Consensus Mean Research Articles

Navigating ChatGPT's alignment with expert consensus on pediatric OSA management

ObjectiveThis study aimed to evaluate the potential integration of artificial intelligence (AI), specifically ChatGPT, into healthcare decision-making, focusing on its alignment with expert consensus statements regarding the management of persistent pediatric obstructive sleep apnea. MethodsWe analyzed ChatGPT's responses to 52 statements from the 2024 expert consensus statement (ECS) on the management of pediatric persistent OSA after adenotonsillectomy. Each statement was input into ChatGPT using a 9-point Likert scale format, with each statement entered three times to calculate mean scores and standard deviations. Statistical analysis was performed using Excel. ResultsChatGPT's responses were within 1.0 of the consensus statement mean score for 63 % (33/52) of the statements. 13 % (7/52) were statements in which the ChatGPT mean response was different from the ECS mean by 2.0 or greater, the majority of which were in the categories of surgical and medical management. Statements with ChatGPT mean scores differing by more than 2.0 from the consensus mean highlighted the risk of disseminating incorrect information on established medical topics, with a notable variation in responses suggesting inconsistencies in ChatGPT's reliability. ConclusionWhile ChatGPT demonstrated a promising ability to align with expert medical opinions in many cases, its inconsistencies and potential to propagate inaccuracies in contested areas raise important considerations for its application in clinical settings. The findings underscore the need for ongoing evaluation and refinement of AI tools in healthcare, emphasizing collaboration between AI developers, healthcare professionals, and regulatory bodies to ensure AI's safe and effective integration into medical decision-making processes.

B-324 Pilot Study Result of EQA for Fecal Immunochemical Test for Hemoglobin Using a Novel Ready-to-Use Sample Material

Abstract Background The primary screening method for colorectal cancer is fecal immunochemical test (FIT) detecting human hemoglobin (Hb) in feces. There are several tests on the market both for automated analyzers and point-of-care testing (POCT). To ensure high quality results, the tests should be monitored with appropriate quality assessment procedures including participation in external quality assessment (EQA) programs. By participating in an EQA program using a stool-like material, clinical laboratories and POCT sites can fulfil the ISO 15189 requirements of monitoring the complete laboratory process from pre- to postanalytical phases in addition to the quantitative analytical phase of FIT. Here we present the first results of an international EQA pilot study for quantitative FIT using a novel ready-to-use stool-like material, performed by EQA provider Labquality. Methods 40 participants from 8 countries using 9 different FIT reagents were recruited for the pilot study performed in 2023. A set of artificial stool samples containing human hemoglobin uniformly was shipped to the participants at ambient temperature. The sample material is developed by HECTEF (Health Care Technology Foundation, Japan). The participants were instructed to collect the sample with their test specific sample collection kit and perform analysis according to the manufacturer’s instructions as a regular patient sample. Quantitative results (µg Hb/g feces) and qualitative interpretations (positive/negative) were reported in Labquality’s electronic platform LabScala. The quantitative target value was a method group consensus mean. A questionnaire regarding the usability of the sample material was sent to all participants. Results Sample S001 contained no Hb and all participants (40/40) reported a result corresponding to the lower detection limit of their test in use or a low numeric result most likely explained by unspecific background. All reported a negative interpretation. Sample S002 was a high positive sample for Hb. The measured value exceeded the upper detection limit of 4/9 tests (Exdia iFOB, Precision Biosensor; Fecal Occult Blood (iFOB) Neo, Boditech; FOB Test, VedaLab; NADAL FOB Quant test, Nal von Minden). The mean values and CV% were 116 µg/g and 8% for iFOBT, Aidian; 192 ug/g and 4% for Standard iFOB FIA, SD Biosensor; 144 µg/g and 45% for FOB assay kit FOB Gold, Sentinel Diagnostics (different clinical chemistry analyzers used); 91 µg/g and 26% for OC-Sensor FIT, Eiken Chemical. All participants responded a positive qualitative clinical interpretation. The majority of the responders on the feedback questionnaire (26/35) found the samples to be easy to use including comments of the sample being user-friendly and ready-to-use, resembling a patient sample and easy to apply with the test specific sample collection kit. Conclusions The fecal-like sample used in this Labquality’s EQA pilot study evaluates the complete analytical process including the preanalytical, analytical and postanalytical phases. An EQA scheme using this sample material is more compliant to ISO 15189 requirements compared to schemes where liquid or lyophilized samples are used. The new sample material used on this pilot study was positively received by most of the participants and it was compatible with all tests included in the study.

Analysis of sulfur in soil and plant digests using methane as a reaction gas for ICP-MS

Quantitation of sulfur (S) is vitally important for analysis of agricultural soil and plant samples due to the requirement of S in living organisms. Although inductively coupled plasma mass spectrometry (ICP-MS) is a commonly used and robust instrument for multi-elemental detection, S is usually analysed by ICP-optical emission spectroscopy (OES) since S quantitation poses a particular challenge for ICP-MS due to interferences on all S isotopes. The requirement for analysis by two instruments increases time and cost for sample analysis, hence analysis by one instrument is desirable. The use of reaction gases in ICP-MS can improve the performance by shifting S to a mass for detection where no interference is present. This work explored the potential of methane as a reaction gas for analysis of S in soil and plant samples to give users an alternative option to oxygen. The product ion clusters CH2SH+ were monitored (m/z 47 and 49 on ICP-MS and with mass shift of +15 from Q1 → Q2 using 32 → 47 and 34 → 49 on triple quadrupole ICP-MS). As expected, triple quadrupole ICP-MS performed better than single quadrupole ICP-MS containing a reaction cell due to the ability to preselect the m/z of choice and remove ions that may react with methane in the reaction cell. The method detection limit (MDL) was 150 mg kg−1 S for plants and 53 mg kg−1 S for soils which is fit for requirements. This is the first-time methane has been reported as a reaction gas for analysis of S and shows promising results for agricultural samples when using a triple quadrupole ICP-MS. Results compared well to those obtained via the more commonly used ICP-optical emission spectroscopy (OES) method with results <20 % for all samples. Interlaboratory comparison samples were within 2 Z-scores of the consensus mean. In the absence of ICP-MS/MS, Q-ICP-MS with detection of cluster m/z 47 was deemed to be suitable for detection of S in plant samples, with acceptable MDL (250 mg kg−1 S), acceptable precision (<20 % RSD) and <20 % variation to the reported ICP-OES result.

HUMANE: Harmonious Understanding of Machine Learning Analytics Network—global consensus for research on artificial intelligence in medicine

Aim: AI research, development, and implementation are expanding at an exponential pace across healthcare. This paradigm shift in healthcare research has led to increased demands for clinical outcomes, all at the expense of a significant gap in AI literacy within the healthcare field. This has further translated to a lack of tools in creating a framework for literature in the AI in medicine domain. We propose HUMANE (Harmonious Understanding of Machine Learning Analytics Network), a checklist for establishing an international consensus for authors and reviewers involved in research focused on artificial intelligence (AI) or machine learning (ML) in medicine. Methods: This study was conducted using the Delphi method by devising a survey using the Google Forms platform. The survey was developed as a checklist containing 8 sections and 56 questions with a 5-point Likert scale. Results: A total of 33 survey respondents were part of the initial Delphi process with the majority (45%) in the 36–45 years age group. The respondents were located across the USA (61%), UK (24%), and Australia (9%) as the top 3 countries, with a pre-dominant healthcare background (42%) as early-career professionals (3–10 years’ experience) (42%). Feedback showed an overall agreeable consensus (mean ranges 4.1–4.8, out of 5) as cumulative scores throughout all sections. The majority of the consensus was agreeable with the Discussion (Other) section of the checklist (median 4.8 (interquartile range (IQR) 4.8-4.8)), whereas the least agreed section was the Ground Truth (Expert(s) review) section (median 4.1 (IQR 3.9–4.2)) and the Methods (Outcomes) section (median 4.1 (IQR 4.1–4.1)) of the checklist. The final checklist after consensus and revision included a total of 8 sections and 50 questions. Conclusions: The HUMANE international consensus has reflected on further research on the potential of this checklist as an established consensus in improving the reliability and quality of research in this field.

Association of Physicians of India Expert Recommendations on Oral Fluid, Electrolytes, and Energy Management during Transition Care and Discharge for Hospitalized Patients with Nondiarrheal Illnesses.

Acute nondiarrheal illnesses (NDIs) involve overt or subclinical dehydration, requiring rehydration and electrolyte repletion. Dehydration is frequently under-recognized and under-managed, both in outpatient departments (OPDs) and inpatient departments (IPDs). Postadmission dehydration is associated with longer hospital stays and higher inhospital mortality rates. Recognizing and understanding dehydration in hospitalized patients is necessary due to the adverse outcomes associated with this condition. In this article, we aimed to develop practical consensus recommendations on the role of oral fluid, electrolyte, and energy (FEE) management in hospitalized patients with FEE deficits in NDI. The modified Delphi consensus methodology was utilized to reach a consensus. A scientific committee comprising eight experts from India formed the panel. Relevant clinical questions within three major domains were formulated for presentation and discussion: (1) burden and factors contributing to dehydration in hospitalized patients; (2) assessment of fluid and electrolyte losses and increased energy requirements in hospitalized patients; and (3) management of FEE deficits in hospitalized patients [at admission, during intravenous (IV) therapy, IV to oral de-escalation, and discharge]. The consensus level was classified into agreement (mean score ≥4), no consensus (mean score <4), and exclusion (mean score <4 after the third round of discussion). The questions that lacked agreement were discussed during the virtual meeting. The experts agreed that the most common factors contributing to dehydration in patients with NDI hospitalized in IPDs include decreased oral fluid intake, increased fluid loss due to the illness, insensible fluid loss, and a lack of awareness among doctors about dehydration, which can result in poor fluid intake. Time constraints, discontinuity of care, lack of awareness of the principles of fluid balance, lack of formal procedures for enforcing hydration schemes, and lack of adequate training are most often barriers to the assessment of hydration status in hospital settings. Experts used hydration biomarkers, such as changes in body weight, serum, or plasma osmolality; fluid intake; and fluid balance charts; along with urine output, frequency, quantity, and color, to determine hydration status in hospital settings. Experts agreed that appropriate FEE supplementation in the form of ready-to-drink (RTD) fluids can restore FEE deficits and shorten the length of hospital stays in hospitalized patients at admission, during de-escalation from IV to oral therapy, and at discharge. RTD electrolyte solutions with known concentrations of electrolytes and energy are good choices to avoid taste fatigue and replenish FEE in hospitalized patients during transition care and at discharge.

Comparison of ChatGPT knowledge against 2020 consensus statement on ankyloglossia in children

ObjectiveThis paper evaluates ChatGPT's accuracy and consistency in providing information on ankyloglossia, a congenital oral condition. Assessing alignment with expert consensus, the study explores potential implications for patients relying on AI for medical information. MethodsStatements from the 2020 clinical consensus statement on ankyloglossia were presented to ChatGPT, and its responses were scored using a 9-point Likert scale. The study analyzed the mean and standard deviation of ChatGPT scores for each statement. Statistical analysis was conducted using Excel. ResultsAmong the 63 statements assessed, 67 % of ChatGPT responses closely aligned with expert consensus mean scores. However, 17 % (11/63) were statements in which the ChatGPT mean response was different from the CCS mean by 2.0 or greater, raising concerns about ChatGPT's potential influence in disseminating uncertain or debated medical information. Variations in mean scores highlighted discrepancies, with some statements showing significant deviations from expert opinions. ConclusionWhile ChatGPT mirrored medical viewpoints on ankyloglossia, alignment with non-consensus statements raises caution in relying on it for medical advice. Future research should refine AI models, address inaccuracies, and explore diverse user queries for safe integration into medical decision-making. Despite potential benefits, ongoing examination of ChatGPT's power and limitations is crucial, considering its impact on health equity and information access.

Investigating the Current Harmonization Status of Tumor Markers Using Global External Quality Assessment Programs: A Feasibility Study.

The harmonization status of most tumor markers (TMs) is unknown. We report a feasibility study performed to determine whether external quality assessment (EQA) programs can be used to obtain insights into the current harmonization status of the tumor markers α-fetoprotein (AFP), prostate specific antigen (PSA), carcinoembryonic antigen (CEA), cancer antigen (CA)125, CA15-3 and CA19-9. EQA sample results provided by 6 EQA providers (INSTAND [Germany], Korean Association of External Quality Assessment Service [KEQAS, South Korea], National Center for Clinical Laboratories [NCCL, China], United Kingdom National External Quality Assessment Service [UK NEQAS, United Kingdom], Stichting Kwaliteitsbewaking Medische Laboratoriumdiagnostiek [SKML, the Netherlands], and the Royal College of Pathologists of Australasia Quality Assurance Programs [RCPAQAP, Australia]) between 2020 and 2021 were used. The consensus means, calculated from the measurement procedures present in all EQA programs (Abbott Alinity, Beckman Coulter DxI, Roche Cobas, and Siemens Atellica), was used as reference values. Per measurement procedure, the relative difference between consensus mean for each EQA sample and the mean of all patient-pool-based EQA samples were calculated and compared to minimum, desirable, and optimal allowable bias criteria based on biological variation. Between 19040 (CA15-3) and 25398 (PSA) individual results and 56 (PSA) to 76 (AFP) unique EQA samples were included in the final analysis. The mean differences with the consensus mean of patient-pool-based EQA samples for all measurement procedures were within the optimum bias criterion for AFP, the desirable bias for PSA, and the minimum bias criterion for CEA. However, CEA results <8 µg/L exceeded the minimum bias criterion. For CA125, CA15-3, and CA19-9, the harmonization status was outside the minimum bias criterion, with systematic differences identified. This study provides relevant information about the current harmonization status of 6 tumor markers. A pilot harmonization investigation for CEA, CA125, CA15-3, and CA19-9 would be desirable.

A liquid chromatography-tandem mass spectrometry method for the analysis of dehydroepiandrosterone sulphate (DHEAs) in serum and plasma with comparison to an immunoassay method in a neonatal population

The measurement of dehydroepiandrosterone-sulphate (DHEAs) is an important second-line test to aid in the diagnosis of premature adrenarche, peripubertal gynaecomastia in males and in identifying the source of elevated androgens in females. Historically, DHEAs has been measured by immunoassay platforms which are prone to poor sensitivity and more importantly poor specificity. The aim was to develop an LC-MSMS method for the measurement of DHEAs in human plasma and serum, develop an in-house paediatric (<6 year old) reference limit and compare the performance against the Abbott Alinity DHEAs immunoassay method.Following pre-treatment with an internal standard, samples were loaded onto EVOLUTE® EXPRESS ABN plate. Analytes were separated with reverse-phase chromatography using ACQUITY® UPLC® HSS T3 2.1 mm × 50 mm, 1.8 μm column. Mass spectrometry detection was performed using a Waters® Xevo TQ-XS in electrospray negative mode. For the paediatric reference range, samples were collected from an inpatient setting (age ≤ 6 years old) with no evidence of adrenal dysfunction or history of/current steroid use. The method comparison was performed using samples from this cohort aged between 0 and 52 weeks.The assay demonstrated linearity up to 15 µmol/L (r2 > 0.99) with a functional sensitivity of 0.1 µmol/L. Accuracy results revealed a mean bias of 0.7% (−14% to 15%) when compared against the NEQAS EQA LC-MSMS consensus mean (n = 48). The paediatric reference limit was calculated as ≤ 2.3 µmol/L (95% C.I. 1.4 to 3.8 µmol/L) for ≤ 6 year olds (n = 38). Comparison of neonatal (<52 weeks) DHEAs with the Abbott Alinity revealed that the immunoassay ran at a 166% positive bias (n = 24) which appeared to lessen with increasing age.Described is a robust LC-MSMS method for the measurement of plasma or serum DHEAs validated against internationally recognised protocols. Comparison of paediatric samples of <52 weeks against an immunoassay platform demonstrated that in the immediate new-born period results generated from the LC-MSMS method offer superior specificity than an immunoassay platform.

Efficient calculation of radiative intensity in three-dimensional atmospheres based on the Pn-IMS truncation method with a backward ray tracing system

The computational efficiency of solving the radiative transfer (RT) equation is an important issue for remote sensing and the monitoring of aerosols, clouds, and radiation, all of which involve the analysis of large volumes of data. In this study, based on the Improved Multiple and Single scattering (IMS) correction method, a backward ray tracing method was developed for the three-dimensional RT calculation (3D-IMS). We extended the IMS method to the 3D-RT problem using a backward ray tracing Monte Carlo system for calculation of both upward and downward radiance fields. In the 3D-IMS method, photons are assumed to be of two orthogonal types: one has less anisotropic scattering, while the other has highly anisotropic scattering decomposed by the delta-M method of Wiscombe (1977) to truncate a spherical harmonics expansion series. In this manner, an accurate radiance field is reconstructed by two separated ray tracings in the two independent spaces (i.e., delta-M and IMS spaces). Compared to the ordinary Monte Carlo method with the original phase function, the 3D-IMS method can better reduce the total photon number for the reconstruction of radiances. The performance of the 3D-IMS method was evaluated for plane-parallel atmospheres and for the case-4 experiment datasets of the Intercomparison of 3D Radiation Codes (I3RC) project. Among solvers included in the intercomparison, in cases with both completely backward and lateral scattering regions, the 3D-IMS method belonged to the group near the I3RC consensus mean data.

Theoretical Difference and the Significance of Experimental Setting in Nursing Education

Aim: The medical classroom management has been validated as an important component of a nursing curriculum, providing learners with different learning knowledge in which classroom philosophy in addition abilities are pushed to limit in real-life scenarios. Methods: This researcher used a mixed qualitative cross-sectional methodology that lasted a year, from October 2020 to September 2021. Topics were readily chosen from among the accessible students in the Lahore’s six primary health centers. Results: According to the data, the majority of students (58.4 percent) remained enrolled in senior stage of program. Here seemed to be clear consensus (Mean 4.6, t = 9.2) among student nurses concerning the function of environment accessibility in narrowing the hypothesis gap, with the procedure of orientation to the site of training capturing the highest score (mean= 5.8, 79 percent). From the other hand, the survey found high borderline disagreement (4.6, 69 percent) concerning the presence of simulated labs at nursing colleges, which may represent the existing decreased existence of simulator in several nursing institutions in Lahore. Conclusion: There is really no doubt that the discrepancy occurrence exists and has advantages and disadvantages that may then remain enhanced through harmonizing theoretical nursing method only through patient care methodology and providing chances for both medical teachers also students to collaborate in the somewhat extra creative medical setting. Keywords: medical classroom management, real-life scenarios, nursing education.

델파이 절차를 통한 재난정신건강지원 인력의 역할 및 자격 제안

This study aimed to derive expert consensus regarding roles and responsibilities of disaster mental health personnel using a Delphi process. The Delphi panel was composed of twenty multidisciplinary experts from the field of psychology, nursing, social welfare, and psychiatry. Based on literature review, focus group interviews, and a public forum, 20 categories and 69 subdivisions of roles and responsibilities of disaster mental health workforce were developed. The Dephi panel assessed relevance of the content and suggested qualified mental health personnel for each role and responsibility. The result indicated that expert consensus was derived for all 20 categories and 69 subdivisions, with the consensus mean of 8 or above on a scale of 1 to 10. On the other hand, there was a slight difference in expert consensus regarding qualifications of personnel to perform each role and responsibility. These results were based on the viewpoints of experts, and thus its clinical applications and practical utility in the disaster mental health field were discussed.

Training Radiologists to Interpret Contrast-enhanced Mammography: Toward a Standardized Lexicon.

Using terms adapted from the BI-RADS Mammography and MRI lexicons, we trained radiologists to interpret contrast-enhanced mammography (CEM) and assessed reliability of their description and assessment. A 60-minute presentation on CEM and terminology was reviewed independently by 21 breast imaging radiologist observers. For 21 CEM exams with 31 marked findings, observers recorded background parenchymal enhancement (BPE) (minimal, mild, moderate, marked), lesion type (oval/round or irregular mass, or non-mass enhancement), intensity of enhancement (none, weak, medium, strong), enhancement quality (none, homogeneous, heterogeneous, rim), and BI-RADS assessment category (2, 3, 4A, 4B, 4C, 5). "Expert" consensus of 3 other radiologists experienced in CEM was developed. Kappa statistic was used to assess agreement between radiologists and expert consensus, and between radiologists themselves, on imaging feature categories and final assessments. Reproducibility of specific feature descriptors was assessed as fraction of consensus-concordant responses. Radiologists demonstrated moderate agreement for BPE, (mean kappa, 0.43; range, 0.05-0.69), and lowest reproducibility for "minimal." Agreement was substantial for lesion type (mean kappa, 0.70; range, 0.47-0.93), moderate for intensity of enhancement (mean kappa, 0.57; range, 0.44-0.76), and moderate for enhancement quality (mean kappa, 0.59; range, 0.20-0.78). Agreement on final assessment was fair (mean kappa, 0.26; range, 0.09-0.44), with BI-RADS category 3 the least reproducible. Decision to biopsy (BI-RADS 2-3 vs 4-5) showed moderate agreement with consensus (mean kappa, 0.54; range, -0.06-0.87). With minimal training, agreement for description of CEM findings by breast imaging radiologists was comparable to other BI-RADS lexicons.

Lateral vs. Supine Positioning for Femoral Intramedullary Nailing: A Systematic Review of Comparative Studies

Femoral shaft fractures are devastating injuries that usually result from high-energy mechanisms in victims of poly-trauma. Reamed and statically locked intramedullary nailing (IMN) is the definitive treatment modality for femoral shaft fractures. Patients are most commonly positioned either supine or lateral decubitus. There remains considerable concern regarding the safety of lateral positioning in the traumatized patient, particularly in the management of a potentially difficult airway or concomitant C-spine injuries. We therefore undertook a systematic review of intraoperative positioning among patients with femoral shaft fractures following PRISMA guidelines. Title and abstract screening, full text screening, and data abstraction were all completed in duplicate. Methodological Index for Nonrandomized Studies (MINORS) scores were used to evaluate methodological quality. Results: 3018 studies were included in initial screening, with three studies ultimately meeting all inclusion criteria. A total of 1,949 patients were analyzed, with 684 patients treated in lateral positioning and 1,215 patients in supine positioning. Level of agreement was strong across title (κ = 0.872; 95% CI 0.794 to 0.951), abstract (κ = 0.801; 95% CI 0.585 to 1.000), and full-text screening (κ = 1.000). The consensus mean MINORS score of included studies was 17.67 ± 0.58, indicating good to high quality of evidence. Neither patient positioning offered obvious benefits such as fewer complications or shorter operative time. Furthermore, length of admission, days in ICU or on ventilator, and overall morbidity were not found to be significantly different between positions. Lateral positioning for intramedullary nailing of mid-shaft femur fractures appears to be a safe alternative to the standard supine positioning. There is a lack of both prospective and retrospective comparative studies investigating functional clinical outcomes in the literature.

Performance of Norudia Glycated Albumin Assay on Multiple Analytical Platforms and Comparison to Lucica Assay.

The Norudia glycated albumin (GA) assay was evaluated for analytical performance and assay applicability on multiple analytical platforms. The evaluation included precision, linearity, reference interval, and comparison with Lucica GA assay. A multicenter study was conducted to compare the results of Norudia GA assay on five kinds of widely used automated clinical chemistry analyzers. Within-laboratory imprecisions for GA% presented 1.3 - 3.3% and 0.8 - 2.6% for low- and high-level control materials, respectively, on different analyzers. GA assay was linear from 20.0 to 680.0 µmol/L of GA. The claimed reference range (12 - 16 GA%) was verified. Norudia GA showed a good GA% correlation with Lucica GA (correlation coefficient 0.999). GA% from each analyzer showed good correlation with the consensus mean of the results of five analyzers (correlation coefficient 0.997 - 0.999). The Norudia GA assay can successfully be implemented in all the tested platforms, with good GA% correlation.

Laboratory Performance of Serum Holotranscobalamin Assay in the United Kingdom (UK) As Assessed By the UK National External Quality Assessment Scheme for Haematinics

Background Although serum B12 assay is the most commonly used routine test for assessing cobalamin status in the body, it has its limitations (Mackenzie F and Devalia V (2018) Laboratory performance of serum B12 assay in the United Kingdom (UK) as assessed by the UK National External Quality Assessment Scheme for haematinics: implications for clinical interpretation. BLOOD, 132, suppl 1, 2230). Holotranscobalamin assay(HoloTC), also known as 'Active B12' assay, is an alternative test which is increasingly used as a first line test since it is felt to represent the assessment of the functional component of the cobalamin status of the body, and possibly a more relevant assessment clinically. However, its technical performance in terms of reliability and suitability in a routine diagnostic laboratory for clinical assessment has not been published. In the United Kingdom, there are over 30 laboratories performing the assay using five different platforms. The numerical value obtained of any sample can vary considerably between the different methodologies used.. External quality assessment of the assays is organised by UK NEQAS for Haematinics by sending three serum samples every 3 months. An 'all participants' consensus mean is calculated and used as the target value and the results analysed with respect to intra-group variation. The percentage bias from the target value is used to assess performance. Aim We present data on one such assessment to demonstrate the performance of the serum holotranscobalamin assay (Survey number 248, April 2018) and also how it is interpreted by the laboratory for clinical use. Method Three serum samples with a HoloTC target value of approximately 7.98 (low/indeterminate), 35.7 (normal/indeterminate) and 53.2 (normal) pmol/L were sent to participating laboratories for analysis (labelled as 248A, B and C respectively: see figure 1). Laboratories were also asked for an interpretation of their result which would be reported to the requesting clinician, namely from low to high (see figure 2). Results Fig 1 shows an individual laboratory's result in relation to all laboratories using the same technology (shaded histogram) or all methods (open histogram). There is a significant variation with an overall co-efficient of variation of around 10% within all the three different samples. Fig 2 shows the distribution of results in the different methodologies used and how each laboratory interpreted its result. It demonstrates the bias of results obtained by the different methods.The vast majority use the Abbot Architect (AB13) platform, and there is a suggestion of a trend of the results obtained to lie on the lower side than the other platforms used. For sample 248A, all laboratories reported it as 'low' or deficient. For sample 248B, there is a significant variation is reporting the sample as 'low', 'normal' or 'indeterminate' within the same platform used, clearly seen in the Abbot Architecture group. Indeed, the interpretation provided by the laboratory varies even with the same numerical value of the result. Discussion These data demonstrate that serum HoloTC assay has an overall co-efficient of variation around 10%. The numerical value obtained of any sample can vary considerably according to the technology used, and the clinical interpretation provided by the laboratory can be variable and not entirely concordant with the numerical result of the assay used. This is particularly evident around the 30-40 pmol/L range. This may be partly explained by the fact that it is not quite clear what would be regarded as the normal or reference range, which has been previously taken as 40 - 200 pmol/L (according to previous publications). Conclusion The UK NEQAS Haematinics Programme is unique in providing external quality assessment for laboratories using HoloTC assays for determining body cobalamin status in a style that is also unique across EQA/ PT schemes. Laboratories need to assess their performance in analysis of serum HoloTC levels in order to provide appropriate clinical advice. Ideally clinicians should be aware of the limitations of the HoloTC assay as demonstrated in this external quality assessment scheme exercise. Disclosures No relevant conflicts of interest to declare.

Validating curricular competencies in innovation and entrepreneurship for biomedical research trainees: A modified Delphi approach.

Biomedical researchers need skills in innovation and entrepreneurship (I&E) to efficiently translate scientific discoveries into products and services to be used to improve health. In 2016, the European Union identified and published 15 entrepreneurial competencies (EntreComp) for the general population. To validate the appropriateness of these competencies for I&E training for biomedical researchers and to identify program content, we conducted six modified Delphi panels of 45 experts (6-9 per panel). Participating experts had diverse experience, representing such fields as entrepreneurship, academic research, venture capital, and industry. The experts agreed that all 15 EntreComp competencies were important for biomedical research trainees and no additional competencies were identified. In a two-round Delphi process, the experts identified 120 topics to be included in a training curriculum. They rated the importance of each topic using a 5-point scale from not at all important (1) to extremely important (5) for two student groups: entrepreneurs (those interested in starting their own ventures) and intrapreneurs (those wanting to be innovative and strategic within academia or industry). Consensus (mean importance score >4) was reached that 85 (71%) topics were of high importance for the curriculum. Four topics were identified by multiple panels for both student groups: resiliency, goal setting, team management, and communication skills. I&E training for biomedical trainees should address all 15 EntreComp competencies, including "soft skills," and be flexible to accommodate the needs of trainees on different career trajectories.

PB2280 LABORATORY PERFORMANCE OF SERUM FOLATE ASSAY IN THE UNITED KINGDOM (UK) AS ASSESSED BY THE UK NATIONAL EXTERNAL QUALITY ASSESSMENT SCHEME FOR HAEMATINICS: IMPLICATIONS FOR CLINICAL INTERPRETATION

Background:Serum Folate assay is the most commonly used routine test for assessing folate status in the body. In the United Kingdom, there are around 320 laboratories performing the assay using nine different platforms. External quality assessment of the assays is organised by UK NEQAS for Haematinics by sending a serum sample every 3 months. An ‘all participants’ consensus mean is calculated and used as the target value and the results analysed with respect to intra‐ and inter‐ group variation.The percentage bias from the target value is used to assess performance.Aims:We present data on one such assessment to demonstrate the problems of the serum folate assay (Survey number 248, April 2018) and also how it is interpreted by the laboratory for clinical use.Methods:A serum sample with a folate target value of approximately 2.84 μg/L was sent to participating laboratories for analysis. Laboratories were also asked for an interpretation of their result which would be reported to the requesting clinician, namely from low to high.Results:Fig 1 shows an individual laboratory's result (indicated by the arrow) in relation to all laboratories using the same technology (shaded histogram) or all methods (open histogram).There is a significant variation ranging from 1.6 to 4.0 μg/L depending on the assay used, with an overall standard deviation of 0.34 and co‐efficient of variation of 11.9 %.Fig 2 shows the distribution of results in the different methodologies used and how each laboratory interpreted its result. It demonstrates the bias of results obtained by the different methods.The assays using BO5 gave lower results than other methods, with CO 10 showing slightly higher results.Most strikingly there is no consistency both between methods and within methods for interpreting the sample as ‘normal’, ‘deficient’, or ‘indeterminate’ in relation to the numerical value obtained. For example, within the group using BO5, one laboratory reported its level of 3.6 μg/L as ‘low’ despite the result being the highest within its group. Within the full range of results obtained by all groups, there is variable reporting of ‘low’ and ‘normal.Summary/Conclusion:The numerical value obtained of any sample can vary considerably between the different methodologies used. In addition, the interpretation provided by the laboratory can also be highly variable. This may have profound implications for clinical assessment and management. In addition, this is compounded by the fact that it is not quite clear what the reference range is. Our data shows that the different reference ranges quoted by the kit manufacturers do not correspond to their assay bias, ie there is no simple direct correlation between the ranges provided against the bias of their particular assay.Conclusion:The UK NEQAS Haematinics Programme has demonstrated variable performance of the serum folate assay in terms of results obtained, bias and interpretation of results in a style that is unique across EQA/PT schemes. Laboratories and Clinicians need to be aware of the of the shortcomings in assessing serum folate levels in order to provide appropriate clinical advice.image

PB2273 LABORATORY PERFORMANCE OF SERUM HOLOTRANSCOBALAMIN ASSAY IN THE UNITED KINGDOM (UK) AS ASSESSED BY THE UK NATIONAL EXTERNAL QUALITY ASSESSMENT SCHEME FOR HAEMATINICS

Background:Although serum B12 assay is the most commonly used routine test for assessing cobalamin status in the body, it has its limitations (Mackenzie F and Devalia V (2018) Laboratory performance of serum B12 assay in the United Kingdom (UK) as assessed by the UK National External Quality Assessment Scheme for haematinics: implications for clinical interpretation. BLOOD, 132, suppl 1, 2230). Holotranscobalamin assay is an alternative test which is increasingly used as a first line test since it is felt to represent the assessment of the functional component of the cobalamin status and possibly a more relevant assessment clinically. However, its technical performance in terms of reliability and suitability in a routine diagnostic laboratory for clinical assessment has not been published. In the United Kingdom, there around 31 laboratories performing the assay using five different platforms. The numerical value obtained of any sample can vary considerably between the different methodologies used. It is not quite clear what would be regarded as the normal or reference range, but it has been previously taken as 40 – 200 pmol/L. External quality assessment of the assays is organised by UK NEQAS for Haematinics by sending three serum samples every 3 months. An ‘all participants’ consensus mean is calculated and used as the target value and the results analysed with respect to inter and intra‐group variation. The percentage bias from the target value is used to assess performance.Aims:We present data on one such assessment to demonstrate the performance of the serum holotranscobalamin assay and also how it is interpreted by the laboratory for clinical use.Methods:Three serum samples with a HoloTC target value of approximately 16.89 (low/indeterminate), 44,7 (normal) and 72.4 μg/L (high normal) were sent to participating laboratories for analysis. Laboratories were also asked for an interpretation of their result which would be reported to the requesting clinician, namely from low to high.Results:Fig 1 shows an individual laboratory's result (indicated by the arrow) in relation to all laboratories using the same technology (shaded histogram) or all methods (open histogram). There is a significant variation with an overall co‐efficient of variation of around 11% within all the three different samples. Fig 2 shows the distribution of results in the different methodologies used and how each laboratory interpreted its result. It demonstrates the bias of results obtained by the different methods. The assays using Beckman Coulter Access/Dxl (SF5 and SF6) gave much lower results than other methods. In the group SF5, three laboratories interpreted the result as ‘normal’ and one as ‘indeterminate’. In the groups Abbot Architect (AB13) and Roche Cobas/Modular (BO5), although having higher results than other groups, there are significant laboratories interpreting the result as ‘low’ and also ‘normal’ or ‘indeterminate’.Summary/Conclusion:These data demonstrate that serum HoloTC assay has an overall co‐efficient of variation around 11%. The numerical value obtained of any sample can vary considerably although the clinical interpretation provided by the laboratory does not seem to be markedly discordant. Conclusion: The UK NEQAS Haematinics Programme is unique in providing external quality assessment for laboratories using HoloTC assays for determining body cobalamin status in a style that is also unique across EQA/ PT schemes. As a result, laboratories are made aware of their performance in assessing serum HoloTC level in order to provide appropriate clinical advice.image

Current state of the global operational aerosol multi-model ensemble: An update from the International Cooperative for Aerosol Prediction (ICAP).

Since the first International Cooperative for Aerosol Prediction (ICAP) multi‐model ensemble (MME) study, the number of ICAP global operational aerosol models has increased from five to nine. An update of the current ICAP status is provided, along with an evaluation of the performance of ICAP‐MME over 2012–2017, with a focus on June 2016–May 2017. Evaluated with ground‐based Aerosol Robotic Network (AERONET) aerosol optical depth (AOD) and data assimilation quality MODerate‐resolution Imaging Spectroradiometer (MODIS) retrieval products, the ICAP‐MME AOD consensus remains the overall top‐scoring and most consistent performer among all models in terms of root‐mean‐square error (RMSE), bias and correlation for total, fine‐ and coarse‐mode AODs as well as dust AOD; this is similar to the first ICAP‐MME study. Further, over the years, the performance of ICAP‐MME is relatively stable and reliable compared to more variability in the individual models. The extent to which the AOD forecast error of ICAP‐MME can be predicted is also examined. Leading predictors are found to be the consensus mean and spread. Regression models of absolute forecast errors were built for AOD forecasts of different lengths for potential applications. ICAP‐MME performance in terms of modal AOD RMSEs of the 21 regionally representative sites over 2012–2017 suggests a general tendency for model improvements in fine‐mode AOD, especially over Asia. No significant improvement in coarse‐mode AOD is found overall for this time period.

Organochlorine Pesticides in Ginseng Root

Ginseng is one of the most important traditional herbal medicines for health care and treatment of diseases. Trading of ginseng and related products is a multi-million dollar business. Four major countries including South Korea, China, Canada and the United States are the biggest producers and account for more than 99% of the total ginseng production around the world (i.e. about 80,000 tons). The Commission Regulation of European Union sets up that the maximum residue level (MRL) for hexachlorocyclohexane (sum of alpha, beta and delta isomers, except lindane) is 0.02 mg/kg and that for lindane is 1 mg/kg in ginseng. The use of reliable methods for measurement of these organochlorine pesticides is important in safeguarding the quality of ginseng and related products and public health.The Government Laboratory, Hong Kong (GLHK) previously coordinated and completed CCQM-K95 "Mid-polarity Analytes in Food Matrix: Mid-polarity Pesticides in Tea". Two organochlorine pesticide residues,beta-endosulfan and endosulfan sulfate, were selected for analysis. It is noteworthy that participating institutes in CCQM-K95 found that wetting of test samples prior to extraction was crucial for complete extraction of the incurred analytes in the test material of dried tea. It is apparent that sample extraction is a real technical challenge in the analysis of dried plant material.Ginseng root is collected after years of cultivation. It represents a higher level of analytical challenge for the participating national metrology institutes (NMIs) and designated institutes (DIs) in measuring the incurred organochlorine pesticides in dried ginseng/ginseng root, where the pesticides have been gradually accumulated in the plant material for several years. In this regard, GLHK proposed a new APMP supplementary comparison on determination of organochlorine pesticides in ginseng root at the APMP TCQM meeting in November 2015. The supplementary comparison was further discussed at the CCQM OAWG meeting in April 2016. The Chair of APMP TCQM approved the proposed supplementary comparison for 2016/17 with a study number of APMP.QM-S11 in May 2016. To allow wider participation, a pilot study APMP.QM-P32, was run in parallel with this supplementary comparison.Evidence of successful participation in formal, relevant international comparisons is needed to document calibration and measurement capability claims (CMCs) made by national metrology institutes (NMIs) and designated institutes (DIs).Seven NMIs/DIs participated in this Supplementary Comparison APMP.QM-S11 Organochlorine pesticides in ginseng root. Participants were requested to evaluate the mass fractions, expressed in μg/kg, of alpha-hexachlorocyclohexane (α-BHC, CAS No. 319-84-6) and gamma-hexachlorocyclohexane (Lindane, CAS No. 58-89-9) in a relatively complex food/plant material, termed ginseng root. The purpose of the comparison is to enable participating laboratories to demonstrate their capability in the determination of organochlorine pesticides in a relatively complex food/plant material. All participating laboratories performed wetting before extraction. Different extraction methods such as soxhlet extraction, accelerated solvent extraction, ultrasonic extraction, QuEChERS technique, shaking and vortex were used among the participants. For the instrumental analysis, all laboratories employed GC techniques for chromatographic separation and most laboratories used MS related techniques for detection and quantification. For α-BHC, the consensus mean was 413 μg/kg with standard deviation of 35.3 μg/kg from 4 participating institutes' results. For lindane, the consensus mean was 104 μg/kg with standard deviation of 10.9 μg/kg from 5 participating institutes' results.Successful participation in APMP.QM-S11 demonstrates the following measurement capabilities in determining mass fraction of organic compounds, with molecular mass of 100 g/mol to 500 g/mol, having low polarity pKow < -2, in mass fraction range from 10 μg/kg to 1000 μg/kg in food/plant matrices.KEY WORDS FOR SEARCHGinseng, Organochlorine Pesticide, alpha-hexachlorocyclohexane, gamma-hexachlorocyclohexane, Lindane, α-BHCMain textTo reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).