Response Categories Research Articles

Concordance between physician response assessment and a novel method per Lugano criteria in patients with lymphoma using real-world data.

e19082 Background: Clinical response assessment criteria, such as RECIST v1.1 and Lugano 2014, provide a standardized approach to assess treatment effectiveness in oncology clinical trials. Corresponding methodologies are needed for real-world data (RWD) to improve interpretability alongside clinical trial data and facilitate replication of results across RWD studies. We developed a RWD novel methodology, real-world Lugano (rwLugano), derived from Lugano 2014 criteria to classify lymphoma treatment response among patients with diffuse large B-cell lymphoma (DLBCL). Methods: A retrospective multisite RWD study identified adult patients with DLBCL treated with first line chemoimmunotherapy in US clinical practice (01JAN2015-31DEC2022). Participating sites abstracted clinical data via medical chart review and positron emission tomography-computed tomography (PET-CT) reports. Deidentified digital PET-CTs taken at treatment initiation and first response assessment were uploaded for BICR. Three distinct methods were used to assess treatment response: 1) physician-reported obtained from unstructured clinical notes in medical records, 2) rwLugano calculated using data (i.e., components of Lugano 2014) from PET-CT reports, and 3) BICR adjudication by two lymphoma radiologists using Lugano 2014 criteria. We compared the proportion of patients by response category: complete (CR), partial (PR), stable (SD) and progressive (PD) for each method. Analyses included agreement (%), concordance (Cohen’s kappa [κ]), and odds ratios with 95% confidence interval (OR; 95%CI) estimated using multivariable generalized linear mixed models (GLMM) adjusted for baseline characteristics. Results: The study identified 174 patients with DLBCL (female n=71 [41%]; white n=135 [78%]; Hispanic n=13 [7%]; mean age 66 years). Fewer patients were classified as CR at initial response via physician-reported response (n=111, 64%) compared to rwLugano (n=145, 83%), and BICR (n=142, 82%). Overall and CR agreement with BICR (see Table) was higher for rwLugano (overall: 83%, κ=0.49; CR: 86%, κ=0.50) than physician-charted response (overall: 72%, κ=0.45; CR: 76%, κ=0.43). In GLMM models, physician-charted response underestimated CR compared to BICR (OR=0.22, 95%CI:0.12-0.43), whereas rwLugano was statistically similar to BICR (OR=1.2, 95%CI:0.6-2.4). Conclusions: This study found that physician-reported response may underestimate CR at initial response, and rwLugano may be more consistent with BICR for treatment response assessment. Use of rwLugano warrants further evaluation as a methodology to assess treatment response in RWD lymphoma research. [Table: see text]

Nutritional Screening, Initial Management and Referral for Older People with Sarcopenia or Frailty - Results from a UK-Wide Survey.

We surveyed healthcare staff working with older people to understand current practice in nutrition screening, initial management and referral for older people with sarcopenia and frailty. We conducted a UK-wide web-based survey of staff working with older people in both hospital and community settings. Surveys were distributed through professional organisation e-mail lists and social media channels. Descriptive data were generated from categorical responses and inductive thematic analysis was applied to free-text responses. Data were analysed from 169 respondents (110 hospital, 59 community), representing 99 healthcare organisations. 91 (83%) hospital respondents and 24 (41%) community respondents reported that nutrition screening was performed on all patients with sarcopenia or frailty. The Malnutrition Universal Screening Tool was most commonly used to trigger referral to dietetics teams, but there was considerable variation in management before referral, referral thresholds and referral pathways. Themes derived from free-text responses included the need for training, issues of responsibility and ownership, inadequate resources (time, staff and equipment) and ineffective or inefficient processes for referral and management. Current UK nutritional care for older people with sarcopenia and frailty is heterogeneous. There are opportunities for better tools, processes, training and resources to improve current practice and pathways.

Improving goal concordant care clinician workshops: Do patients benefit?

9035 Background: From 2020-2023, the Alliance of Dedicated Cancer Centers (ADCC) undertook a national initiative to improve goal concordant care (IGCC) where all cancer patients and their families receive care that aligns with their values and priorities. One of the core components of the program was to implement a formal communications skills training program supporting the delivery of goal concordant care. As an ADCC member, City of Hope’s (COH) Department of Supportive Care Medicine created the Improving Goal Concordant Care Virtual Workshop Series to address this need. Methods: The 2-part workshop series covered: Goal concordant care, having difficult conversations, advanced care planning (ACP), advance directives, Physician Orders for Life Sustaining Treatment forms, and code status. Physicians and nurse practitioners (NPs) were independently evaluated regarding their quality of care pre-/post workshop #1 by their outpatients through the “Heard and Understood (HAU)” survey, a patient-reported quality measure with 4 items: I felt heard and understood (HU), Provider understood what was important my life (UL), Provider saw me as a person (SP), Provider put my best interests first (BI). Response categories ranged from 1, not at all trueto 5, completely true. Top-box rates and percentage of patients responding completely true for a given item were calculated for each clinician. Pre-/post changes in top-box rates were examined with paired t-tests. Differences in rates over time, by clinician type, were evaluated using mixed effect modeling. Survey items were initially analyzed individually, then combined. A p-value < 0.05 was considered statistically significant. Results: A total of 37 clinicians (26 Physicians and 11 NPs) were evaluated. Patients’ experience with physicians (NPs excluded) improved between pre/post training: The rates increased for the overall HAU scale (4.31, p=0.002), as well as for several individual items such as HU, UL and BI (5.24, 6.33 and 2.52 respectively, p-values<0.05). Notably, the rates for HU increased for physicians but not for NPs (5.24 vs -3.22, difference= 8.46, p=0.012), though NPs had a higher top-box rate at baseline compared to physicians (90.74 vs 78.04, p<0.001). Between group rate differences were not significant for the overall HAU scale over time. Conclusions: Patients’ experience with hematology and oncology physicians improved after physicians received IGCC communication skills training. Moreover, the patients’ experience with NPs was rated higher than physicians before training, but there were no significant differences after training. To further improve physician-patient communication regarding ACP and goal concordant care, the program will adapt and expand to additional departments throughout the COH clinical network.

Initial evaluation of measurement properties of the Work Environment Impact Questionnaire (WEIQ) - using Rasch analysis

BackgroundTo provide both preventive and rehabilitative conditions in a workplace, one must understand how employees experience work demands. Such an understanding can be obtained from each individual with valid and quality-assured questionnaires. The Work Environment Impact Questionnaire (WEIQ) is a new questionnaire for measuring employees’ self-perceived work ability in relation to their specific workplace environment. The purpose of this study was to assess the measurement properties in terms of construct validity of the WEIQ.MethodsA cross-sectional survey study was conducted with 288 respondents from three different workplaces involving assisted living personnel, vocational rehabilitation personnel and personnel at a research institute. The measurement properties of the WEIQ were assessed according to Rasch Measurement Theory (RMT), including assessment of item-to-sample targeting, threshold ordering, item fit statistics, unidimensionality and reliability.ResultsItem fit, i.e., fit residuals, item characteristic curves (ICC) and chi square values, were all satisfactory, and no disordered thresholds were present after collapsing the lowest response categories. However, issues with local dependent (LD) item correlations was present in 7.6% cases, four items showed statistically significant differential item functioning (DIF), where 11% of the respondents had person fit residuals outside the recommended range of ± 2.5 and the t-test for unidimensionality did not meet the criterion of 5%. Scale-to-sample targeting and reliability (0.92) were good. LD could be resolved with testlets and at the same time maintaining fit and improving dimensionality, but then the reliability decreased to 0.82.ConclusionsThis study provides an initial validation of the WEIQ to be used for assessing employees’ self-perceived work ability. Most measurement properties were acceptable, but further exploration of LD, DIF and unidimensionality in additional work settings and with larger sample sizes is warranted.Trial registrationNot applicable.

Rasch analysis of the self efficacy (SE-12) questionnaire measuring clinical communication skills

ObjectiveThe aim of this study was to examine the construct validity and reliability of the Self Efficacy (SE-12) questionnaire using Rasch analysis. MethodsThe SE-12 was administered to Danish health care professionals prior to their participation in a communication skills training program. Analysis of fit to the Rasch model, ordering of response categories, dimensionality-testing, test for differential item functioning, test for local dependency, and calculation of reliability were used to evaluate the psychometric characteristics of the SE-12. ResultsIn this study, 1057 respondents were analyzed. Overall, the SE-12 demonstrated an acceptable fit to the Rasch model. Response categories were appropriately ordered for all twelve items. However, items 6 (structure) and item 8 (empathy) demonstrated differential item functioning, with men being more likely to affirm the first and women the last item. Local dependency was observed between five item groups but adjusting for these improved fit indices significantly. The SE-12 exhibited high reliability with PSI ranging from 0.92 to 0.94. A transformation table converting ordinal scores to interval scores is provided. ConclusionThe SE-12 demonstrates good construct validity and excellent reliability. Minor issues regarding local dependency and differential functioning require attention.Innovation: A 5-item version could be explored without compromising validity and reliability.

Rumination in patients with major depressive disorder before and after antidepressant treatment

BackgroundRumination is a maladaptive response to distress characteristic of Major Depressive Disorder (MDD). It is unclear to what degree rumination is associated with depression severity prior to treatment and how it responds to antidepressant treatment. Therefore, we evaluated the association between rumination and depression severity in 92 untreated patients with MDD and explored the changes in rumination after initiation of antidepressant medication. MethodWe measured rumination using the Rumination Response Scale (RRS) and depression severity with the Hamilton Depression Rating Scale (HDRS17 or HDRS6) before and after initiation of 12 weeks of antidepressant treatment. The association between RRS and pre-treatment HDRS17 was evaluated using a linear regression model. RRS at week 4, 8, and 12 across treatment response categories (remission vs. non-response) were evaluated using a mixed effect model. ResultsRRS was positively associated with depression severity prior to treatment at a trend level (p = 0.06). After initiation of treatment RRS decreased significantly (p < 0.0001) and remitters exhibited lower rumination compared to non-responders at week 4 (p = 0.03), 8 (p = 0.01), and 12 (p = 0.007). LimitationsThe study had no placebo group. ConclusionsAlthough pre-treatment rumination did not significantly associate with depressive symptoms, rumination was closely connected to change in depressive symptoms. Tormented patients could be reassured that rumination symptoms may be alleviated over the course of antidepressant treatment.

Clinical inertia in thyrotropin suppressive therapy for low-risk differentiated thyroid cancer: A real-world experience at an endocrine center in Bangkok.

The management of low-risk differentiated thyroid cancer (DTC) has evolved over time toward treatment de-escalation. However, overtreatment with supraphysiological dose of levothyroxine (LT4) continues to be observed despite current clinical guideline. This study aimed to assess the actual thyrotropin suppressive therapy for low-risk DTC patients at an endocrine center in Bangkok. This retrospective study included patients with low-risk DTC who were regularly follow-up for at least 18 months at Theptarin Hospital between 2016 and 2022. The serum thyroid stimulating hormone (TSH) levels were stratified as TSH < 0.1 mIU/L; TSH 0.1 to 0.5 mIU/L; TSH 0.5 to 2.0 mIU/L; and TSH > 2.0 mIU/L. The initial risk stratification (IRS) and dynamic risk stratification were determined at 12 months of follow-up after completing the initial treatment and at the last visit. The clinical factors associated with overtreatment with LT4 were analyzed. A total of 102 patients (83.3% female, age at diagnosis 41.8 ± 13.6 years, mean tumor size 1.6 ± 1.0 cm) were evaluated with a mean follow-up of 5.9 years. The IRS classified 92.2% of patients after the initial treatment and 93.1% of patients at the last follow-up visit into the excellent response category. The mean LT4 daily dosage at the last follow-up was 121.3 ± 44.8 µg/day. Serum TSH levels were in an appropriate target range according to IRS in only 8.8% (9/102) of the patients and then improved to 19.6% (20/102) at the last follow-up visit. Further analysis showed that treating physicians with ≥10 years of practice was associated with severe TSH suppression therapy (TSH < 0.1 mIU/L). Despite the current clinical guideline recommendations and scientific evidences, less than one-fifth of low-risk DTC patients achieved the appropriate serum TSH target. While the proportion of an optimum LT4 suppressive had improved during the study period, further efforts are needed to overcome this clinical inertia.

Factors of Social Networking Influencing Tourists' Destination Selection in Ho Chi Minh City

Objective: The overarching objective of this study is to identify the salient factors within social networks, specifically Facebook, TikTok, Instagram, and YouTube, and their impact on tourists' decision-making processes in selecting Ho Chi Minh City as a destination. Subsequently, we offer managerial recommendations aimed at aiding tourism enterprises in Vietnam to enhance their understanding of the social network components that positively influence tourists' choices to visit. Furthermore, we suggest potential avenues for performance enhancement to optimize advertising effectiveness across social media platforms, including Facebook, TikTok, Instagram, and YouTube. Theoretical Framework: To date, numerous international research endeavors have scrutinized the determinants within social networks that shape tourists' intentions and decision-making processes regarding travel destination selection. However, within the Vietnamese context, scholarly investigations have predominantly centered on factors such as pricing, destination imagery, quality, and allure, while neglecting to explore the influence of social network factors on tourists' decisions regarding destination selection in Ho Chi Minh City. Consequently, the thematic focus on "Factors of Social Networks Influencing Tourists' Destination Selection Decisions in Ho Chi Minh City" represents an evolutionary progression from antecedent research studies, albeit purposefully tailored and refined by the researcher to align with their specific research aims. Method: The quantitative data gathered aimed to systematically examine and comprehend tourists' behaviors in their decision-making processes regarding destination selections facilitated by social media platforms. Employing an online survey hosted on Google Forms facilitated the data collection endeavor. The survey instrument featured a Likert scale spanning from 1 to 5, encompassing response categories delineated as follows: (1) Strongly Disagree, (2) Disagree, (3) Neutral, (4) Agree, and (5) Strongly Agree. Results and Discussion: Following the regression model analysis conducted on a dataset comprising 307 survey samples, the researcher observed the rejection of one initial research hypothesis, denoted as H1, while five subsequent hypotheses, namely H2, H3, H4, H5, and H6, were accepted. This determination was made based on the statistical significance values (Sig.) obtained from the t-test results presented in Table 4.19. Notably, factors with Sig. &gt; 0.05 were deemed lacking in statistical significance, indicating a negligible influence on the dependent variable. Specifically, hypothesis H1, which pertained to the subjective norm factor, was rejected due to its Sig. value exceeding 0.05 (Sig. = 0.651). Conversely, the five accepted hypotheses (H2, H3, H4, H5) all demonstrated Sig. values below 0.05 (Sig. = 0.000). In summary, the study effectively achieves its predetermined objectives by identifying and analyzing five social media factors influencing tourists' destination selection decisions in Ho Chi Minh City. Additionally, the research assesses the magnitude of their impact and examines disparities in research outcomes across different customer segments in Ho Chi Minh City concerning travel destination decisions. Based on these findings, the researcher proposes managerial implications to support tourism businesses in Vietnam intending to utilize social media platforms for advertising. These implications aim to furnish essential insights for selecting and prioritizing key factors when designing advertising campaigns on social media, thereby enhancing brand effectiveness.

#1883 SUrvey of renal Biopsy database and Anti-cancer dRUg therapy in Japan (SUBARU-J study)

Abstract Background and Aims The frequency of consultations for renal complications associated with anti-cancer drug therapy has greatly increased in recent years, but the actual situations remain yet to be fully understood. We aimed to investigate the clinical outcomes of anti-cancer drug therapy-associated renal complications, using the Japan Renal Biopsy Registry (J-RBR), a nationwide registry system in Japan. Method This nationwide survey was performed in 449 cases with “drug-induced” checked in J-RBR database from 2018 to 2021. In total 449 subjects, top-ranked histopathological diagnoses were as follows, TIN (49.8%), TMA (14.5), MN (10.0), MCNS (6.5), FSGS (4.4), Vasculitis (2.2) and others (12.2). Regardless of the causative agent, TIN was the most common diagnosis. Though, it was followed by TMA or MN in anti-cancer drug (n = 139)- or non-anticancer drug (n = 190)-related cases, respectively. Because there was also TMA included as 2nd highest in causative-agent unidentified cases (n = 120), we employed total 259 subjects of anti-cancer drug-related and causative-agent unidentified for this survey. Our surveillance files investigating on renal pathology, medications and cancer prognosis were distributed. Of the 224 cases with a file uploaded, a total of 135 anti-cancer drug-related cases confirmed by the information were analyzed. Patients’ clinical data collected at pre- and post-biopsy as well as histopathological diagnoses were used for epidemiological and clinicopathological analyses. Mann-Whitney U test or chi-square test was used for continuous or categorical variables. Overall survival (OS) was estimated using Kaplan–Meier method and compared by log-rank test. Results In total 135 subjects, top-ranked histopathological diagnoses were as follows: tubulointerstitial nephritis (TIN; 64 cases), thrombotic microangiopathy (TMA; 48), focal segmental glomerulosclerosis (FSGS; 5), IgA nephropathy (IgAN; 4), acute tubular necrosis (ATN; 3), minimal change nephrotic syndrome (MCNS; 3), crescentic glomerulonephritis (CrGN; 2), membranoproliferative glomerulonephritis (MPGN; 2) and others (4). 80% of TIN and 75% of TMA, the most frequent diagnoses in our survey, were associated with immune-checkpoint inhibitors (ICI) and anti-angiogenic therapy (AAG), respectively. All IgAN, MCNS and CrGN cases were ICI-related. Proton pump inhibitors and antibiotics were used concomitantly in TIN (p = 0.054) and TMA (p &amp;lt; 0.001), respectively. Among cases with TIN, their OS in the subgroups of targeted therapy (Tx), and the combination with Tx and conventional cytotoxic agents (Combi) seemed to be worse than that of cytotoxic agents alone (CTx); it may be due to more cases in the Tx and Combi subgroups with treatment response category of progressive disease (by RECIST criteria). In contrast, among TMA cases, OS in each of the three subgroups of Tx, CTx, and Combi seemed to be overlapped, suggesting the prognostic impact of TMA on OS. The serum LDH level was higher in TMA associated with CTx (CTx-TMA) than that with others (Fig. 1: 393.2 vs. 225.1 U/L, p = 0.06). Of note, Kaplan-Meier curves for OS in TMA cases with increased LDH (&amp;gt;220 U/L) showed poor prognosis in CTx-TMA than in others-TMA (Fig. 2: p = 0.018). Conclusion Our nationwide survey using J-RBR registry database with renal biopsy data provides a snapshot of kidney complications associated with anti-cancer drug therapy. Higher LDH in CTx-TMA cases may be associated with systemic TMA, probably leading to the poor prognosis. To explore the detail of anti-cancer drug-associated TMA and other complications, further research employing more sample size is warranted in the future.

Factors of Social Networking Influencing Tourists' Destination Selection in Ho Chi Minh City

Objective: The overarching objective of this study is to identify the salient factors within social networks, specifically Facebook, TikTok, Instagram, and YouTube, and their impact on tourists' decision-making processes in selecting Ho Chi Minh City as a destination. Subsequently, we offer managerial recommendations aimed at aiding tourism enterprises in Vietnam to enhance their understanding of the social network components that positively influence tourists' choices to visit. Furthermore, we suggest potential avenues for performance enhancement to optimize advertising effectiveness across social media platforms, including Facebook, TikTok, Instagram, and YouTube. Theoretical Framework: To date, numerous international research endeavors have scrutinized the determinants within social networks that shape tourists' intentions and decision-making processes regarding travel destination selection. However, within the Vietnamese context, scholarly investigations have predominantly centered on factors such as pricing, destination imagery, quality, and allure, while neglecting to explore the influence of social network factors on tourists' decisions regarding destination selection in Ho Chi Minh City. Consequently, the thematic focus on "Factors of Social Networks Influencing Tourists' Destination Selection Decisions in Ho Chi Minh City" represents an evolutionary progression from antecedent research studies, albeit purposefully tailored and refined by the researcher to align with their specific research aims. Method: The quantitative data gathered aimed to systematically examine and comprehend tourists' behaviors in their decision-making processes regarding destination selections facilitated by social media platforms. Employing an online survey hosted on Google Forms facilitated the data collection endeavor. The survey instrument featured a Likert scale spanning from 1 to 5, encompassing response categories delineated as follows: (1) Strongly Disagree, (2) Disagree, (3) Neutral, (4) Agree, and (5) Strongly Agree. Results and Discussion: Following the regression model analysis conducted on a dataset comprising 307 survey samples, the researcher observed the rejection of one initial research hypothesis, denoted as H1, while five subsequent hypotheses, namely H2, H3, H4, H5, and H6, were accepted. This determination was made based on the statistical significance values (Sig.) obtained from the t-test results presented in Table 4.19. Notably, factors with Sig. &gt; 0.05 were deemed lacking in statistical significance, indicating a negligible influence on the dependent variable. Specifically, hypothesis H1, which pertained to the subjective norm factor, was rejected due to its Sig. value exceeding 0.05 (Sig. = 0.651). Conversely, the five accepted hypotheses (H2, H3, H4, H5) all demonstrated Sig. values below 0.05 (Sig. = 0.000). In summary, the study effectively achieves its predetermined objectives by identifying and analyzing five social media factors influencing tourists' destination selection decisions in Ho Chi Minh City. Additionally, the research assesses the magnitude of their impact and examines disparities in research outcomes across different customer segments in Ho Chi Minh City concerning travel destination decisions. Based on these findings, the researcher proposes managerial implications to support tourism businesses in Vietnam intending to utilize social media platforms for advertising. These implications aim to furnish essential insights for selecting and prioritizing key factors when designing advertising campaigns on social media, thereby enhancing brand effectiveness.

Association between clinical and laboratory factors and response to sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes: a retrospective observational study

ABSTRACT Background This study aimed to investigate the association between clinical and laboratory parameters and response to therapy with sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2D). Research design and methods We retrospectively analyzed the medical records of people with T2D in whom SGLT2i was started. Clinical and laboratory parameters were recorded before, 3 and 6 months after starting treatment. Specific criteria were applied to classify participants into good and poor responders in terms of weight loss (primary outcome) and glycemic control (secondary outcome), separately. Results Fifty individuals (64% men) with a mean age of 65.8 ± 8.5 years were included in the analysis. 86% and 64% of the participants were classified into good response categories for glycemic control and weight loss, respectively. Good responders in terms of glycemic control had lower high-density lipoprotein cholesterol levels at baseline compared to poor responders (43.3 vs 57.4 mg/dl, p = 0.044). In the logistic regression analysis, a higher baseline weight was associated with a better response to therapy in terms of weight loss (p = 0.04). Conclusions Our findings suggest that specific clinical and laboratory parameters are associated with response to SGLT2i treatment and can contribute to a more personalized approach to T2D care.

The Surgical Stress Response and Anesthesia: A Narrative Review.

The human physiological response "to stress" includes all metabolic and hormonal changes produced by a traumatic event at the micro or macro cellular levels. The main goal of the body's first response to trauma is to keep physiological homeostasis. The perioperative non-specific adaptation response can sometimes be detrimental and can produce systemic inflammatory response syndrome (SIRS), characterized by hypermetabolism and hyper catabolism. We performed a narrative review consisting of a description of the surgical stress response's categories of changes (neurohormonal and immunological response) followed by reviewing methods found in published studies to modulate the surgical stress response perioperatively. We described various preoperative measures cited in the literature as lowering the burden of surgical trauma. This article revises the anesthetic drugs and techniques that have an impact on the surgical stress response and proven immune-modulatory effects. We also tried to name present knowledge gaps requiring future research. Our review concludes that proper preoperative measures, adequate general anesthetics, multimodal analgesia, early postoperative mobilization, and early enteral nutrition can decrease the stress response to surgery and ease patient recovery. Anesthetics and analgesics used during the perioperative period may modulate the innate and adaptive immune system and inflammatory system, with a consecutive impact on cancer recurrence and long-term outcomes.

Sustainable Employability of People with Limited Capability for Work: The Participatory Development and Validation of a Questionnaire.

Understanding sustainable employability (SE) of people with limited capability for work (LCW) due to physical or mental disability is crucial for the sustainable participation of this target group. Therefore, adequate measurement instruments for SE are needed. This study aims to validate a questionnaire to measure SE among people with LCW using a participatory approach, including person-job fit (PJ fit) and work-related sense of coherence (Work-SoC). Existing scales for the main concepts were tested and adapted for face validity via cognitive interviews (n = 6), with the involvement of a co-researcher with LCW in the research team. Next, the questionnaire was administered among people with LCW (n = 248) to assess its factor structure (Confirmatory Factor Analysis) and reliability (Cronbach's alpha). Analysis of the cognitive interviews identified problems with clarity and readability of items, instructions and response categories of used (existing) scales. The main adjustments concerned the shortening of text length, the usage of familiar language and examples, and the addition of an introduction game. Most of the adapted SE indicator scales showed an overall good fit and acceptable-to-good internal reliability. The overall SE model had an overall good fit, and excluding 'internal employability' further improved this fit. PJ fit and Work-SoC had an acceptable/good model fit and internal consistency. The participatory validation process resulted in a validated and comprehensive questionnaire to measure SE, PJ fit and Work-SoC among people with LCW, which enables research into the development of their SE. This questionnaire can be utilised to contribute to a more inclusive labour market.

A Web-Based, Respondent-Driven Sampling Survey Among Men Who Have Sex With Men (Kai Noi): Description of Methods and Characteristics.

Thailand's HIV epidemic is heavily concentrated among men who have sex with men (MSM), and surveillance efforts are mostly based on case surveillance and local biobehavioral surveys. We piloted Kai Noi, a web-based respondent-driven sampling (RDS) survey among MSM. We developed an application coded in PHP that facilitated all procedures and events typically used in an RDS office for use on the web, including e-coupon validation, eligibility screening, consent, interview, peer recruitment, e-coupon issuance, and compensation. All procedures were automated and e-coupon ID numbers were randomly generated. Participants' phone numbers were the principal means to detect and prevent duplicate enrollment. Sampling took place across Thailand; residents of Bangkok were also invited to attend 1 of 10 clinics for an HIV-related blood draw with additional compensation. Sampling took place from February to June 2022; seeds (21 at the start, 14 added later) were identified through banner ads, micromessaging, and in online chat rooms. Sampling reached all 6 regions and almost all provinces. Fraudulent (duplicate) enrollment using "borrowed" phone numbers was identified and led to the detection and invalidation of 318 survey records. A further 106 participants did not pass an attention filter question (asking recruits to select a specific categorical response) and were excluded from data analysis, leading to a final data set of 1643 valid participants. Only one record showed signs of straightlining (identical adjacent responses). None of the Bangkok respondents presented for a blood draw. We successfully developed an application to implement web-based RDS among MSM across Thailand. Measures to minimize, detect, and eliminate fraudulent survey enrollment are imperative in web-based surveys offering compensation. Efforts to improve biomarker uptake are needed to fully tap the potential of web-based sampling and data collection.

Abolition of coercion in mental health services – A European survey of feasibility

BackgroundIn 2019, the Council of Europe agreed to urge member states to take steps toward total abolition of psychiatric coercive measures. AimsTo test if this aspiration is perceived as realistic and what the alternative would be in the event of a total abolition, we surveyed members of the European FOSTREN network of mental health practitioners and researchers, which is specifically dedicated to exchanging knowledge on reducing psychiatric coercion to its minimum. MethodsWeb-based survey. Categorical responses were analyzed using frequencies, and free text responses were analyzed through thematic analysis. ResultsIn total, out of 167 invitations to FOSTREN network members, 76 responded to the survey (Response Rate 45.5%). A minority (31%) of participating experts dedicated to the reduction of psychiatric coercive measures believed a total abolition to be an achievable goal. A commonly held belief was that total abolition is not achievable because mental health disorders are difficult to treat and may cause violence, necessitating coercion, and there is a need to protect the involved persons from harm. Those responding that complete abolition is achievable argued that the consequences of coercion outweigh any gains and indicated that use of advance directives are sufficient as alternatives to coercion. ConclusionOf a European group of experts specifically dedicated to the reduction of psychiatric coercion who participated in this questionnaire study, a minority believed a total abolition be an achievable goal. The study adds to the empirical evidence of the feasibility of the aspiration to totally abolish involuntary measures in the mental health services from the perspective of experts.

Statistical Models for High-Risk Intestinal Metaplasia with DNA Methylation Profiling.

We consider the newly developed multinomial mixed-link models for a high-risk intestinal metaplasia (IM) study with DNA methylation data. Different from the traditional multinomial logistic models commonly used for categorical responses, the mixed-link models allow us to select the most appropriate link function for each category. We show that the selected multinomial mixed-link model (Model 1) using the total number of stem cell divisions (TNSC) based on DNA methylation data outperforms the traditional logistic models in terms of cross-entropy loss from ten-fold cross-validations with significant p-values 8.12×10-4 and 6.94×10-5. Based on our selected model, the significance of TNSC's effect in predicting the risk of IM is justified with a p-value less than 10-6. We also select the most appropriate mixed-link models (Models 2 and 3) when an additional covariate, the status of gastric atrophy, is available. When the status is negative, mild, or moderate, we recommend Model 2; otherwise, we prefer Model 3. Both Models 2 and 3 can predict the risk of IM significantly better than Model 1, which justifies that the status of gastric atrophy is informative in predicting the risk of IM.

Treatment-Responsive Acute Graft-versus-Host Disease after Post-Transplantation Cyclophosphamide-Based Prophylaxis: Incidence and Clinical Outcomes

Post-transplantation cyclophosphamide (PTCy) following hematopoietic cell transplantation (HCT) has emerged as standard of care for graft-versus-host disease (GVHD) prevention in adult patients without increasing malignant relapse. We previously defined acute GVHD (aGVHD) treatment response categories as corticosteroid-sensitive (SS), -dependent (SD), or -resistant (SR) based on response to first-line corticosteroids and reported their clinical outcomes following non-PTCy-based prophylaxis. More than one-third of patients developed aGVHD necessitating systemic therapy. Cases were predominantly SR, with a 14% overall incidence of SR aGVHD. The incidence and clinical outcomes of these 3 distinct aGVHD treatment response groups following PTCy-based prophylaxis have not been well described. The objective of this retrospective single-institution cohort study was to assess the incidence and clinical outcomes of SS, SD, and SR aGVHD following HCT with PTCy-based prophylaxis using a prophylactic regimen of PTCy, tacrolimus, and mycophenolate mofetil (MMF). We included 196 consecutive adult and pediatric patients undergoing allogeneic HCT for malignant and non-malignant disorders at the University of Minnesota between 2017 and 2021. Patients received PTCy on days +3 and +4 plus tacrolimus and MMF prophylaxis. Bone marrow and peripheral blood stem cell graft sources and related and unrelated donors were included. Recipients received myeloablative or reduced-intensity conditioning regimens. Of the 196 allografts, 54 (28%) developed aGVHD before day +180, with a median time to onset of 50 days (interquartile range, 34 to 71 days). Of those, 32 patients (16% overall) developed maximum grade II-III aGVHD necessitating systemic corticosteroids, with the following response: 13 SS (41%), 10 SD (31%), and 9 SR (28%). The overall incidence of SR aGVHD was 4.6%. Only 12 patients (6%) developed maximum grade III aGVHD, and none had grade IV aGVHD. The 2-year overall survival analyzed from 80 days after initiation of systemic treatment was similar in the SS and SD groups (77 and 75%, respectively), comparable to those without aGVHD (81%), and was lowest in the SR group (20%), with GVHD the primary cause of death. Nonrelapse mortality was highest in the SR group. MN high-risk and higher GVHD grade at onset were risk factors for developing SR aGVHD. Overall, we report a low incidence (16%) of aGVHD requiring systemic corticosteroids with PTCy-based prophylaxis. aGVHD cases were predominantly SS aGVHD, with lower incidences of SD and SR aGVHD. Our findings suggest that PTCy-based prophylaxis reduces the rate of treatment-resistant aGVHD. Patients with SR aGVHD had the worst clinical outcomes and poorest survival. Those with SS and SD aGVHD had similar clinical outcomes, both better than seen with SR aGVHD.

Development of a Self-Report Measure of Prediction in Daily Life: The Prediction-Related Experiences Questionnaire.

Predictions are complex, multisensory, and dynamic processes involving real-time adjustments based on environmental inputs. Disruptions to prediction abilities have been proposed to underlie characteristics associated with autism. While there is substantial empirical literature related to prediction, the field lacks a self-assessment measure of prediction skills related to daily tasks. Such a measure would be useful to better understand the nature of day-to-day prediction-related activities and characterize these abilities in individuals who struggle with prediction. An interdisciplinary mixed-methods approach was utilized to develop and validate a self-report questionnaire of prediction skills for adults, the Prediction-Related Experiences Questionnaire (PRE-Q). Two rounds of online field testing were completed in samples of autistic and neurotypical (NT) adults. Qualitative feedback from a subset of these participants regarding question content and quality was integrated and Rasch modeling of the item responses was applied. The final PRE-Q includes 19 items across 3 domains (Sensory, Motor, Social), with evidence supporting the validity of the measure's 4-point response categories, internal structure, and relationship to other outcome measures associated with prediction. Consistent with models of prediction challenges in autism, autistic participants indicated more prediction-related difficulties than the NT group. This study provides evidence for the validity of a novel self-report questionnaire designed to measure the day-to-day prediction skills of autistic and non-autistic adults. Future research should focus on characterizing the relationship between the PRE-Q and lab-based measures of prediction, and understanding how the PRE-Q may be used to identify potential areas for clinical supports for individuals with prediction-related challenges.

Factor retention in ordered categorical variables: Benefits and costs of polychoric correlations in eigenvalue-based testing

An essential step in exploratory factor analysis is to determine the optimal number of factors. The Next Eigenvalue Sufficiency Test (NEST; Achim, 2017) is a recent proposal to determine the number of factors based on significance tests of the statistical contributions of candidate factors indicated by eigenvalues of sample correlation matrices. Previous simulation studies have shown NEST to recover the optimal number of factors in simulated datasets with high accuracy. However, these studies have focused on continuous variables. The present work addresses the performance of NEST for ordinal data. It has been debated whether factor models – and thus also the optimal number of factors – for ordinal variables should be computed for Pearson correlation matrices, which are known to underestimate correlations for ordinal datasets, or for polychoric correlation matrices, which are known to be instable. The central research question is to what extent the problems associated with Pearson correlations and polychoric correlations deteriorate NEST for ordinal datasets. Implementations of NEST tailored to ordinal datasets by utilizing polychoric correlations are proposed. In a simulation, the proposed implementations were compared to the original implementation of NEST which computes Pearson correlations even for ordinal datasets. The simulation shows that substituting polychoric correlations for Pearson correlations improves the accuracy of NEST for binary variables and large sample sizes (N = 500). However, the simulation also shows that the original implementation using Pearson correlations was the most accurate implementation for Likert-type variables with four response categories when item difficulties were homogeneous.

Damage to monumental masonry buildings in Hatay and Osmaniye following the 2023 Turkey earthquake sequence: The role of wall geometry, construction quality, and material properties

Damage to monumental masonry buildings in Hatay and Osmaniye following the 2023 Turkey earthquake sequence: The role of wall geometry, construction quality, and material properties