methods This was a secondary analysis of the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial, which randomized participants from April 2014 to March 2020 with stages II or III rectal adenocarcinoma to undergo either induction or consolidation TNT. Participants enrolled in the OPRA trial who underwent restaging MRI were eligible for inclusion in the present study. Radiologists classified participants as having clinical complete response (cCR), near-complete clinical response (nCR), or incomplete clinical response (iCR) based on restaging MRI at a mean of 8 weeks ± 4 (SD) after treatment. Oncologic outcomes according to MRI response category were assessed using Kaplan-Meier curves. Logistic regression analysis was performed to identify imaging characteristics associated with RD. Results A total of 277 participants (median age, 58 years [IQR, 17 years]; 179 male) who were randomized in the OPRA trial had restaging MRI forms completed. The median follow-up duration was 4.1 years. Participants with cCR had higher rates of organ preservation compared with those with nCR (65.3% vs 41.6%, log-rank P < .001). Five-year disease-free survival for participants with cCR, nCR, and iCR was 81.8%, 67.6%, and 49.6%, respectively (log-rank P < .001). The MRI response category also predicted overall survival (log-rank P < .001), distant recurrence-free survival (log-rank P = .005), and local regrowth (log-rank P = .02). Among the 266 participants with at least 2 years of follow-up, 129 (48.5%) had RD. At multivariable analysis, the presence of restricted diffusion (odds ratio, 2.50; 95% CI: 1.22, 5.24) and abnormal nodal morphologic features (odds ratio, 5.04; 95% CI: 1.43, 23.9) remained independently associated with RD. Conclusion The MRI response category was predictive of organ preservation and survival. Restricted diffusion and abnormal nodal morphologic features on restaging MRI scans were associated with increased likelihood of residual tumor. ClinicalTrials.gov identifier: NCT02008656 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Milot in this issue.

Linguistic and cultural validation of symptom questionnaire for visual dysfunctions (SQVD) for psychometric analysis in the Chinese context.

The Spanish scale symptom questionnaire for visual dysfunctions (SQVD) was sinicized and tested for reliability and validity in the Chinese context, employing both classical measurement theory and item response theory. A meticulous translation was conducted using the modified Brislin translation model, with input from experts for cross-cultural debugging and in-depth review. Following a pre-survey study, the Chinese version of the SQVD was finalized. A convenience sampling method was used to select 270 patients from the target group and 252 valid questionnaires were successfully collected. The Rasch model was employed to assess response category functionality, fit statistics, unidimensionality, person and item reliability, separation, targeting, and differential item functioning. Classical test theory was applied to evaluate internal consistency and retest reliability, supplemented by correlation analysis. Job characteristic curves were also plotted to assess diagnostic accuracy. The Chinese SQVD conformed to a unidimensional structure with excellent reliability and validity. Person and item reliabilities were 0.85 and 0.99, respectively, indicating, high stability. Person and item separation indices were 2.37 and 11.54, respectively, signifying strong differentiation ability. Retest reliability was 0.917, further emphasizing the stability of the scale. The area under the receiver operating characteristic curve was 0.908 (95% CI: 0.854, 0.962), with a cutoff value of 7.5 and Youden index of 0.733, highlighting the scale's high diagnostic accuracy. The translated and culturally adapted Chinese SQVD demonstrated excellent psychometric properties. With streamlined items, short assessment time, and high efficiency, the scale is a stable and reliable clinical tool for detecting a variety of conditions related to refractive, regulatory, and binocular vision dysfunction.

Validating self-reported driving behaviours as determinants of real-world driving speeds

Self-reported driver behaviour has long been a tool used by road safety researchers to classify drivers and to evaluate the impact of interventions yet the relationship with real-world driving is challenging to validate due to the need for extensive, detailed observations of normal driving. This study examines this association by applying the large UDRIVE naturalistic driving study data involving 96 car drivers, comprising 131,462 trips and 1,459,110 km travelled over a duration of 32,096 hours, to compare individual questions and composite indicators based on the Driver Behaviour Questionnaire with real world driving. Self-reported speed behaviour was compared to the measured values under urban and highway conditions. Generalised Linear Mixed Models were developed to examine the relationships between the observed speed behaviours with DBQ errors and violations scores in conjunction with traffic and environmental factors. Drivers’ self-reported data on speed selection seldom aligned with their real-world behaviour and there were no meaningful differences between many of the response categories. The DBQ violations and errors scales showed a highly significant correlation with driving speed indicators however they had a low explanatory power compared to other traffic situational and driving factors. Overall, the study highlights the need to validate self-reported driving data against the accuracy and relevance to real-world driving.

How many grades of response categories does the commitment to the profession of medicine scale provide the most information?

In the present study, we examined the psychometric properties of the data obtained from the Commitment to Profession of Medicine Scale (CPMS) with 4-point, 5-point, 6-point, and 7-point response sets based on Item Response Theory (IRT). A total of 2150 medical students from 16 different universities participated in the study. The participants were divided into four groups consisting of 560, 544, 502, and 544 medical students. The first group (n=560) was assigned four-point, the second group (n=544) five-point, the third group (n=502) six-point, and the fourth group (n=544) seven-point Likert forms. We used R statistical software to analyze the data. The results of item calibrations conducted with the Graded Response Model (GRM) were analyzed. The results show that the eigenvalue increased from 4-point to 7-point. Similarly, the explained variance percentage and the scale's reliability increased gradually from 4-point to 7-point. The explained variance, reliability level, and eigenvalue were very close in the 5-point and 6-point forms.

Physiotherapy practices in the clinical assessment of lateral elbow tendinopathy: An international survey.

Understanding physiotherapy practices is important to identify variations from empirical evidence and highlight requirements for training. This survey explored international physiotherapy practices for assessment of lateral elbow tendinopathy (LET). Two hundred ninety-nine surveyed physiotherapists from eight member countries of the International Federation of Manual and Orthopaedic Physical Therapists completed the survey. Respondents rated their frequency of use (never, rarely, sometimes, often, and always) for items related to: patient history; diagnostic tests; grip and upper limb strength; cervical and neurological assessment; and medical imaging. To establish practices, the five response categories were dichotomised into routine practice (often, always) and not-routine practice (sometimes, rarely, never). A response rate of ≥70% for each dichotomy was used to determine whether an assessment item was deemed routine practice or not, with items not meeting either criterion considered neither routine nor not-routine practice. Most respondents were from United States (63%). The 'chair pick up test', 'cervical special tests', and 'plain radiograph' met our criteria for not routine practice (i.e., 70%, 72%, and 71%, respectively). All other assessment items did not meet the criteria to be considered routine or not-routine practice. The chair pick-up test, cervical spine special tests (e.g., Spurling's test), and plain radiography appear to not be routinely used in the assessment of LET. The finding that no assessment technique met the criteria for routine use may imply that physiotherapists adopt a nuanced approach to selecting clinical assessment items as opposed to routinely applying tests.

Trajectory modeling and response prediction in transcranial magnetic stimulation for depression

BackgroundRepetitive transcranial magnetic stimulation (rTMS) therapy could be improved by more accurate and earlier prediction of response. Latent class mixture (LCMM) and non-linear mixed effects (NLME) modeling have been applied to model the trajectories of antidepressant response (or non-response) to TMS, but it is not known whether such models are useful in predicting clinically meaningful change in symptom severity, i.e. categorical (non)response as opposed to continuous scores. MethodsWe compared LCMM and NLME approaches to model the antidepressant response to TMS in a naturalistic sample of 238 patients receiving rTMS for treatment resistant depression, across multiple coils and protocols. We then compared the predictive power of those models. ResultsLCMM trajectories were influenced largely by baseline symptom severity, but baseline symptoms provided little predictive power for later antidepressant response. Rather, the optimal LCMM model was a nonlinear two-class model that accounted for baseline symptoms. This model accurately predicted patient response at 4 weeks of treatment (AUC=0.70, 95 % CI=[0.52–0.87]), but not before. NLME offered slightly improved predictive performance at 4 weeks of treatment (AUC=0.76, 95 % CI=[0.58–0.94], but likewise, not before. ConclusionsIn showing the predictive validity of these approaches to model response trajectories to rTMS, we provided preliminary evidence that trajectory modeling could be used to guide future treatment decisions.

Interactive robots for personalised multimodal comedy experiments

This research proposes a novel system for personalising humour delivery using interactive robots with AI, natural language processing, and human-robot interaction technologies. The robots can adapt the multimodal content of jokes tactically now and strategically over time based on recording and analyzing each user’s subjective emotional reactions. The study evaluated pragmatic aspects of timing and framing jokes by having the robots try different “comeback tactics” and observing audience response. An ANOVA analysis revealed six distinct response categories. 78 % of participants positively rated the personalized robot comedy across the six scenarios. However, when both robot comedians took a negative tone, only 23 % approved (p < 0.001). Interestingly, audiences validated the robot comedian’s performance (89 % approval) more than the human comedian (54 % approval), a statistically significant difference (p < 0.01). These findings shed light on ideal characteristics for effective human-robot comedy interactions, highlighting the importance of topicality, maintaining a generally positive mood, and the unique strengths of robot performers. The study paves the way for further optimization of personalized, adaptive robot humour systems leveraging multimodal AI capabilities to enhance entertainment experiences tailored to individuals.

Response processes for patients providing quantitative self-report data: a qualitative study.

To identify factors that influence response processes for patients providing quantitative self-report data. Secondly, due to the lack of integrative and explanatory models in this area, to develop a model of patients' response processes that can guide what to look for when considering validity evidence and interpreting scores on individual items. Participants (n = 13) were recruited from a specialized substance use disorder treatment clinic and interviewed while responding to items from a clinical feedback system implemented for routine outcome monitoring in that setting. The interview approach was based on cognitive interviewing. Data collection and analysis were inspired by a grounded theory approach. We identified several variables that influenced the participants' response processes. The variables were organized into five categories: context-related variables; item-related variables; response base variables; reasoning strategies; and response selection strategies. We also found that the participants' responses for many items were affected by different aspects of the response process in ways that are relevant to interpretation but not necessarily discernible from the numerical scores alone, and we developed response categories to capture this. The findings suggest that patients providing quantitative self-report data encounter conditions in the response process that challenge and influence their ability to convey meaning and accuracy. This results in responses that for many of the items reflect messages important for interpretation and follow-up, even if it does not appear from the numerical scores alone. The proposed model may be a useful tool when developing items, assessing validity, and interpreting responses.