Standard Score Research Articles

A solution to the pervasive problem of response bias in self-reports

Self-reports are used ubiquitously to probe people's thoughts, feelings, and behaviors and inform medical decisions, enterprise operations, and government policy and legislation. Despite their pervasive use, self-report measures such as Likert scales have a profound problem: Standard analytic approaches do not control for the confounding effects of idiosyncratic response biases. Here, we present a model-based solution to this problem. Our model disentangles response bias from latent constructs of interest to obtain less biased scores of the latent states of respondents. Inspired by Thurstonian approaches in the psychophysics literature, the model requires nothing further than standard Likert scale design assumptions. The model uses a data-driven approach to control for response biases, without the need to prespecify bias types or response strategies. We demonstrate the model's ability to uncover more precise estimates of latent state associations, outperforming bias-affected standard scoring techniques, and garner insights into previously undetected codependencies between certain latent states and particular forms of response bias. The model is thus a tool which outperforms standard scoring methods and generates insights into, and controls for, the potentially confounding effects of response bias on self-report Likert scale data.

Psychometric validation of the Copenhagen Hip and Groin Outcome Score (HAGOS) and Oxford Hip Score (OHS) in patients with hip-abductor tendon pathology

ObjectiveValidated patient-reported outcome measures for patients with hip-abductor tendon pathology are lacking. Recent studies indicate that the Copenhagen Hip and Groin Outcome Score (HAGOS), in the original or the revised...

Emotional and Behavioural Adjustment in Children and Adolescents with Short Stature vs. Their Normal-Statured Peers

Background/Objectives: the aim of the current cross-sectional study is to explore and compare the emotional and behavioural conditions of children and adolescents with short stature (i.e., familial short stature and constitutional delay of growth), idiopathic growth hormone deficiency (GHD), and normal height. Methods: Twenty-nine participants (15 males, 14 females; mean age ± standard deviation (SD) = 11.2 ± 1.96 years) with short stature (height standard deviation score (SDS): −2.10 ± 0.57), 10 age-matched participants (4 males, 6 females; mean age ± SD = 10.9 ± 2.35 years) with growth hormone deficiency (GHD; height SDS: −2.44 ± 0.29), and 36 age-matched participants (19 males, 17 females; mean age ± SD = 11.3 ± 1.93 years) with normal stature (height SDS: 0.56 ± 0.78) were admitted to this study. Psychological distress was evaluated using the Depression Anxiety and Stress Scale (DASS-21), and emotional and behavioural problems using the Child Behaviour Checklist for Children (CBCL) and the Strengths and Difficulties Questionnaire (SDQ). Results: Participants with GHD exhibited higher levels of the “withdrawn/depressed subscale” score of CBCL (H = 7.794, df = 2, p = 0.020), compared to their peers with normal height, while no significant differences were observed between participants with short stature and those with normal stature. Normal-statured participants reported higher levels of the “conduct problems” subscale score (H = 10.421, df = 2, p = 0.005) and the “rule-breaking behaviour” subscale score of CBCL (H = 10.358, df = 2, p = 0.006) compared to both short-statured groups. No significant differences among the three subgroups were found in the DASS-21 and SDQ scores questionnaires, suggesting the lack of short stature-dependent effects on psychological distress and emotional and behavioural adjustment. Conclusions: Although participants with GHD exhibited higher levels of the “withdrawn/depressed subscale” score of CBCL (H = 7.794, df = 2, p = 0.020) compared to their peers with normal height, participants with short stature did not experience the same problems. Although short-statured participants had lower levels of “conduct problems” and “rule-breaking behaviours” scores than their normal-statured peers, the psychological distress and emotional and behavioural adjustment were not affected by short stature, being comparable to those recorded in normal-statured participants.

Migraine Genetic Susceptibility Does Not Strongly Influence Migraine Characteristics and Outcomes in a Treated, Real-World, Community Cohort

Background/Objectives: Migraine is a common neurological disorder with highly variable characteristics. While genome-wide association studies have identified genetic risk factors that implicate underlying pathways, the influence of genetic susceptibility on disease characteristics or treatment response is incompletely understood. We examined the relationships between a previously developed standardized integrative migraine polygenic genetic risk score (PRS) and migraine characteristics in a real-world, treated patient cohort. Methods: This retrospective cohort study used covariate-adjusted regression to comprehensively evaluate associations between the PRS and clinical characteristics in 1653 treated migraine cases with European ancestry at baseline and, in 800 cases, after one year. Cases were deeply phenotyped by neurologists during extensive interviews, using structured clinical documentation tools to record ~200 discrete data elements. Results: In treated patients, higher standardized PRS showed associations with two common migraine symptoms: photophobia (odds ratio [confidence interval]: 1.33 [1.13–1.56], p = 0.001) and stabbing pain (1.21 [1.08–1.36], p = 0.001]; both retained significance at Q = 0.05. Associations with phonophobia, nausea, emesis, and unilateral headache had similar effect sizes but did not survive correction for multiple tests. In this population, the PRS was not associated with other symptoms of migraine attacks, objective measures of migraine disability, frequency, severity, average duration, time-to-peak intensity of migraine attacks, chronification, emergency department visits, triptan responsiveness, or changes at follow-up. Conclusions: In treated patients, genetic risk was associated with common migraine symptoms but not with the severity of migraine characteristics or treatment outcomes. This suggests that in treated patients, other genetic and non-genetic factors influence migraine symptom severity and disease course more strongly than genetic susceptibility.

Quality of Life in Adults with Atopic Dermatitis in Relation to Disease Severity: Nationwide Data in Japan.

The impact of atopic dermatitis (AD) on daily life and different levels of quality of life (QOL) according to AD severity has not been fully elucidated. This study aimed to assess QOL in relation to the AD severity in Japan. This observational study used anonymized data of health insurance association members and their families registered to a mobile health app. The QOL measures included the Dermatology Life Quality Index (DLQI), EuroQol five-dimensional five-level descriptive system (EQ-5D-5L), Work Productivity and Activity Impairment (WPAI), and sleep disturbance Numerical Rating Scale (NRS). The data were assessed according to AD severity: the Patient-Oriented Eczema Measure (POEM: 0-2, "clear/almost clear"; 3-7, "mild"; 8-16, "moderate"; 17-24, "severe"; 25-28, "very severe"); and itch NRS (0-10). Of 1507 adults with AD symptoms or undergoing treatments, 882 were identified with AD diagnosis records. Of those, 229 (26.0%), 242 (27.4%), 273 (31.0%), and 138 (15.6%) were included in the clear/almost clear, mild, moderate, and severe/very severe POEM groups, with mean ± standard deviation DLQI scores of 2.0 ± 2.7, 3.6 ± 3.3, 6.1 ± 4.4, and 10.4 ± 5.7, respectively. Higher DLQI scores were observed with increasing POEM severity and itch NRS (Spearman's rank correlation coefficient 0.629 and 0.615, respectively). EQ-5D-5L scores slightly lowered with increasing POEM severity, whereas WPAI percentage slightly increased. Sleep disturbance NRS increased with increasing AD severity in terms of POEM and itch NRS. Adults identified with AD diagnosis records (n = 882) yielded higher WPAI percentages than those without (n = 1204) in all four domains (Wilcoxon rank sum test, p < 0.001 for all). This study, using real-world data in Japan, presented valuable data on the relationship between AD severity and various aspects of QOL. The data suggested greater QOL impairment with increasing AD severity; even at lower severity levels, QOL was impacted to some extent. The results highlight the need for careful consideration during clinical practice.

Mitigation of Mycotoxin Content by a Single-Screw Extruder in Triticale (x Triticosecale Wittmack)

The aim of this study was to investigate the effects of extrusion processing parameters—moisture content (M = 20 and 24%), feeding rate (FR = 20 and 25 kg/h), and screw speed (SS = 300, 390 and 480 RPM), on the content of deoxynivalenol (DON), 15-Acetyl Deoxynivalenol (15-AcDON), 3-Acetyl Deoxynivalenol (3-AcDON), HT-2 Toxin (HT-2), tentoxin (TEN) and alternariol monomethyl ether (AME), using a pilot single-screw extruder in whole-grain triticale flour. The temperature at the end plate of the extruder ranged between 97.6 and 141 °C, the absolute pressure was from 0.10 to 0.42 MPa, the mean retention time of material in the barrel was between 16 and 35 s, and the specific energy consumption was from 91.5 to 186.6 Wh/kg. According to the standard score, the optimum parameters for the reduction of the content of analysed mycotoxins were M = 24 g/100 g, FR = 25 kg/h, SS = 480 RPM, with a reduction of 3.80, 60.7, 61.5, 86.5, 47.7, and 55.9% for DON, 3-AcDON, 15-AcDON, HT-2, TEN, and AME, respectively. Under these conditions, the bulk density, pellet hardness, water absorption index, and water solubility index of the pellet were 0.352 g/mL, 13.7 kg, 8.96 g/g, and 14.9 g/100 g, respectively.

Changes in body composition and muscle strength in girls with idiopathic central precocious puberty during gonadotropin-releasing hormone agonist therapy

Aims: Our objective is to explore changes in body fat distribution and muscle strength among a cohort of girls with idiopathic central precocious puberty (ICPP) undergoing the gonadotropin-releasing hormone analogs (GnRHa) therapy. Methods: A total of 50 patients who were newly diagnosed with ICPP and treated with GnRHa were included in the study. Patients were investigated at baseline, 6th months and 12th months. Results: Body-mass index (BMI) standard deviation score (SDS) was similar throughout the treatment duration. The percentage of body fat (PBF) increased from 24.2±5.1% at the beginning to 26.3±5.3% at the 6th month and to 27.7±5.43% at the 12th month (p

Predicting Age and Visual-Motor Integration Using Origami Photographs: Deep Learning Study.

Origami is a popular activity among preschool children and can be used by therapists as an evaluation tool to assess children's development in clinical settings. It is easy to implement, appealing to children, and time-efficient, requiring only simple materials-pieces of paper. Furthermore, the products of origami may reflect children's ages and their visual-motor integration (VMI) development. However, therapists typically evaluate children's origami creations based primarily on their personal background knowledge and clinical experience, leading to subjective and descriptive feedback. Consequently, the effectiveness of using origami products to determine children's age and VMI development lacks empirical support. This study had two main aims. First, we sought to apply artificial intelligence (AI) techniques to origami products to predict children's ages and VMI development, including VMI level (standardized scores) and VMI developmental status (typical, borderline, or delayed). Second, we explored the performance of the AI models using all combinations of photographs taken from different angles. A total of 515 children aged 2-6 years were recruited and divided into training and testing groups at a 4:1 ratio. Children created origami dogs, which were photographed from 8 different angles. The Beery-Buktenica Developmental Test of Visual-Motor Integration, 6th Edition, was used to assess the children's VMI levels and developmental status. Three AI models-ResNet-50, XGBoost, and a multilayer perceptron-were combined sequentially to predict age z scores and VMI z scores using the training group. The trained models were then tested using the testing group, and the accuracy of the predicted VMI developmental status was also calculated. The R2 of the age and the VMI trained models ranged from 0.50 to 0.73 and from 0.50 to 0.66, respectively. The AI models that obtained an R2>0.70 for the age model and an R2>0.60 for the VMI model were selected for model testing. Those models were further examined for the accuracy of the VMI developmental status, the correlations, and the mean absolute error (MAE) of both the age and the VMI models. The accuracy of the VMI developmental status was about 71%-76%. The correlations between the final predicted age z score and the real age z score ranged from 0.84 to 0.85, and the correlations of the final predicted VMI z scores to the real z scores ranged from 0.77 to 0.81. The MAE of the age models ranged from 0.42 to 0.46 and those of the VMI models ranged from 0.43 to 0.48. Our findings indicate that AI techniques have a significant potential for predicting children's development. The insights provided by AI may assist therapists in better interpreting children's performance in activities.

Neural invasion severity is a strong predictor of local recurrence in pancreatic ductal adenocarcinoma.

In pancreatic ductal adenocarcinoma, neural invasion is being increasingly recognized as an unfavorable predictor of patient outcomes. Neural invasion severity seems to have a stronger clinical impact on patient prognosis than neural invasion status alone. Therefore, this study aims to assess the impact of severity of neural invasion on overall survival and disease-free survival in pancreatic ductal adenocarcinoma. To assess the impact of intrapancreatic neural invasion severity, tumor specimens resected from patients with pancreatic ductal adenocarcinoma between 2007 and 2014 were systematically re-evaluated, and neural invasion severity was determined using the standardized neural invasion severity score. In our cohort (n= 216), an increased neural invasion severity score was associated with markedly shorter overall survival in pancreatic head ductal adenocarcinoma (neural invasion severity score low: 22.8months vs neural invasion severity score high: 17.6months: P= .001). An external European validation cohort confirmed these results and showed significantly better survival of patients with lower neural invasion (20.5 vs 15.4months, P= .026). The disease-free survival time was also substantially decreased in patients with pancreatic head pancreatic ductal adenocarcinoma and increased neural invasion severity (neural invasion severity score low: 19.1months vs neural invasion severity score high: 10.4months; P= .004). Moreover, the neural invasion severity score was an important independent factor influencing overall survival (hazards ratio 1.024, P= .04) and disease-free survival (hazards ratio 1.03, P= .01) using an adjusted Cox proportional hazards model. Importantly, higher neural invasion severity score leads to significantly more and earlier local recurrence than to distant tumor recurrence. Neural invasion severity is a powerful independent factor influencing overall survival and local recurrence in patients with pancreatic ductal adenocarcinoma. Therefore, individuals with high neural invasion severity score values should be regarded as a specific subgroup of pancreatic ductal adenocarcinoma patients and may benefit from more tailored postoperative oncologic therapy.

Deep Learning for Classification of Inflammatory Bowel Disease Activity in Whole Slide Images of Colonic Histopathology.

Grading activity of inflammatory bowel disease (IBD) using standardized histopathological scoring systems remains challenging due to limited availability of pathologists with IBD expertise and inter-observer variability. In this study, a deep learning model was developed to classify activity grades in hematoxylin and eosin-stained whole slide images (WSIs) from patients with IBD, offering a robust approach for general pathologists. This study utilized 2,077 WSIs from 636 patients who visited Dartmouth-Hitchcock Medical Center in 2018 and 2019, scanned at 40× magnification (0.25 μm/pixel). Board-certified gastrointestinal pathologists categorized the WSIs into four activity classes: inactive, mildly active, moderately active, and severely active. A transformer-based model was developed and validated using five-fold cross-validation to classify IBD activity. Using HoVerNet, neutrophil distribution across activity grades was examined. Attention maps from the model highlighted areas contributing to its prediction. The model classified IBD activity with weighted averages of 0.871 [95% Confidence Interval (CI): 0.860-0.883] for the area under the curve, 0.695 [95% CI: 0.674-0.715] for precision, 0.697 [95% CI: 0.678-0.716] for recall, and 0.695 [95% CI: 0.674-0.714] for F1-score. Neutrophil distribution was significantly different across activity classes. Qualitative evaluation of attention maps by a gastrointestinal pathologist suggested their potential for improved interpretability. The model demonstrates robust diagnostic performance and could enhance consistency and efficiency in IBD activity assessment.

Social, Emotional, and Behavioral Functioning in Adolescents with Klinefelter Syndrome.

Klinefelter syndrome (KS) is a common genetic condition in males associated with an extra X chromosome (i.e., 47,XXY). Individuals with KS often experience androgen insufficiency and tall stature and are at increased risk for depression, anxiety, and social challenges. This cross-sectional study investigates social and emotional functions in 52 boys with KS and 62 typically developing (TD) boys, aged 8 to 13 years. Self-report measures of anxiety, depression, and behavior and parent-report measures of social functioning and behavior were completed. In primary analyses, linear regression was used to test the effect of group (KS, TD) on standardized scores derived from widely used rating scales. In secondary analyses, we explored the influence of pubertal status on these scores and concordance between self- and parent ratings. Our results indicate that boys with KS exhibit significantly increased anxiety, depression, and social difficulties relative to TD peers. Among participants with KS, peripubertal boys generally experienced more difficulties in aspects of social and emotional functioning as compared to prepubertal boys. Concordance analyses revealed differences between parent- and child-reports. These findings indicate that alterations in social, emotional, and behavioral functions are present in boys and adolescents with KS and may be influenced by puberty.

Challenges in alpine meadow recovery: The minor effect of grass restoration on microbial resource limitation.

Microorganisms play a vital role in restoring soil multifunctionality and rejuvenating degraded meadows. The availability of microbial resources, such as carbon, nitrogen, and phosphorus, often hinders this process. However, there is limited information on whether grass restoration can alleviate microbial resource limitations in damaged slopes of high-altitude regions. This study focused on alpine bare land impacted by engineering activities, with the goal of using grass seeds to improve soil resource availability and multifunctionality. High-throughput sequencing and enzyme stoichiometry (vector analyses) were employed to analyze microbial community composition and assess resource limitations. Our findings suggested that soil carbon, nitrogen, and phosphorus contents were low, ranging from 7.67 to 12.6gkg-1for carbon, 0.61 to 0.98gkg-1,for nitrogen, and 0.65 to 0.78gkg-1for phosphorus. Nevertheless, the standardized scores for high yield and resource acquisition strategies remained at 0.26 and 1.36 in the four groups, which were lower than those of the stress tolerance strategy. Microorganisms primarily employed the stress tolerance strategy, focusing on repairing injured cells rather than promoting cell growth, which suggests that microbial growth and metabolism were only marginally enhanced. Because of this strategy's limited impact on enhancing microbial community diversity and fostering a co-occurrence network, the resultant levels remained comparable to those observed in degraded meadows. In this case, microbial resource limitations persisted, with phosphorus remaining a constraint. Consequently, grass restoration alone offered limited relief for microbial resource limitations in alpine meadows, underscoring the challenges of solely relying on grass seeds to recover damaged alpine ecosystems.

Endocan expression and correlation with other endothelial determinants in developing a score for early identification of diabetic peripheral neuropathy

Diabetic peripheral neuropathy is a common complication of diabetes mellitus that has dire outcomes, affecting the economic profile of a country. Despite the multifactorial background of the pathogenesis of this disease, the mechanism underlying peripheral neuropathy is still unclear. Endothelial damage is a new determinant of pathogenesis, with endocan as a potential biomarker for endothelial dysfunction in diabetic peripheral neuropathy patients. In this cross-sectional study, with 49 patients with diabetes with peripheral neuropathy and 48 patients with diabetes without neuropathy, endothelial biomarkers such as endocan, hs-CRP, vitamin D, and lipid profiles were measured and analyzed in both groups. The standardized scores for dyslipidemia, inflammation, vitamin D and endocan were calculated. All of these biomarkers were significantly altered in peripheral neuropathy patients. A strong correlation between endocan levels and lipid profiles and between hs-CRP and vitamin D levels was detected. The inflammatory score and a combined score including all the above biomarkers might help in the early stratification of diabetic patients who are at greater risk of developing peripheral neuropathy.

Baseline characteristics and 2-year functional outcome data of patients undergoing an arthroscopic rotator cuff repair in Switzerland, results of the ARCR_Pred study.

The ARCR_Pred study was initiated to document and predict the safety and effectiveness of arthroscopic rotator cuff repair (ARCR) in a representative Swiss patient cohort. In the present manuscript, we aimed to describe the overall and baseline characteristics of the study, report on functional outcome data and explore case-mix adjustment and differences between public and private hospitals. Between June 2020 and November 2021, primary ARCR patients were prospectively enrolled in a multicenter cohort across 18 Swiss and one German orthopedic center. Baseline characteristics, including sociodemographic and diagnostic variables, were reported. Clinical scores and patient-reported outcome measures were assessed up to 24-month follow-up. After screening 2350 individuals, 973 patients with ARCR were included. Follow-up rates reached 99%, 95%, 89% and 88% at 6 weeks, 6, 12, and 24 months, respectively. While the proportion of massive tears was higher in the study population (44% vs. 20%, Std. Diff. = 0.56), there were no other major differences in key characteristics between enrolled and non-enrolled patients or in patients lost to follow-up. Functional scores improved over time, with positive changes rates ranging from 83% to 92% at 6-month, reaching 91% to 97% at 12- and 24-month follow-up. In linear mixed models, used to estimate the associations between baseline factors, hospital type and standardized 0-100 scores, marginal effects for time ranged from 20 to 30, 28 to 39 and 34 to 41 points at the 6-, 12- and 24-month follow-up, respectively. Except at the 12-month follow-up, where marginal effects for the interaction terms ranged from -5 to -4 points in the standardized scores, there were no consistent outcome differences between public and private hospitals. Increasing number of years of education was consistently associated with better scores, greater feelings of depression and anxiety, smoking and ASA group III-IV were consistently associated with worse scores. Tear severity showed a consistent negative association solely for the Constant-Score. The ARCR_Pred study shows high potential for generalizability to the population of patients undergoing an ARCR in Switzerland. Further analyses are needed to establish relevant clinimetrics for the Swiss population and to compare outcomes for surgical techniques, surgeon experiences profiles and post-operative management.

Novel Gel Formulation and Deep Injection Techniques for Lifting Effects in Cosmetic Dermatology.

In recent years, the field of aesthetic dermatology has witnessed a surge in demand for minimally invasive procedures aimed at rejuvenating aging skin. This study aims to address this demand by evaluating the effectiveness of the injectable gel in rejuvenating aging skin, particularly by targeting collagen regeneration and lifting effect. The study involved 43 participants who underwent three monthly injection sessions targeting retaining ligaments. The injections were administered deeply to ensure proper targeting. Follow-up assessments were conducted after each treatment session and three months after the final injection. Evaluation methods included subjective assessments by both patients and investigators using the Global Aesthetic Improvement Scale (GAIS), as well as objective assessments using a 3D photosystem to measure wrinkle conditions and vectors of traction. All participants completed the study, with no significant adverse effects observed apart from mild swelling at the injection sites. Despite the high viscosity of HA necessitating the use of a 27 G needle, the injection process was generally comfortable and minimally painful. Subjective evaluations revealed consistent improvements in skin appearance from the first application, which continued to increase throughout the study and remained high even 3 months post-treatment. Objective evaluations demonstrated significant improvements in wrinkle conditions and lifting effects, with a substantial increase in the standard deviation score for wrinkle conditions and the average traction vector length measuring 1.6 mm. The study findings confirm the safety and efficacy of the injectable formula, with high patient satisfaction, noticeable lifting effects, and significant improvements in wrinkle conditions. These results support the use of the injectable as a promising option for non-invasive skin rejuvenation treatments.

Longitudinal analysis of anthropometric measures over 5 years in patients with Friedreich ataxia in the EFACTS natural history study.

Friedreich ataxia is a rare neurodegenerative disorder caused by frataxin deficiency. Both underweight and overweight occur in mitochondrial disorders, each with adverse health outcomes. We investigated the longitudinal evolution of anthropometric abnormalities in Friedreich ataxia and the hypothesis that both weight loss and weight gain are associated with faster disease progression. Participants were drawn from the European Friedreich's Ataxia Consortium for Translational Studies (EFACTS). Age- and sex-specific BMI and height scores were calculated using the KIGGS-BMI percentiles for children. Height correction was applied for scoliosis. Longitudinal data were analysed using linear mixed effects models and incremental standard deviation scores and growth mixture models identified subclasses with varying BMI trajectories. Five hundred and forty-three adults and fifty-nine children were assessed for up to 5 years. In children, severe underweight (26%), underweight (7%), severe short stature (16%) and short stature (23%) were common. The corrected BMI percentile was stable in children, although 48% had negative incremental BMI scores over 1 year and 63% over 3 years versus 10%/year in a normal reference cohort. Overweight was common in adults (19%), with a slight increase in BMI over time. Longer GAA repeat size was linked to lower BMI in adults. Weight trajectory was not associated with ataxia progression in adults. Significant anthropometric abnormalities were identified, with underweight and short stature prevalent in children and overweight in adults. These findings highlight the need for regular nutritional monitoring and interventions to manage underweight in children and promote healthy weight in adults.

Pituitary abnormalities in patients with pediatric growth hormone deficiency in a single tertiary center.

There is controversy as to whether brain magnetic resonance imaging (MRI) should be performed on all children with growth hormone deficiency (GHD) including those judged to have mild GHD. This study was aimed to determine the frequency of pituitary or intracranial abnormalities in pediatric GHD and to identify risk factors that may predict pituitary or intracranial abnormalities. A total of 95 pediatric GHD patients were included. Their medical records and brain magnetic resonance (MR) images were reviewed retrospectively. Abnormal pathogenic MR images were found in 14 patients (14.7%), including 10 (10.5%) with pituitary hypoplasia and 4 (4.2%) with pituitary stalk interruption syndrome. Serum levels of insulin-like growth factor-I (IGF-I), IGF-I standard deviation score (SDS), insulin-like growth factor binding protein 3 (IGFBP3), and growth hormone (GH) peak level of GH stimulation test were statistically significantly lower in the group with abnormal brain MRI. The frequency of abnormal MRI was statistically significantly higher in the complete GHD group. IGF-1 SDS showed the highest area under the curve which can predict the presence of brain abnormality with a sensitivity of 85% and a specificity of 71.4%, if IGF-1 SDS was less than -1.365. IGF-1, IGFBP3, and GH peak levels also showed good sensitivity of over 80% for predicting brain abnormalities with cutoff values of 70.285 ng/mL, 1,604 ng/mL, and 4.205 ng/mL, respectively. The sensitivity and specificity of each cutoff value of IGF-1, IGF-1 SDS, IGFBP3, and GH peak levels were good and statistically significant in predicting brain MRI abnormalities. However, it was insufficient to predict all brain abnormalities with these variables. Therefore, we would like to recommend performing a brain MRI if a child is diagnosed with GHD.

Age of menarche and final height in patients with permanent congenital hypothyroidism.

We compared the age at menarche and standard deviation score (SDS) of final height (FH) in permanent congenital hypothyroidism (CH) patients with those of healthy female adolescents and assessed their associations with CH screening-related variables or demographic factors. In this cross-sectional study, we included 207 female CH patients and 598 healthy age-matched female adolescents. Ages at puberty onset and menarche, height at puberty and menarche, and the FH and its SDS were evaluated in the 2 groups and compared. Associations between screening variables and anthropometric data with age at menarche and SDS of FH were also assessed in CH patients. In the included population, 113 patients with CH and 453 healthy girls attained their FH. The mean ages at puberty onset and menarche in CH patients were higher than those in the healthy population (P<0.05). The mean height at menarche and the FH and its SDS were not different between the 2 groups (P>0.05). There was no significant association between FH SDS in CH patients and age of treatment (P=0.30). Age at menarche was significantly higher in CH patients with delayed age at treatment initiation (P=0.04). The difference between FH and target height was not significantly different among CH patients (P=0.83). While CH patients had a significantly higher age at menarche compared to the healthy population, appropriate treatment changed this age to be similar to that in the healthy group. However, CH patients who experienced delayed treatment had a higher age at menarche. Age at treatment initiation was the only screening-related variable related to age at onset of menarche and puberty.

Analyzing diversity, equity, and inclusion content on dermatology fellowship program websites

ABSTRACT Diversity, Equity, and Inclusion (DEI) initiatives have garnered increasing attention within medical education as there have been increased efforts to diversify the physician workforce among medical students, residents, fellows, and attendings. One way in which programs can improve their DEI initiatives and attract a more diverse pool of applicants is through DEI content on their graduate medical education websites. Prior studies characterizing the content and prevalence of DEI material on residency webpages have shown that dermatology residencies have relatively low levels of DEI content on their websites in which almost ¾ of all programs having no DEI content. Little is known, however, if similar findings are to be expected for the three main dermatology subspecialty fellowship program webpages: Dermatopathology, Pediatric Dermatology, and Micrographic Surgery and Dermatology Oncology. Fellowship programs were identified using the Accreditation Council for Graduate Medical Education’s online database of fellowship programs. Programs were evaluated on a standardized scoring system for five equally weighted criteria: fellowship-specific DEI webpage, DEI commitment statement, DEI initiatives (summer research opportunities for under-represented minorities, DEI council, etc.), link to the institution’s DEI homepage, and information about bias training. The mean score among all programs was 12.5. Pediatric dermatology ranked the highest among all specialties, while Mohs ranked the lowest. A link to the institution’s DEI homepage was the most prevalent factor accounting for 42.1% of all programs collected, whereas information about bias training and fellowship-associated DEI webpage were the least prevalent. The results of this study reveal an overall lack of DEI content across all dermatology subspecialties’ webpages and represent an actionable area of improvement for fellowship directors to increase their DEI efforts to attract a diverse pool of applicants to their program.

Diagnostic Value of the Color Doppler Ultrasound Standardized Semiquantitative Score Combined With Sound Touch Elastography in Liver Fibrosis in Patients With Chronic Hepatitis B: A Retrospective Cohort Study.

This study aims to evaluate the diagnostic value of standardized semiquantitative scoring of color Doppler ultrasound combined with liver stiffness measurement (LSM) of sound touch elastography (STE) in chronic hepatitis B (CHB) patients, providing a reference for the liver fibrosis diagnosis. We performed ultrasound and STE on CHB patients, with liver biopsies as the benchmark. We compared the differences in ultrasound standardized semiquantitative scoring and LSM among patients with different stages of liver fibrosis, and evaluated the diagnostic efficacy of significant liver fibrosis using receiver operating characteristic (ROC) curves and the area under the ROC curve alone or in combination. The total scores of ultrasound semiquantitative scoring and LSM showed statistically significant differences among patients with different stages of liver fibrosis (P < 0.05). There was no statistically significant difference in the total scores of S0 and S1 stages or in the LSM values (P > 0.05). However, the total scores and LSM values for patients at stages S2 and S3 were both higher than those at stage S0, and increased with the severity of fibrosis staging, with statistically significant differences (P < 0.05). The results of the ROC curve analysis showed that the combined diagnosis of significant liver fibrosis with ultrasound standardized semiquantitative scoring and STE had an area under the curve of 0.807, which was significantly greater than using ultrasound standardized semiquantitative scoring (0.694, P < 0.05) or shear wave elastography alone (0.706, P < 0.05). Color Doppler ultrasound with standardized semiquantitative scoring combined with STE examination can detect significant liver fibrosis (≥S2) in CHB patients.