Background. Accurate anatomical assessment is essential for pre-procedural planning in structural heart disease. Advanced 3D imaging could offer improved visualization for more accurate reconstruction. We assessed the performance of a novel immersive 3D virtual reality (VEA) for the pre-procedural planning of transcatheter aortic valve implantation (TAVI) candidates. Methods. Measurement of cardiac-gated contrast-enhanced computed tomography (CT) scans was performed with the novel VEA and established tools: 3Mensio and Horos. Results. 50 consecutive patients were included. Annular and LVOT measurements obtained with VEA were strongly correlated with those derived from standard CT analysis. The intraclass correlation coefficient (ICC) confirmed excellent consistency for annular measurements (ICC = 0.93), while the concordance correlation coefficient indicated very good overall agreement (CCC = 0.83, 95% CI 0.73–0.90). Similarly, LVOT measurements obtained with VEA showed strong correlation with CT values, with good consistency (ICC = 0.90) and good overall agreement (CCC = 0.77, 95% CI 0.64–0.86). VEA-based planning improved prosthesis size selection accuracy, achieving higher concordance with implanted valves and a significant net reclassification gain over conventional CT. Conclusions. Given the increasing use of advanced 3D cardiac imaging technologies, understanding their diagnostic accuracy to guide pre-procedural planning of TAVI is paramount. In our study, VEA provided reliable assessment of aortic root anatomy for TAVI planning. This novel 3D software provides accurate, patient-specific reconstructions of the aortic root and surrounding structures that may optimize valve sizing, improve procedural safety and enhance procedural outcomes. This provides a rationale for future studies to assess the procedural benefit derived from a three-dimensional assessment of the aortic valve geometry.

The Mean flow index (Mxa) is widely used to assess dynamic cerebral autoregulation in different clinical populations. This calculation is based on defined characteristics, including blocks, overlap periods, and epochs of the whole recordings. This study aimed to investigate the reproducibility of different Mxa calculations, using variable blocks, overlap periods, and epochs. We retrospectively analyzed 50 transcranial Doppler recordings from septic shock patients, acquired within 48h of ICU admission. Mxa was computed using eight signal-processing strategies that varied by block duration (5-10s), overlap percentage (20%, 50%, 80%), and epoch length (3-5min), as well as a continuous approach without epochs. Each configuration was labeled using the format epoch-block-overlap. Mxa values were compared using repeated measures analyses, intraclass correlation coefficients (ICC), Bland-Altman plots, and polychoric correlation heatmaps. Median Mxa values ranged from 0.36 to 0.45 across configurations, with no statistically significant differences in within-patient comparisons (p > 0.05). ICCs demonstrated excellent agreement (ICC > 0.90) between approaches using the same epoch duration. Agreement declined modestly when comparing configurations with different epoch lengths (e.g., ICC = 0.782 between 3-10-50 and 5-10-50). Fixed-effects analysis did not identify any individual segmentation parameter as a significant source of variability. Mxa values calculated using different combinations of block, overlap, and epoch duration were consistent within patients, particularly when epoch length was maintained. These findings support the reproducibility of Mxa and suggest flexibility in processing strategies, provided methodological consistency is maintained. Further validation is warranted.

While numerous tools exist for grip strength measurement, there is a lack of research for assessing the individual finger flexor strength. This study aimed to evaluate the test-retest reliability of measuring individual finger flexion strength in healthy adults using the smallest bulb of the Martin Vigorimeter (MV). Grip strength of 100 adults without hand pathology was measured using the large bulb of the MV, while individual finger flexor strength was assessed using the small bulb. Measurements were repeated after 3 weeks to evaluate test-retest reliability. Contribution of each finger flexor was calculated and compared to the previously reported values obtained using specialized equipment or protocol. The MV showed excellent reliability for grip strength (intraclass correlation coefficient > 0.9) and good-to-excellent reliability for individual finger flexor strength (intraclass correlation coefficient = 0.805-0.914). The middle finger contributed the most (approximately 30%), followed by the index and ring fingers (25%-26%), which were comparable to values previously reported using specialized equipment or protocols. Normalized minimal detectable change values for finger flexor strength ranged from 9.7% to 14.2%. These findings suggest that the smallest bulb of the MV is a reliable and accessible tool for measuring individual finger flexor strength in healthy adults, with results comparable to those obtained using specialized equipment or protocols.

Cardiorespiratory fitness is a crucial component for health. However, measuring cardiorespiratory fitness in older adults with intellectual disabilities (ID) in practice and in large-scale studies remains challenging. The Two-Minute Step Test (2MST) is a submaximal cardiorespiratory fitness test that is brief, relatively easy to perform, and does not require any expensive materials. However, the clinimetric properties of the 2MST for older adults with ID are unknown. Therefore, this study aimed to determine the feasibility, reliability and convergent validity of the 2MST in older adults with ID. This was a cross-sectional study within the 'Healthy Ageing and Intellectual Disabilities' (HA-ID) cohort study. Participants (n = 180, 70.6 [66-75] years) that participated in the physical fitness assessment were included in this study. Feasibility was defined as a successful completion according to protocol. Test-retest reliability was assessed over two measurements, on the same day, with the intraclass correlation coefficient (ICC). Convergent validity was assessed relative to other fitness components (static balance, muscular endurance, comfortable and fast gait speed), with Pearson's and Spearman's correlation coefficients. The 2MST showed moderate feasibility for the first (49.4%) and second (48.3%) measurement. Feasibility was good in participants with borderline, mild and moderate ID (57.1%-80%), but low in participants with severe (15.2%) and profound ID (7.7%). Test-retest reliability was excellent (ICC = 0.88). The 2MST had a moderate correlation with static balance (r = 0.46) and comfortable (r = 0.42) and fast (r = 0.51) gait speed, and a good correlation with muscular endurance (r = 0.63). Based on predefined criteria, all correlations were at least moderate (r > 0.30), supporting good convergent validity (categorised as good if three or more out of four correlations were at least moderate). The 2MST is a feasible, reliable and valid test to use in older adults with ID. Feasibility was especially good in older adults with borderline to moderate ID; however, it was low in adults with more severe ID. The excellent test-retest reliability and good indications for convergent validity show this test is a suitable field test for cardiorespiratory fitness to use in older adults with ID.

Reliability is crucial in psychometrics, reflecting the extent to which a measurement instrument can discriminate between individuals or items. While classical test theory and intraclass correlation coefficients are well-established for quantitative scales, estimating reliability for binary outcomes presents unique challenges due to their discrete nature. This paper reviews and links three major approaches to estimate reliability for single ratings on binary scales: the normal approximation approach, kappa coefficients, and the latent variable approach, which enables estimation at both latent and manifest scale levels. We clarify their conceptual relationships, show conditions for asymptotical equivalence, and evaluate their performance across two common study designs, repeatability and reproducibility studies. Then, we extend the Bayesian Dirichlet-multinomial method for estimating kappa coefficients to settings with more than two replicates, without requiring Bayesian software. Additionally, we introduce a Bayesian method to estimate manifest scale reliability from latent scale reliability that can be implemented in standard Bayesian software. A simulation study compares the statistical properties of the three major approaches across Bayesian and frequentist frameworks. Overall, the normal approximation approach performed poorly, and the frequentist approach was unreliable due to singularity issues. The findings offer further refined practical recommendations.

Purpose This study aimed to determine the optimal threshold for computed tomography perfusion (CTP)-defined ischemic core in patients with basilar artery occlusion (BAO) that predicts functional outcome. Methods A retrospective analysis was conducted on BAO patients who underwent endovascular thrombectomy at our stroke center between January 2018 and March 2024. Ischemic core was estimated using following thresholds: cerebral blood flow (CBF) < 10 or 15 mL/100 g/min by Syngo.via, cerebral blood volume < 1.2 mL/100 mL by Syngo.via, and time to maximum (Tmax) > 10 s by RAPID. A favorable functional outcome was defined as a modified Rankin Scale score of 0–3 at 90-day post-onset. The Posterior Circulation Alberta Stroke Program Early computed tomography Score (pc-ASPECTS) was semi-quantified to assess ischemic changes. Statistical analysis included intraclass correlation coefficient (ICC) and receiver operating characteristic analyses. Results A total of 85 patients were enrolled, and 39 (45.9%) had a favorable functional outcome. The ICC for pc-ASPECTS based on four core approaches between junior and senior observers ranged from 0.90 to 0.96. For the classification of favorable outcome, the volume and pc-ASPECTS core estimation approach (CBF < 10 mL/100 g/min by Syngo.via) had the best performance, with the largest area under the curve of 0.86 [(95% confidence intervals, 0.78–0.94); p < 0.001] and 0.87 [(95% confidence intervals, 0.80–0.94); p < 0.001], with a cut-off value of ≤ 2.2 (78.3%% sensitivity, 84.6% specificity), and ≥ 7 (92.3% sensitivity, 65.2% specificity). Conclusion In BAO patients following successful recanalization, the volume and pc-ASPECTS core estimation approach (CBF < 10 mL/100 g/min by Syngo.via) demonstrated the strongest predictive value for favorable functional outcomes.

Background and Objectives: This study was conducted in order to develop and validate the Latvian version of the Orofacial Aesthetic Scale (OES-LV) and to assess its psychometric properties in patients with aesthetic, functional or no treatment needs. Materials and Methods: The English version of the OES was translated into Latvian following international guidelines for establishing cultural equivalency of instruments. The test group consisted of 101 subjects comprised of those without treatment requirement, with functional impairment (tooth loss) and with aesthetic treatment needs. Internal consistency, test–retest reliability and convergent validity were investigated. Responsiveness was not tested in the current study. Results: The test–retest assessment of this study was performed on 31 subjects and showed intra-class correlation coefficients ranging from 0.80 to 0.81, which was considered to be good. Cronbach’s α was 0.91, demonstrating the strong internal consistency of the scale. Spearman’s rank correlation coefficients between the OHIP and OES scores varied across subgroups, ranging from −0.35 to −0.57 and showed a negative correlation between OES-LV and selected OHIP items. Conclusions: The Latvian OES demonstrated strong psychometric properties, supporting its use in assessing self-perceived orofacial aesthetics, clinical research, prosthodontic evaluation and dental education. Further studies on responsiveness are recommended.

This study aimed to validate a new MRI-based scoring system for pyogenic spondylodiscitis (PS) using contrast-enhanced MRI at admission. The system was designed to classify disease severity and provide a quantifiable tool for risk stratification and treatment planning. We retrospectively analysed 60 patients with clinically and laboratory-confirmed PS at a single tertiary hospital between September 2016 and September 2024. A novel scoring system, the MRI-SSI, evaluated vertebral destruction, signal abnormalities, endplate erosion, and epidural or paravertebral extension. The scores (0-9, 10-19, ≥ 20) categorised disease as mild, moderate, or severe. Two experienced radiologists scored the images, and we recorded hospitalisation duration and the need for surgery. Statistical analysis included independent samples t-tests, ANOVA, and interobserver agreement was assessed using Cohen's kappa and intraclass correlation coefficients (ICCs). Of the 60 patients, 17 (28.3%) required surgical intervention. Patients needing surgery had significantly higher MRI-SSI scores than those managed conservatively (18.58 vs. 13.86; p = 0.004). The scoring system had a strong predictive value for surgical requirement (AUC = 0.720), with 58% sensitivity and 88% specificity. Interobserver agreement for the total MRI-SSI score was excellent (ICC = 0.906). The MRI-SSI accurately predicted hospitalisation duration and surgical needs in PS patients. This tool, based solely on admission MRI findings, can refine initial treatment decisions, leading to more targeted resource utilisation and improved overall patient outcomes.

Abstract Purpose The primary aim was to compare the variability and repeatability of medial posterior tibial slope (MPTS) measurements on lateral knee radiographs between osteoarthritic (OA) and non‐OA knees, and the secondary aim was to assess their implications for clinical classification. Methods Lateral knee radiographs from a retrospective institutional database were reviewed, including patients with and without radiographic OA. Only radiographs fulfilling strict quality criteria for MPTS measurement were included. MPTS was measured by two observers at two time points using the method of Dejour and Bonnin. Inter‐ and intra‐rater reliability were assessed with intra‐class correlation coefficients (ICC), and agreement was evaluated with Bland–Altman analysis. Comparisons between groups were performed using Fisher's Z ‐transformation. Misclassification across the 10° clinical threshold was analysed within and between raters. Results A total of 160 radiographs met the inclusion criteria, comprising 80 OA knees (mean age 73 ± 10 years, 45% female) and 80 non‐OA knees (mean age 39 ± 16 years, 48% female). Variability of MPTS was higher in OA knees (10.6° ± 5.1°; confidence interval [CI]: 9.8°–11.4°) than in non‐OA knees (9.3° ± 2.6°; CI: 8.9°–9.7°). ICCs were significantly lower in OA knees for both inter‐rater (0.79 vs. 0.89, p < 0.001) and intra‐rater reliability (0.92/0.84 vs. 0.99/0.96, p < 0.001). Bland–Altman analysis demonstrated wider limits of agreement in the OA group (–5.1° to 8.3°) versus controls (–3.9° to 2.3°). The two raters disagreed on whether MPTS exceeded 10° in 31.3% of OA knees and 16.3% of non‐OA knees, while intra‐rater disagreement between the first and second readings was 10.0% (OA) and 5.0% (non‐OA) for rater 1, and 13.8% and 3.8% for rater 2, respectively. Conclusion MPTS measurement on lateral radiographs showed increased variability and reduced repeatability in OA knees. Surgeons should exercise caution when applying fixed thresholds on radiographs of OA knees, as small variations may lead to misclassification and influence decision‐making. Level of Evidence Level III, diagnostic study.

The aim of this study was to compare patient perception and data repeatability of conventional and wireless standardized surface electromyography (ssEMG). The electromyographic recordings with both devices were collected at two timepoints (T1 and T2; mean interval 26 days). At T1, participants rated comfort, quickness, and stress on a 10-point Likert scale, with differences assessed using Student's t-test. Data repeatability was analyzed through a linear mixed model (LMM), testing the effects of device type and timepoint on EMG values. Repeatability of ssEMG indices across T1 and T2 was further examined with intraclass correlation coefficients (ICCs). A final sample of 45 participants (37 women, mean age 22.8±1.3 years) was included. Wireless ssEMG was rated significantly more comfortable and quicker. LMM revealed no statistically significant main effects for device (estimate 1.7, 95% CI -3.83 to 7.23) or for timepoint (estimate 0.11, 95% CI -5.41 to 5.64), indicating consistent performance across conditions. Despite moderate-to-good within- and between-device reliability (ICC), several indices showed considerable variability across measurements. Concluding, wireless ssEMG is preferred by patients due to their comfort and quickness. ssEMG indices demonstrate good repeatability across devices, but the substantial variability limits their diagnostic utility.

The gold standard for measuring hip and knee strength is isokinetic dynamometry. This study evaluated the reliability and concurrent validity of a handheld dynamometer (HHD) and a externally fixated dynamometer (ForceFrame [FF]) against isokinetic dynamometry, considering their practicality, cost-effectiveness, and ease of use in clinical practice. The FF and HHD are reliable and valid for assessing hip and knee strength. Controlled laboratory study. Level 4. Maximal isometric hip strength (extension, flexion, abduction, adduction, internal and external rotation) and knee strength (extension and flexion) of 14 healthy persons (7 men; age, 24.4 ± 3.1 years; height, 176.3 ± 9.7 cm; weight, 68.5 ± 10.8 kg) was assessed with an isokinetic dynamometer, HHD, and FF. Measurements were repeated on 2 different days for test-retest reliability and by 2 different investigators on 1 day for interrater reliability. Intraclass correlations (ICC) were calculated, and Pearson correlation coefficients assessed concurrent validity. Moderate to good test-retest reliability was found for both the HHD (ICC, 0.62-0.88; MDC, 10-21%) and FF (ICC, 0.61-0.82; MDC, 15-38%). Interrater reliability was poor to good (HHD ICC, 0.15-0.80; FF ICC, 0.14-0.77). Concurrent validity was better for the HHD than FF. Both the HHD and FF provide stable measurements of hip and knee strength over a 1-week interval. The calculated MDCs (HHD, 10-21%; FF, 15-38%) suggest that only differences exceeding these thresholds can be interpreted as true changes, rather than measurement errors. Inter-rater reliability was rather low, indicating that repeated evaluations are best performed by the same tester. Poor concurrent validity cautions against substituting the HHD and FF for isokinetic dynamometry. HHD and FF offer practical and cost-effective alternatives for a single tester to evaluate strength changes over time.

Electrophysiological testing of the eye and visual system is important in the diagnosis of some diseases. Unlike the electrocardiogram and other more common tests, the amplitudes of the signals are very small and subject to noise and interference. Innovative signal processing algorithms have been shown to be helpful for the electroretinogram (ERG). In this paper, we extend that work to the pattern ERG (PERG), which has utility in the assessment, diagnosis and management of central retinal and optic nerve disease. The use of the PERG has been limited by the small amplitude signal and low signal-to-noise ratio. The aim of this study was to use adaptive denoising techniques to improve the reliability and utility of the PERG. PERGs were performed on 70 eyes of 36 patients following ISCEV protocols. After a short break of approximately 2-5min, a second recording was obtained to assess test-retest reliability of denoising. Denoising was performed on both recordings using five different adaptive filtering algorithms. Denoising algorithms generally improved test-retest reliability measured with intraclass correlation coefficient (ICC) and coefficient of repeatability (CoR). Empirical Wavelet Transform provided the best overall improvement in reliability, improving ICC from 0.79 to 0.84 (p = 0.049) and CoR from 2.12 µV to 1.69 µV (p = 0.02). Adaptive denoising algorithms may improve the reliability of PERG.

Numerous deep learning (DL) and foundational models (FMs) designed for digital pathology analysis employ advanced feature extraction techniques from digitized hematoxylin and eosin (H&E) slides obtained from tissue sections. These extracted features may serve as the input for complex models enabling automated classification tasks, slide searching, and other various medical inferences. Subtle variations in morphology observed in distinct cross sections of the same tissue sample may introduce variability that may be of little to no clinical relevance. The reproducibility of features derived from DL models and FMs on ostensibly identical tissue cross sections remains largely unexplored. In this study, we aimed to characterize the reproducibility of features extracted from three sequential cross sections of 50 independent normal prostate samples. Slides were sectioned at approximately 50μm intervals and we extracted cell-type specific counts, proportions, and spatial features per slide using DL models, along with feature embeddings from popular digital pathology FMs. Reproducibility of the features across sequential cross sections of tissues was assessed using intra-class correlation coefficient (ICC) for DL model features, while extracted FM embedding distributions were evaluated via maximum mean discrepancy (MMD), and Wasserstein's distance. The median [IQR] ICC estimates for cell-type specific proportion and spatial features from the cross sections was 0.838 [0.764, 0.897], and 0.873 [0.809, 0.923] respectively. The bootstrapped mean differences of ICC estimates for the features were significantly lower (p-value < 0.05) for distant cross sections compared to the two neighboring cross sections. The feature embeddings derived from state-of-the-art digital pathology FMs showed an overall high agreement with the median [IQR] MMD of 0.06 [0.016, 0.169], and median [IQR] Wasserstein's distance of 0.021 [0.011, 0.038]. These findings demonstrate that the features derived from multiple cross sections of the same tissue exhibit overall high reproducibility, while also illustrating the expected increase in intra-sample variability as a function of physical distance between sections.

Capsulorhexis is a critical and technically demanding step in cataract surgery where slight errors can cause serious complications, making repeated simulation-based training essential. Limited access to hands-on surgicaltraining has increased reliance on simulators, but existing models are often costly and limited. To address this, the Farra Eye Model was developed as a low-cost, reusable 3D-printed simulator offering realistic eye simulation. This study aims to assess its construct validity in distinguishing between different levels of surgical expertise. A cross-sectional pilot study was conducted with 33 participants (11 novices, 11 intermediates,and 11 experts) grouped by cataract surgery experience. Each performed three capsulorhexis attempts on the Farra Eye Model, with the second and third attempts recorded. Two blinded consultants independently assessed the masked videos using the capsulorhexis indices intheICO-OSCAR: Phaco assessment tool, along with forceps grabs and procedure duration. Construct validity was tested using one-way ANOVA or Kruskal-Wallis tests, and inter-rater reliability was measured using intraclass correlation coefficients (ICC), with values > 0.7 considered satisfactory. Intermediate and expert groups outperformed novices in capsulorhexis, with higher ICO-OSCAR scores, fewer forceps grabs, and shorter procedure durations (p < 0.001). No statisticallysignificant differences were found between the intermediate and expert groups (p > 0.05). Inter-rater reliability was excellent for all parameters (ICC > 0.7). The Farra Eye Model can distinguish between novice and experienced surgeons (intermediate and expert groups), demonstrating construct validity. However, the inability to distinguish between intermediate and expert performance suggests limited sensitivity to advanced skill levels, highlighting the need for further refinements.

Conventional methods of functional assessment include subjective self/informant- report, which may be biased by personal characteristics, cognitive abilities, and lack of standardization (e.g., influenced by idiosyncratic task demands). Traditional performance-based assessments offer some advantages over self/informant reports but are time consuming to administer and score. To evaluate the validity and reliability of the Virtual Kitchen Challenge -Version 2 (VKC-2), an objective, standardized, and highly efficient alternative to current functional assessments for older adults across the spectrum of cognitive aging, from preclinical to mild dementia. 236 community-dwelling diverse older adults completed a comprehensive neuropsychological evaluation to classify their cognitive abilities as healthy, mild cognitive impairment or mild dementia, after adjustment of demographic variables (age, education, sex, estimated IQ). Participants completed two everyday tasks (breakfast, lunch) in a virtual kitchen (VKC-2) using a touch-screen interface to select objects and sequence steps. Automated scoring reflected completion time and performance efficiency (e.g., number of screen interactions, % time spent off screen, interactions with distractor objects). Participants also completed the VKC-2 tasks using real objects (Real Kitchen). All participants and informants for 219 participants completed questionnaires regarding everyday function. A subsample of participants (n = 143) performed the VKC-2 again in a second session 4-6 weeks after the baseline for retest analyses. Analyses evaluated construct and convergent validity and retest and internal reliability of VKC-2 automated scores. A principal component analysis showed that the primary VKC-2 automated scores captured a single dimension and could be combined into a composite score reflecting task efficiency. Construct validity was supported by ANCOVA results showing participants with healthy cognition obtained significantly better VKC-2 scores than participants with cognitive impairment (all Ps < .001), even after controlling for demographics and general computer visuomotor dexterity. Convergent validity was supported by significant correlations between VKC-2 scores and performance on the Real Kitchen (r values = -.58 to .64, Ps < .001), conventional cognitive test scores (r values = -.50 to -.22, Ps < .001), and self and informant questionnaires evaluating everyday function (r values = .25 to .43, Ps < .001). Intraclass correlations (ICC) indicated moderate to excellent retest reliability (ICC =.70 - .90) for VKC-2 scores after 4-6 weeks. Reliability improved in analyses including only participants who reported no change in cognitive status between time 1 and time 2 (n=123). Spearman-Brown correlations showed acceptable to good internal consistency between the VKC-2 tasks (breakfast, lunch) for all scores (.77 to .84) supporting the use of total scores. The VKC-2 is an efficient, valid, and sensitive measure of everyday function for diverse older adults and holds promise to improve the status quo of functional assessment in aging particularly when informants are unavailable or unreliable.

Patients with fibromyalgia often experience repetitive negative thinking, which contributes to psychological distress. The Perseverative Thinking Questionnaire (PTQ) is a tool designed to assess this cognitive pattern. However, its psychometric properties have not been tested in fibromyalgia. This study aimed to assess the validity and reliability of the PTQ in patients with fibromyalgia. A cross-sectional study was conducted in patients meeting the 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Participants were asked to complete the PTQ, Revised Fibromyalgia Impact Questionnaire (FIQR), Hospital Anxiety and Depression Scale (HADS), long version of the Ruminative Response Scale (RRS), and Short Form-12 (SF-12). Test-retest reliability was assessed over a 15-day interval. Internal consistency was evaluated using Cronbach's alpha, and construct validity was examined via Spearman's correlation analyses. The study included 57 patients (55 female, 2 male) with a mean age of 45.1 ± 10.0years. The PTQ demonstrated excellent internal consistency (Cronbach's alpha = 0.996) and test-retest reliability (intraclass correlation coefficient (ICC) = 0.992, 95% CI = 0.986 to 0.996, p < 0.001). Correlation analyses revealed that PTQ scores were strongly correlated with the RRS, HADS total, HADS-anxiety, HADS-depression,and SF-12 mental component scores, and moderately correlated with SF-12 physical component scores. Higher levels of perseverative thinking were associated with poorer physical, psychological, and mental health outcomes. However, a ceiling effect was detected, suggesting limited discrimination at the higher score range. The PTQ is a reliable and valid tool for assessing perseverative thinking in patients with fibromyalgia. The strong psychometric properties support its use in clinical and research settings. However, ceiling effects should be considered when interpreting scores. Key Points • The PTQ demonstrated excellent internal consistency and test-retest reliability in patients with fibromyalgia. • The PTQ demonstrated moderate-strong correlations with rumination, anxiety, depression, and quality of life. • The PTQ is a reliable and valid tool for assessing perseverative thinking in patients with fibromyalgia.

Varus mechanical alignment of the knee is a recognized contributor to medial compartment osteoarthritis (OA). Medial meniscus tears (MMT) frequently occur with knee OA. The present study aimed to analyze the association between mechanical alignment and MMT. We retrospectively analyzed 201 knee joints from patients with knee pain who underwent whole-leg weight-bearing radiographs and magnetic resonance imaging (MRI). Mechanical alignment was quantified using the hip-knee-ankle angle (HKAA), measured independently by two radiologists with excellent interrater reliability (intraclass correlation coefficient = 0.93). MMTs were assessed on MRI with high diagnostic agreement (κ = 0.87). Based on MRI findings, participants were classified into two groups: those with MMT (n = 104) and those without MMT (n = 97). Group comparisons were performed using t-tests and chi-square tests. Patients with MMT had greater varus alignment (HKAA: -6.2 ± 3.4 vs. -2.4 ± 1.4 degrees, p < 0.001), were older (53.7 ± 8.3 vs. 49.3 ± 9.0 years, p < 0.001), and had higher body mass index (26.6 ± 3.0 vs. 25.2 ± 2.4 kg/m2, p = 0.001). Sex distribution did not differ between groups (p = 0.479). Logistic regression identified HKAA as the only independent predictor of MMT. When entered as a continuous variable, each additional degree of varus increased the odds of MMT nearly 2-fold (adjusted OR = 2.01, 95% confidence interval [CI]: 1.64-2.47, p < 0.001). The complementary binary analysis showed that patients with varus alignment had over a 3-fold higher risk of MMT compared with those with neutral or valgus alignment (OR = 3.25, 95% CI: 1.85-5.72, p < 0.001). Posterior horn tears were the most common subtype (47.1%), followed by multisite tears (33.7%). MMTs are strongly associated with varus mechanical alignment. Each incremental degree of varus increased the likelihood of MMT, and posterior horn tears were the most prevalent subtype. These findings highlight the pivotal role of mechanical alignment in the prevention, early detection, and management of MMT.

The correct identification of the knee joint line is essential for successful primary and revision total knee arthroplasty (TKA). Small misalignments can cause restricted range of motion, patellofemoral maltracking, and extensor mechanism imbalance leading to pain and functional impairment. This study aimed to evaluate the reliability of five radiographic anatomical landmarks - the fibular head, inferior patellar pole, tibial tubercle, and both femoral epicondyles - for estimating the joint line level in healthy Turkish adults. A retrospective radiographic analysis was conducted on 100 healthy adults (61 male, 39 female; 18-50 years). Perpendicular distances from these five bony landmarks to the joint line were measured digitally by two independent observers using a PACS system under standardized calibration to minimize projection errors. Inter-observer reliability was assessed by the intraclass correlation coefficient (ICC). Power analysis was based on the fibular-head-joint-line (FH-JL) distance as the primary outcome measure. The FH-JL distance measured 11.4 ± 1.8mm with a coefficient of variation of 15.8%, showing the highest reliability. Sex-based differences were significant (11.8mm in men vs. 10.7mm in women, p = 0.002). ICC values for all measurements ranged from 0.91 to 0.96, indicating excellent agreement between observers. No age-related differences were found (p = 0.835). The fibular head showed strong correlations with both epicondyles (r = 0.724 and r = 0.689). In healthy adults, the fibular head serves as a reliable radiologic landmark that may assist in joint line restoration during revision TKA, pending validation in clinical settings. The study also acknowledges its limitations of using plain radiographs and excluding the adductor tubercle as a reference point.

To evaluate the comparative performance of SF-6Dv2 and EQ-5D-5L in the general population of Quebec (Canada), Tehran (Iran), and Japan. Data on SF-6Dv2 and EQ-5D-5L were collected in the three countries. Descriptive differences in utility values between SF-6Dv2 and EQ-5D-5L were assessed using t-tests, as well as ceiling effects were evaluated based on the percentage of "no problem" levels reported. The known-group validity of both measures was assessed by comparing utility scores across health and demographic subgroups using t-tests or ANOVA and by calculating effect sizes across known groups. The area under the receiver operating characteristic curve (AUROC) analysis and F-statistic ratios were used to further validate the findings from the known-group validity analyses. Convergent validity for both instruments was assessed using Spearman's rank correlation coefficient. The agreement between instruments was evaluated using intraclass correlation coefficients (ICC) and Bland-Altman plots. A total of 2,378 respondents for Quebec, 3,061 for Tehran, and 3,933 for Japan were included. Differences in utility values between SF-6Dv2 and EQ-5D-5L were statistically significant, with SF-6Dv2 generally yielding lower utility scores. Both instruments demonstrated strong known-group validity, effectively distinguishing between diseased and healthy groups as well as various demographic characteristics. However, EQ-5D-5L outperformed SF-6Dv2 for most demographic characteristics based on AUROC analysis and F-statistic ratios. In contrast, their performance in distinguishing between healthy and diseased groups did not favor a particular instrument. Convergent validity analyses indicated strong associations between SF-6Dv2 and EQ-5D-5L utility values in Quebec (0.760) and Tehran (0.737). The agreement between SF-6Dv2 and EQ-5D-5L utility values was moderate in Quebec (0.69) and strong in Tehran (0.837). Bland-Altman plots indicated that differences between the two instruments tended to increase as the average score decreased. Both EQ-5D-5L and SF-6Dv2 demonstrated favorable psychometric performance in terms of known-group validity and convergent validity. These findings suggest that both instruments are valid tools for health utility measurement for use in general population.

Introduction: Mass casualty incident (MCI) simulation scenarios are developed based on detailed review and planning by multidisciplinary trauma teams. This study aimed to assess the feasibility of using generative artificial intelligence (AI) in developing mass casualty trauma simulation scenarios. The study evaluated a range of mass casualty trauma simulation scenarios generated from a public generative artificial intelligence platform based on publicly available data with a validated objective simulation scoring tool. Methods: Using a large language model (LLM) platform (ChatGPT4, OpenAI, San Francisco, CA, USA), 10 complex MCI trauma simulation scenarios were generated based on publicly available US reported trauma data. Each scenario was evaluated by two Advanced Trauma Life Support (ATLS) certified raters based on the Simulation Scenario Evaluation Tool (SSET), a validated scoring tool out of 100 points. The tool scoring is based on learning objectives, tasks for performance, clinical progression, debriefing criteria, and resources. Two publicly available mass casualty trauma scenarios were similarly evaluated as controls. Revision and recommended feedback was provided for the scenarios, with review time recorded. Post-revision scenarios were evaluated. Interrater reliability was calculated based on Intraclass Correlation Coefficients (2, k) (ICCs). For the scenarios, scores and review times were reported as medians with interquartile range (IQR) as 25th and 75th percentiles. Results: Ten mass casualty trauma simulation scenarios were generated by an LLM, producing a total of 62 simulated patients. The initial LLM-generated scenarios demonstrated a median SSET score of 78.5 (IQR 74–82), substantially lower than the median score of 94 (IQR 93–95) observed in publicly available scenarios. The interrater reliability ICC for the LLM-generated scenarios was 0.965 and 1.00 for publicly available scenarios. Following secondary human revision and iterative refinement, the LLM-generated scenarios improved, achieving a median SSET score of 94 (IQR 93–96) with an interrater reliability ICC of 0.7425. Conclusions: The feasibility study suggests that a structured, collaborative workflow combining LLM-based generation with expert human review may enable a new approach to mass casualty trauma simulation scenario creation. LLMs hold promise as a scalable tool for the development of MCI training materials. However, consistent human oversight, quality assurance processes, and governance frameworks remain essential to ensure clinical accuracy, safety, and educational value.