Reliable Threshold Research Articles

Efficacy of WT1 gene-guided pre-emptive therapy for prevention of relapse in acute myeloid leukemia after transplantation and its optimal intervention threshold.

Monitoring minimal residual disease (MRD) and timely intervention are effective strategies for preventing relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in adult acute myeloid leukemia (AML). The WT1 gene, a pan-leukemia marker, can be used as an indicator for MRD monitoring in AML patients. Currently, there is no unified standard for the intervention timing or treatment threshold based on WT1 gene detection after transplantation. This study aims to evaluate the clinical value of WT1 gene-guided preemptive therapy and further explore its optimal intervention threshold. Data of adult AML patients with intermediate or high-risk cytogenetics who underwent allo-HSCT between January 2014 and June 2020 at the Department of Hematology, Xiangya Hospital, Central South University, were retrospectively collected. All patients had WT1 gene expression data within three years post-transplantation. We compared the outcomes of WT1-positive patients who received preemptive therapy with those who did not, and both groups with WT1-negative patients. The endpoints analyzed included cumulative incidence of relapse (CIR), disease-free survival (DFS) rate, overall survival (OS) rate, and non-relapse mortality (NRM) rate. Data of patients who did not receive any intervention were included to analyze factors that might influence prognosis. Univariate analysis was performed using factors such as age, gender, transplantation type,cytogenetic risk stratification, pre-transplant disease status, pre- and post-transplant WT1 levels, and donor gender; factors with P<0.10 in univariate analysis were further included in a Cox regression model for multivariate analysis. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off value of WT1 gene expression for predicting relapse. A total of 165 AML patients were included, of whom 86 had WT1 gene positivity within three years post-transplantation. Among these, 58 received preemptive therapy and 28 did not. Compared with WT1-negative patients, those WT1-positive patients who did not receive preemptive therapy had significantly higher 5-year CIR (42.9% vs 10.5%, P<0.001), lower 5-year DFS (50.0% vs. 80.7%, P=0.001), and lower 5-year OS (60.7% vs 82.8%, P=0.018), while the 5-year NRM rates were not significantly different (7.1% vs 8.9%, P=0.744). For patients who received preemptive therapy, no significant differences in these outcomes were observed (all P>0.05). Multivariate analysis revealed that post-transplantation WT1 gene positivity was a poor prognostic factor for AML patients (CIR: HR=6.24, P=0.000 1; DFS: HR=2.77, P=0.009 6). ROC curve analysis indicated that the area under the curve (AUC) for WT1 gene expression predicting post-transplantation relapse within 3 years was 0.727 (95% CI 0.582 to 0.873), with an optimal cut-off value of 122 copies, sensitivity of 60.0%, and specificity of 89.9%. sequential monitoring of WT1 gene expression in intermediate- or high-risk AML patients after allo-HSCT within 3 years, with timely preemptive therapy for those who become WT1-positive, can effectively reduce relapse and improve prognosis. A WT1 gene expression level of 120 copies may be a more precise and reliable intervention threshold for preemptive therapy.

An optimization model for determining cost-efficient maintenance policies for multi-component systems with economic and structural dependencies

In most multi-component systems, the cost-efficiency of maintenance policies depends on technical structural dependencies. Motivated by the recognition that these dependencies must be accounted for in the development of optimal maintenance policies, we develop an optimization model to determine cost-efficient maintenance schedules for multi-component systems. Our main contribution is twofold. First, we introduce directed graphs as an expressive tool to represent the economic and structural dependencies of the system, including situations in which the maintenance of a given component may require other components to be disassembled or maintained. Second, we formulate a Markov Decision Process model, which is solved through the modified policy-iteration algorithm to determine the most cost-efficient policy. This policy indicates which maintenance actions consisting of disassembly and component replacement decisions are optimal when mandatory replacements must be made whenever the system fails, or the reliability of the system falls below a predefined reliability threshold. To our knowledge, this is the first model that provides optimal maintenance policies that comply with reliability requirements in the presence of constraints arising from technical structural dependencies. We illustrate the model with a realistic case study on the development of cost-efficient maintenance policies and show that its results compare favorably with heuristic maintenance policies.

Psychometric evaluation of the Dysphagia Symptom Questionnaire for adults and adolescents with eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a chronic, inflammatory disease of the esophagus leading to symptoms of esophageal dysfunction; dysphagia is the most common symptom experienced by adults and adolescents. We sought to perform a psychometric evaluation of the Dysphagia Symptom Questionnaire (DSQ), a patient-reported outcome measure for patients with EoE. Using baseline and week 24 data from the randomized, interventional, multinational phase 3 R668-EE-1774 trial (NCT03633617), the measurement properties of the DSQ-including reliability, construct and known-groups validity, responsiveness, and interpretation of change-were evaluated. The analysis population comprised 239 patients with EoE (age [mean± SD], 28.1± 13.14 years; 63.6% male; 90.4% White). Intraclass correlation coefficients of 0.92 and 0.97 exceeded the acceptable reliability threshold (≥0.70). Construct validity correlations with EoE symptom and impact measures were moderate at baseline (|r|= 0.44-0.55) and week 24 (|r|= 0.55-0.69), and the DSQ biweekly total score discriminated among groups defined by disease severity. Analyses exploring interpretation of change from baseline on the DSQ biweekly total score indicated thresholds for within-patient improvement ranging from 9 to 23 points; a within-patient improvement from baseline of 13 points or greater could be considered clinically meaningful. This analysis confirmed that the DSQ has acceptable distributional properties, test-retest reliability, construct validity, and ability to detect change. Therefore, theDSQ is a valid and reliable measure to assess the patient-reported symptom of dysphagia among adult and adolescent patients with EoE in the context of a clinical trial setting.

Measurement properties of the Inclusion Body Myositis Functional Rating Scale

ObjectivesTo evaluate the validity, reliability, responsiveness and meaningful change threshold of the Inclusion Body Myositis (IBM) Functional Rating Scale (FRS).MethodsData from a large 20-month multicentre, randomised, double-blind, placebo-controlled trial in...

IT Management Shapes Marketing Using React Native at Gold Konveksi

Gold Konveksi is a small and medium-sized enterprise (SME) engaged in the garment industry that has not yet fully utilized technology in its marketing and product promotion. As a result, Gold Konveksi's market reach has been limited. This study aims to analyze the responses from questionnaires completed by respondents, with a specific focus on respondent profiles to generate brief demographic information. The objective of this study is to assess the readiness of both employees and customers of Gold Konveksi towards the adoption of new technology. The methods used in this research include data collection through questionnaires filled out by 247 respondents. The validity and reliability of the questionnaire instruments were tested using SPSS data processing. The validity test involved applying the r-value formula, compared to the r-table value, to determine validity. The reliability test was conducted using Cronbach's Alpha value compared to the reliability threshold. Additionally, the Technology Readiness Index (TRI) was calculated to measure user readiness in adopting new technology. The results of the study indicated a high level of readiness among users. The program interface was evaluated, and system testing was conducted using black box testing to ensure its functionality. Overall, the findings of the research show a high level of readiness among users in adopting new technology, which is expected to enhance transactions and sales data recording at Gold Konveksi.

Selection criteria and method for deep inspiration breath-hold in patients with left breast cancer undergoing PMRT/IMRT

PurposeThis study explored whether a free-breathing mean heart dose (FB-MHD) of 4 Gy is a reliable dose threshold for selecting left breast cancer patients after modified radical mastectomy suitable for deep inspiration breath-hold (DIBH) and developed anatomical indicators to predict FB-MHD for rapid selection. Materials and methodsTwenty-three patients with left breast cancer treated with DIBH were included to compare FB and DIBH plans. The patients were divided into the high-risk (FB-MHD ≥ 4 Gy) and low-risk (FB-MHD < 4 Gy) groups to compare dose difference, normal tissue complication probability (NTCP) and the DIBH benefits. Another 30 patients with FB only were included to analyze the capacity of distinguishing high-risk heart doses patients according to anatomical metrics, such as cardiac-to-chest Euclidean distance (CCED), cardiac-to-chest gap (CCG), and cardiac-to-chest combination (CCC). ResultsAll heart doses were significantly lower in patients with DIBH plans than in those with FB plans. Based on FB-MHD of 4 Gy cutoff, the heart dose, NTCP for cardiac death, and benefits from DIBH were significantly higher in the high-risk group than in the low-risk group. The CCED was a valid anatomical indicator with the largest area under the curve (AUC) of 0.83 and maintained 95 % sensitivity and 70 % specificity at the optimal cutoff value of 2.5 mm. ConclusionsAn FB-MHD of 4 Gy could be used as an efficient dose threshold for selecting patients suitable for DIBH. The CCED may allow a reliable prediction of FB-MHD in left breast cancer patients at CT simulation.

Target reliabilities for heritage structures derived from cost optimization

AbstractIn the last decade, structural reliability and safety efforts have been oriented toward the assessment of existing structures and the development of related target reliability levels. However, up‐to‐date there is no consensus on the reliability philosophy that should be followed when considering the assessment of heritage structures, and the level of reliability which is appropriate to them. In this study, a framework is proposed which derives new values for the economically optimal target reliability for the upgrade of a structure, , and the reliability threshold for upgrade, , considering the cultural heritage value of the structure. The total expected life cycle cost is minimized, assuming that the structure is given up after collapse, as heritage value is typically lost after failure. The target reliability values are based on three main parameters: the relative annual benefit of using the structure (affected by its heritage value), the relative cost of failure and the relative cost of increasing the reliability. Target reliability values are proposed specifically for heritage structures, considering a range of the main input parameters.

Relationship between preoperative hemoglobin levels and length of stay in elderly patients with hip fractures: A retrospective cohort study.

Globally, hip fractures in elderly individuals are a prevalent and serious issue. Patients typically have a longer length of stay (LOS), which increases the risk of complications and increases hospitalization costs. Hemoglobin (Hb) is a routine blood test that is associated with disease prognosis. This study aimed to investigate the relationship between preoperative Hb and LOS in elderly hip fracture patients and to determine a reliable transfusion threshold. The clinical data of hip fracture patients (aged ≥ 60 years) admitted to the Department of Orthopaedics, Shenzhen Second People's Hospital, between January 2012 and December 2021 were retrospectively analyzed. Multiple linear regression analysis was used to assess the linear relationship between preoperative Hb and LOS. Smooth curve fitting was performed to investigate potential nonlinear relationships. In the case of discovering nonlinear relationships, a weighted two-piecewise linear regression model was built, and the inflection points were determined using a recursive algorithm. Subgroup analyses were conducted based on age and gender. A total of 1444 patients with an average age of (77.54 ± 8.73) years were enrolled. After adjusting for covariates, a nonlinear relationship was found between preoperative Hb and LOS. The two-piecewise linear regression model revealed an inflection point of 10 g/dL. On the left of the inflection point (Hb < 10 g/dL), the LOS was reduced by 0.735 days for every 1 g/dL increase in Hb (β = -0.735, 95% confidence interval: -1.346 to -0.124, P = .019). On the right side of the inflection point (Hb > 10 g/dL), the relationship was not statistically significant (β = 0.001, 95% confidence interval: -0.293 to 0.296, P = .992). In elderly hip fracture patients, there is a nonlinear association between preoperative Hb and LOS. However, when Hb levels were <10 g/dL, there was a negative correlation with the LOS. No correlation was observed when Hb levels were >10 g/dL. These findings underscore the importance of timely intervention to manage Hb levels in elderly patients with hip fractures, potentially reducing hospitalization durations and associated complications.

A tantalum oxide based memristive neuron device for anomaly detection application

Anomaly detection, a data intensive task, is very important in wide application scenarios. Memristor has shown excellent performance in data intensive tasks. However, memristor used for anomaly detection has rarely been reported. In this Letter, a tantalum oxide (TaOx) memristive neuron device has been developed for anomaly detection application. TaOx, a CMOS compatible material, based memristor shows reliable threshold switching characteristics, which is suitable for constructing memristive neuron. Furthermore, the output frequency of the memristive neuron is found to be proportionate to the applied stimulus intensity and at an inflection point starts to decrease, namely, thresholding effect. Based on the thresholding effect of the neuron output, the application of the memristive neuron for anomaly detection has been simulated. The results indicate that the TaOx memristive neuron with thresholding effect shows better performance (98.78%) than the neuron without threshoding effect (90.89%) for anomaly detection task. This work provided an effective idea for developing memristive anomaly detection system.

Measurement of lead, mercury, and cadmium in blood donors in Canada.

Fetal and neonatal exposure to lead is associated with irreversible adverse effects on neural development. There is no reliable threshold for lead effect, so limiting exposure is recommended. A significant correlation has been reported between post-transfusion blood lead level (BLL) in infants and lead levels in transfused RBC units. We measured levels of lead, mercury, and cadmium, in Canadian donor blood to investigate if concerning levels for neonatal transfusion exist. Whole blood samples from blood donors (n = 2529) were shipped cold within 7 days of donation. All permanent blood donation clinics across Canada were sampled. Twelve of these permanent clinics and 8 mobile clinics with a greater potential for having higher lead or mercury levels were oversampled. Heavy metals were measured by inductively coupled plasma mass spectrometry. Of all donations, 2.2% (lead) and 0.4% (mercury) had levels higher than the recommended thresholds for safe neonatal transfusion. BLLs were higher in males but there was no significant difference in the blood mercury levels of males versus females. Cadmium levels were higher in females. There was a positive correlation between donor age and levels of heavy metals, with lead having the strongest correlation (r = 0.47, p < .0001). Three clinics in close proximity to two lead-producing mines were among the clinics with the highest BLLs. Significantly higher blood mercury levels were observed in coastal clinics. Our data on donor blood heavy metal levels supports considering blood transfusion as an exposure source to heavy metals and encourages informed selection of blood units for transfusion to vulnerable groups.

An opportunistic joint maintenance strategy for two offshore wind farms

The expansion of offshore wind farms into deeper waters presents economic challenges due to the rising costs of operation and maintenance. To address this issue, the development of targeted opportunistic maintenance strategies for offshore wind farms is crucial. Existing strategies often overlook the interconnections between maintenance activities across wind farms, focusing solely on individual wind farms. However, joint maintenance of wind farms has been acknowledged as an effective approach to reducing maintenance costs at the operational level. This paper introduces an opportunistic maintenance strategy that considers the joint maintenance of two wind farms and establishes reliability thresholds to guide maintenance decisions. Furthermore, the developed maintenance model is improved by incorporating more realistic vessel models and considering various types of maintenance costs. Conclusions can be drawn from a comprehensive analysis of optimization results across multiple scenarios involving maintenance costs, wind farm parameters, and uncertainties. The comparative analysis demonstrates that, in the farthest offshore distance case, the proposed strategy exhibits a reduction in maintenance costs of 15.67% and 4.87% when compared to two traditional strategies, respectively. This effect is further amplified in scenarios where offshore wind farms are located in close proximity to each other and encounter substantial uncertainties.

PEARLS: NuSTAR and XMM-Newton Extragalactic Survey of the JWST North Ecliptic Pole Time-domain Field II

We present the second NuSTAR and XMM-Newton extragalactic survey of the JWST north ecliptic pole (NEP) time-domain field (TDF). The first NuSTAR NEP-TDF survey had 681 ks total exposure time executed in NuSTAR cycle 5 in 2019 and 2020. This second survey, acquired from 2020 to 2022 in cycle 6, adds 880 ks of NuSTAR exposure time. The overall NuSTAR NEP-TDF survey is the most sensitive NuSTAR extragalactic survey to date, and a total of 60 sources were detected above the 95% reliability threshold. We constrain the hard X-ray number counts, logN – logS , down to 1.7 × 10−14 erg cm−2 s−1 at 8–24 keV and detect an excess of hard X-ray sources at the faint end. About 47% of the NuSTAR-detected sources are heavily obscured (N H > 1023 cm−2), and 18−8+20 % of the NuSTAR-detected sources are Compton-thick (N H > 1024 cm−2). These fractions are consistent with those measured in other NuSTAR surveys. Four sources presented >2σ variability in the 3 yr survey. In addition to NuSTAR, a total of 62 ks of XMM-Newton observations were taken during NuSTAR cycle 6. The XMM-Newton observations provide soft X-ray (0.5–10 keV) coverage in the same field and enable more robust identification of the visible and infrared counterparts of the NuSTAR-detected sources. A total of 286 soft X-ray sources were detected, out of which 214 XMM-Newton sources have secure counterparts from multiwavelength catalogs.

Construct validity, reliability, and threshold value for treatment goals of the Thai version of the 12-item Psoriatic Arthritis Impact of Disease Questionnaire for patients with psoriatic arthritis.

To determine the construct validity, reliability, and treatment goal threshold of a Thai-language version of the 12-item Psoriatic Arthritis Impact of Disease (Thai-PsAID) questionnaire in patients with psoriatic arthritis (PsA). This cross-sectional study involved administering the proposed Thai-PsAID to 117 Thai patients with PsA. Reliability was assessed by Cronbach's α test and intraclass correlation coefficient (ICC). Construct validity was assessed using Spearman correlation with clinical disease activity index for psoriatic arthritis (cDAPSA), the Health Assessment Questionnaire (HAQ), EQ-5D index, and the patient-acceptable symptom state (PASS). The optimal cutoff score of the Thai-PsAID for minimal disease activity (MDA) was determined by receiver operating characteristic curves. Participants had a mean age of 49.5 years, 61 (52.1%) were female, and the median disease duration was 5 years. The median Thai-PsAID score was 2.1, with a Cronbach's α coefficient of .95 and an ICC of 0.77. The mean time to complete the Thai-PsAID was 2.1 min, with no missing data. The Thai-PsAID score demonstrated a moderate correlation with the cDAPSA, HAQ, and EQ-5D with indices (Spearman's rho of .64, .54, and -.55, respectively). The cutoff of 2.7 has 81%-84% sensitivity and 69%-85% specificity for classifying patients with MDA, satisfied PASS, and indicating no need to escalate medication. The Thai-PsAID is a valid, reliable, and feasible tool for measuring PsA prognosis. A cutoff of 2.7 accurately discriminates MDA and PASS and indicates no need for medication escalation. The Thai-PsAID may be used as a standalone measure.

A Simple and Safe Method for Checking the Position of Central Venous Catheters-A New and Reliable Threshold for Right Atrial Swirl Sign in Microbubbles Tests.

Background: Central venous catheters (CVCs) are indispensable tools in intensive care and emergency medicine. CVC malpositions still occur frequently and can cause various complications leading to increased patient mortality. A microbubbles test (MBT) can be used to confirm correct CVC positioning. However, there is serious doubt regarding whether the currently applied threshold of a 2 s push-to-bubbles time (PTB time) for rapid atrial swirl sign (RASS) in an MBT is reliable and accurate. The aim of the present study was to prove the quality of a new threshold: 1 s. Methods: Consecutive patients who were admitted to the intensive care unit (ICU) in a German neurological specialist hospital from 1 March 2021 to 20 July 2022 were enrolled. After ultrasound-guided CVC insertion, an MBT was performed, PTB time was measured, and RASS was interpreted. Additionally, a chest X-ray (CXR) was requested to check CVC position. Results: A total of 102 CVCs (98% jugular and 2% subclavian) were inserted in 102 patients (38% female and 62% male; median age: 66 years). Negative RASS (PTB time > 1 s) was observed in 2 out of 102 patients, resulting in an echocardiographic malposition rate of 2.0%. CXR confirmed the echocardiographic results. After correcting CVC position in the initially malpositioned CVCs, the PTB time was <1 s (positive RASS). The MBT protocol took about 0.5 min on average, while the CXR results were all available within 30 min. Sensitivity, specificity, and positive and negative predictive value were each 100% for the detection of CVC malpositions via an MBT using a threshold of 1 s compared to CXR. Conclusions: A new threshold of a 1 s PTB time for RASS in an MBT could detect CVC malpositions with excellent quality compared to CXR. Since the MBT was fast and safe and could be performed at the bedside, we propose that an MBT with the new and reliable threshold of 1 s should be routinely used in patient care.

A validation study to analyze the reliability of center of pressure data in static posturography in dogs.

Center of pressure (COP) parameters are frequently assessed to analyze movement disorders in humans and animals. Methodological discrepancies are a major concern when evaluating conflicting study results. This study aimed to assess the inter-observer reliability and test-retest reliability of body COP parameters including mediolateral and craniocaudal sway, total length, average speed and support surface in healthy dogs during quiet standing on a pressure plate. Additionally, it sought to determine the minimum number of trials and the shortest duration necessary for accurate COP assessment. Twelve clinically healthy dogs underwent three repeated trials, which were analyzed by three independent observers to evaluate inter-observer reliability. Test-retest reliability was assessed across the three trials per dog, each lasting 20 seconds (s). Selected 20 s measurements were analyzed in six different ways: 1 × 20 s, 1 × 15 s, 2 × 10 s, 4 × 5 s, 10 × 2 s, and 20 × 1 s. Results demonstrated excellent inter-observer reliability (ICC ≥ 0.93) for all COP parameters. However, only 5 s, 10 s, and 15 s measurements achieved the reliability threshold (ICC ≥ 0.60) for all evaluated parameters. The shortest repeatable durations were obtained from either two 5 s measurements or a single 10 s measurement. Most importantly, statistically significant differences were observed between the different measurement durations, which underlines the need to standardize measurement times in COP analysis. The results of this study aid scientists in implementing standardized methods, thereby easing comparisons across studies and enhancing the reliability and validity of research findings in veterinary medicine.

Assessment of pelvic organ prolapse with the Pelvic Inclination Correction System: defining the normal range and threshold to pathology

PurposeTo define the normal range and threshold values for pathologic prolapse on MRI using the PICS line and assess its correlation with the pubococcygeal line (PCL).MethodsThis prospective, IRB-approved study included 20 nulliparous volunteers and 18 prolapse patients (POP-Q Stage ≥ 2). Organ positions (bladder, cervix, anorectal junction) relative to PICS and PCL were measured on dynamic MRI. Differences in organ position were compared. Receiver-operating characteristic (ROC) analysis was performed to identify cutoff values for prolapse using the PICS line. The correlation between PICS and PCL measurements was tested with Spearman’s rank correlation.ResultsIn volunteers, median bladder and cervix positions measured to the PICS at rest were − 2.7 cm and − 5.3 cm compared to − 1.9 cm and − 2.7 cm in patients (p < 0.001). During straining, bladder and cervix were at − 0.9 cm and − 3.2 cm in volunteers versus + 2.5 cm and + 2.5 cm in patients (p < 0.001). Correlation was strong for PICS and PCL measurements for all three compartments (δ = 0.883–0.970, p ≤ 0.001). AUCs of PICS for the anterior and middle compartment were 0.98 (95% confidence interval [CI] 0.96–1.00, p < 0.001) and 0.96 (95% CI 0.89–1.00, p < 0.001) for differentiating patients from healthy volunteers. AUC for the posterior compartment was 0.76 (95% CI 0.57–0.96, p = 0.034).ConclusionPICS measurements reliably differentiate patients from volunteers in the anterior and middle compartment. Future studies need to identify a reliable threshold for the posterior compartment. PICS and PCL measurements are strongly correlated.Graphical abstract

Exploring an effective automated grading model with reliability detection for large‐scale online peer assessment

AbstractBackgroundPeer assessment has played an important role in large‐scale online learning, as it helps promote the effectiveness of learners' online learning. However, with the emergence of numerical grades and textual feedback generated by peers, it is necessary to detect the reliability of the large amount of peer assessment data, and then develop an effective automated grading model to analyse the data and predict learners' learning results.ObjectivesThe present study aimed to propose an automated grading model with reliability detection.MethodsA total of 109,327 instances of peer assessment from a large‐scale teacher online learning program were tested in the experiments. The reliability detection approach included three steps: recurrent convolutional neural networks (RCNN) was used to detect grade consistency, bidirectional encoder representations from transformers (BERT) was used to detect text originality, and long short‐term memory (LSTM) was used to detect grade‐text consistency. Furthermore, the automated grading was designed with the BERT‐RCNN model.Results and ConclusionsThe effectiveness of the automated grading model with reliability detection was shown. For reliability detection, RCNN performed best in detecting grade consistency with an accuracy rate of 0.889, BERT performed best in detecting text originality with an improvement of 4.47% compared to the benchmark model, and LSTM performed best with an accuracy rate of 0.883. Moreover, the automated grading model with reliability detection achieved good performance, with an accuracy rate of 0.89. Compared to the absence of reliability detection, it increased by 12.1%.ImplicationsThe results strongly suggest that the automated grading model with reliability detection for large‐scale peer assessment is effective, with the following implications: (1) The introduction of reliability detection is necessary to help filter out low reliability data in peer assessment, thus promoting effective automated grading results. (2) This solution could assist assessors in adjusting the exclusion threshold of peer assessment reliability, providing a controllable automated grading tool to reducing manual workload with high quality. (3) This solution could shift educational institutions from labour‐intensive grading procedures to a more efficient educational assessment pattern, allowing for more investment in supporting instructors and learners to improve the quality of peer feedback.

Minimal Clinically Important Difference of the Disabilities of the Arm, Shoulder and Hand (DASH) and the Shortened Version of the DASH (QuickDASH) in People With Musculoskeletal Disorders: A Systematic Review and Meta-Analysis.

The objective of this study was to perform a meta-analysis of the minimal clinically important difference (MCID) of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and its shortened version (ie, the QuickDASH). MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Cochrane Library, and Scopus were searched up to July 2022. Studies on people with upper limb musculoskeletal disorders that calculated the MCID by anchor-based methods were included. Descriptive and quantitative synthesis was used for the MCID and the minimal detectable change with 90% confidence (MDC90). Fixed-effects models and random-effect models were used for the meta-analysis. I2 statistics was computed to assess heterogeneity. The methodological quality of studies was assessed with the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist for measurement error and an adaptation of the checklist for the studies on MCID proposed by Bohannon and Glenney. Twelve studies (1677 patients) were included, producing 17 MCID estimates ranging from 8.3 to 18.0 DASH points and 8.0 to 18.1 QuickDASH points. The pooled MCIDs were 11.00 DASH points (95% CI = 8.59-13.41; I2 = 0%) and 11.97 QuickDASH points (95% CI = 9.60-14.33; I2 = 0%). The pooled MDC90s were 9.04 DASH points (95% CI = 6.46-11.62; I2 = 0%) and 9.03 QuickDASH points (95% CI = 6.36-11.71; I2 = 18%). Great methodological heterogeneity in the calculation of the MCID was identified among the primary studies. Reasonable MCID ranges of 12 to 14 DASH points and 12 to 15 QuickDASH points were established. The lower boundaries represent the first available measure above the pooled MDC90, and the upper limits represent the upper 95% CI of the pooled MCID. Reasonable ranges for the MCID of 12 to 14 DASH points and 12 to 15 QuickDASH points were proposed. The lower boundaries represent the first available measure above the pooled MDC90, and the upper limits represent the upper 95% CI of the pooled MCID. Information regarding the interpretability of the 2 questionnaires was derived from very different methodologies, making it difficult to identify reliable thresholds. Now clinicians and researchers can rely on more credible data. The proposed MCIDs should be used to assess people with musculoskeletal disorders. Heterogeneity was found related particularly to the anchor levels used in the primary studies. To promote comparability of MCID values, shared rules defining the most appropriate types of anchoring will be needed in the near future.

P886 Ustekinumab concentrations in induction are associated with mid-term endoscopic outcomes in patients with inflammatory bowel disease

Abstract Background It is unclear whether ustekinumab (UST) concentrations can predict the clinical course of inflammatory bowel disease (IBD) and guide treatment algorithms during the induction phase. The aim of our study was to assess the association between serum UST concentrations during the induction phase and clinical outcomes at week 24 and to determine the validity of a UST threshold for guiding intensification strategies. Methods We conducted a retrospective study including Crohn's disease (CD) and ulcerative colitis (UC) patients who started UST treatment between June 2022 and February 2023. Intensification strategies were determined according to standard clinical practice. UST concentrations were collected at weeks 8, 16, and 24. Quartile analysis and logistic regression were performed to evaluate the association between UST concentrations and treatment targets. Definitions are clinical steroid-free remission as a Harvey-Bradshaw index &amp;lt;5 and a partial Mayo score &amp;lt;2; endoscopic remission as a simple endoscopic score (SES-CD) ≤2 and Mayo endoscopic score (EMS) ≤1; and endoscopic response as a ≥50% reduction in SES-CD and ≥1 point in EMS. Results We included 42 patients (CD: 24). At week 24, clinical remission rates of 67% and endoscopic response and remission rates of 57% and 28%, respectively, were achieved. At week 24, the majority of patients continued intensified treatment: 90 mg subcutaneously every 4 weeks in 55% and 130 mg intravenously every 4 weeks in 36%. Patients who achieved an endoscopic response at week 24 had higher UST levels at week 8 (4.1 vs. 2.9 µg/ml, p=0.029). No significant differences between endoscopic remission rates and UST levels at any week were observed. The differences observed in the quartile analysis between the UST concentrations at week 8 and the endoscopic response were not statistically significant (p=0.451). The area under the ROC curve value for UST levels at week 8 to predict endoscopic response was 0.734 (p=0.012). Logistic regression analysis identified prior exposure to vedolizumab and absence of perianal disease as predictors of endoscopic response and remission at week 24 in univariate analysis, but not in multivariate analysis. No association was observed between UST levels and drug persistence rates. Conclusion In this real-world cohort, higher UST concentrations at week 8 were associated with higher rates of endoscopic response at week 24. A reliable concentration threshold for predicting endoscopic response and treatment intensification could not be determined, probably due to the insufficient number of patients included in the study and the relatively poor performance of the ROC curve. Prospective, randomized studies are needed to validate these results.

Tibial tubercle to trochlear groove and the roman arch method for tibial tubercle lateralisation are reliable and distinguish between subjects with and without major patellar instability

PurposePatellofemoral (PF) instability recurrence depends on several factors including the relative lateralisation of tibial tubercle (TT) regarding the trochlear groove (TG). TT relative lateralisation quantification has long been a topic of debate. Multiple measuring techniques have been described including TT-trochlear groove (TT-TG), TT-posterior cruciate ligament (TT-PCL) and TT-roman arch (TT-RA), with no clear consensus regarding the most reliable index or pathologic threshold. We set out to determine the normal value range of each index and their association with age, sex and PF instability status. Also, this study aims to determine a reliable pathologic distance threshold to effectively predict patellar dislocation. MethodsSkeletally mature patients up to 45 years of age who presented a CT Scan and an MRI of the same knee between 2014 and 2018 were included and divided into subgroups based on history of PF instability. Three indexes (TT-TG, TT-PCL and TT-RA) were assessed by two independent observers blinded to instability history. ROC curves were performed for each index to obtain the cut point that better predicts instability. Univariate and multivariate models adjusted by age, sex, instability history and type of imaging technique were performed to test the influence of these variables. Results208 patients were included. Mean age was 27.93 ​± ​8.48 years, 67.3% were female and 71 patients (34.1%) presented major instability history. Good or excellent inter and intraobserver reliability was found for all three indexes. All indexes presented significantly different distributions between subjects with and without major instability (p ​< ​0.001), except for TT-PCL. Different cut point values differing between imaging modalities were found: 11.4 ​mm for MRI TT-TG, 17 ​mm for CT TT-TG, 15.6 ​mm for MRI TT-RA and 18.2 ​mm for CT TT-RA. ConclusionsAll indexes studied had good or excellent inter and intraobserver reliability. Measurements between imaging techniques (CT and MR) are not interchangeable. Both TT-TG and TT-RA correctly distinguish between subjects with and without major instability, while TT-PCL does not, recommending caution when evaluated on its own. Specific threshold values depending on imaging technique should be considered for surgical decision-making. Level of evidenceLevel IV, Diagnostic Test.