Subjective Grading Research Articles

DETERMINATION OF PARATHYROID FUNCTION AFTER TOTAL THYROIDECTOMY BY OBJECTIVE ANALYSIS OF ITS FLUORESCENCE INTENSITY WITH INDOCYANINE GREEN USING PURPOSE DEVELOPED COMPUTER SOFTWARE

BackgroundTransient postoperative hypocalcaemia is the most common complication following total thyroidectomy. This study explores the correlation between indocyanine green (ICG)-parathyroid fluorescence and parathyroid glandular function post-total thyroidectomy, employing a novel, purpose-built computer software for objective and intraoperative measurement of fluorescence intensity. MethodsA prospective, single-center study was conducted on patients undergoing total thyroidectomy. Parathyroid gland fluorescence intensity after ICG administration in individuals experiencing post-thyroidectomy hypocalcaemia was compared with those without hypocalcaemia. Objective determination of fluorescence intensity using the dedicated computer program was contrasted with subjective analog grading scales. ResultsAnalysis of data from 61 patients revealed that the software-based objective determination of parathyroid fluorescence intensity offered superior predictive value for postoperative normocalcaemia (NPV=95,8%, AUC=0,784, p<0,001) compared to intraoperative PTH gradient (NPV=77,5%, AUC=0,780, p<0,001) and subjective fluorescence intensity determination (NPV=91,3%, AUC=0,762, p=0,001). Additionally, the software-based assessment emerged as the strongest independent predictor of postoperative normocalcaemia (OR=41,791, p=0,001), surpassing the predictive power of PTH gradient (OR=12,472, p=0,004). ConclusionsIntraoperative identification of a single high-intensity fluorescent parathyroid gland using the bespoke computer software is demonstrated to be a reliable predictor, allowing for the avoidance of postoperative hypocalcaemia following total thyroidectomy. This novel approach holds promise for improving surgical outcomes in thyroidectomy procedures.

Meibography health score: a simple grading system for isotretinoin-induced meibography alterations on patients with acne vulgaris.

To develop a simple, subjective, and reliable grading scale for isotretinoin-induced meibography changes. After analyzing meibography images obtained from systemic isotretinoin users, a grading scale was proposed and named "meibography health score." The score ranged from 1 to 3, with decreasing gland reflectivity and identifiable margins. A total of 11 medical professionals were asked to grade 10 meibography images obtained from isotretinoin users using the proposed scale and were divided into three groups: (A) ophthalmologists with experience with meibography, (B) ophthalmologists with no experience with meibography, and (C) radiologists. The kappa statistic was determined to test interrater reliability. The overall kappa was approximately 0.64. The kappa scores for Groups A, B, and C were 0.78, 0.59, and 0.90, respectively. Grade 2 had the lowest kappa scores (0.62, 0.35, and 0.82 for A, B, and C, respectively) and grade 3 the highest (0.78, 0.90, and 1.0 for A, B and C, respectively). Furthermore, Group C had the highest kappa scores and Group B the lowest. The meibography health score exhibited good interrater reliability, particularly in severe cases.

Shapeshifting in Social Spaces: Sociolinguistic Competence of Multilingual Learners

The study aims to determine the sociolinguistic competence level of the multilingual Grade 10 learners at Buhisan Night High School for the Academic Year 2024-2025. Terogo et al. (2018), stated that even though students have been shown to gain exceptional grades in English subjects, they fall short in sociolinguistic competence since it is not practiced more often in the Philippines. Thus, assessing sociolinguistic competence is important as well as addressing the low-level sociolinguistic competency of the learners through an action plan. A descriptive quantitative research method was used to determine the sociolinguistic competence level of the multilingual 48 student-respondents. The researcher adapted a TOIEC test and used a researcher-made questionnaire to assess the learners’ sociolinguistic competence. A weighted average mean was used to determine their proficiency and sociolinguistic competence level. Based on the results of the study, situational judgment got the highest rank while reading comprehension got the lowest rank in terms of the learners’ proficiency level. However, the study revealed that the respondents got a general weighted average of 15.83 which means that the respondents’ sociolinguistic competence level is under “Basic Sociolinguistic Competence” which is below the passing rate with a percentage of 58.63. The study recommends enhancing students’ sociolinguistic competence through the integration of sociolinguistic competence in language teaching through enhancement activities and exercises such as role-playing, dialogues and situational exercises, and future researchers may use the findings as a basis for future research or conduct related studies to enhance the sociolinguistic competence of Filipino multilingual learners.

Outcome Measures after Peripheral Nerve Injury: Past, Present and Future.

Peripheral nerve injuries (PNI) present substantial challenges due to variability in injury severity and limited regenerative capabilities. Historically, PNI research has focussed on measures such as subjective surgeon outcome grading, two-point discrimination (2PD) and the Medical Research Council (MRC) grading system. While these methods have use, there are also limitations related to subjectivity and sensitivity. Electrophysiological studies, including electromyography (EMG) and nerve conduction studies (NCS), provide detailed insights but are invasive and resource intensive. Currently, the landscape of outcome measurements in PNI research is diverse, incorporating a mix of surgeon-scored, patient-reported and objective measures. Advancements in wearable devices and motion-tracking technologies offer the potential for continuous, real-time monitoring of patient recovery. These innovations can provide a more comprehensive and objective view of functional recovery, moving beyond the limitations of periodic clinical assessments. The primary limitation in current PNI research is the lack of standardisation in outcome measures and the arbitrary timing of assessments. This variability complicates data interpretation and comparative effectiveness research. Standardising the selection and timing of outcome measures is crucial for enhancing the reliability of research findings and facilitating collaborative studies. Level of Evidence: Level V (Diagnostic).

Optimising Assessment Workload And Student Experience; A Quantitative And Qualitative Analysis Of An Undergraduate Subject Restructure.

Optimising the workload of university students is important for their academic performance and student experience. Large perceived workloads are associated with poorer academic performance and lower student satisfaction in university students. In response to student feedback in 2021, we redesigned a second-year undergraduate physiology subject in order to optimise workload and improve student experience. The practical assessments (contributing 50% of the subject grade) were consolidated from five small reports to two more comprehensive reports. The new subject design resulted in a 3.85% reduction in practical assessment marks (p<0.05), although students maintained their academic performance in the end of trimester quiz. Upon reflection, the new practical assessments may have been more challenging for students and more discriminating of academic performance, as they required greater levels of critical thinking and more in-depth discussion of complex physiological concepts. Student satisfaction was reduced following the first iteration of the new subject design, but with additional assessment support for students by academic staff in 2022, the student experience ratings were no longer below expected values. In summary, consolidating the number of practical assessments was predicted to foster deeper learning of physiological concepts. However, to successfully achieve this, support from academic staff appears to be an essential factor to foster a positive student experience.

Quantitative assessment of cervical disc degeneration using disc signal intensity index.

The assessment of disc degeneration remains a significant challenge in clinical research. Pfirrmann grade is a frequently used classification for lumbar disc degeneration on MRI. However, there has been no gold standard for cervical spine disc degeneration. Recently, we introduced the Disc Signal Intensity Index (DSI2) as a quantitative disc assessment for the lumbar spine, which is easily measurable in the cervical spine. The aim of this study was to apply DSI2 in the cervical intervertebral disc and investigate the factors associated with the cervical disc degeneration. Cross-sectional study using retrospectively collected data. Cervical MRIs from a database of patients undergoing ACDF between 2015 and 2018 were retrospectively reviewed. Demographic variables included age, sex, body mass index (BMI), race, smoking status, and comorbidities such as diabetes, chronic kidney disease, and coronary artery disease. DSI2 measurements were performed on midsagittal T2-weighted MRI images by determining the intensity within regions of interest (ROI). One ROI was set in the cerebrospinal fluid (CSF) and three ROIs were set per disc at the anterior, middle, and posterior third. The mean of the three measurements per disc was then divided by that of the CSF to calculate the DSI2 score. Multivariable linear regression analyses with mixed model were conducted to determine the potential contributing factors for disc degeneration. A total of 149 patients and 770 discs were included in the final analysis. Ninety-three patients (37.6%) were female and the mean (SD) age was 55.6 (11.7) years. The distribution of DSI2 scores among the different Pfirrmann grades was as follows: Grade 1: 0.259±NA; Grade 2: 0.226±0.090; Grade 3: 0.175±0.070; Grade 4: 0.136±0.060; Grade 5: 0.131±0.050. Multivariable linear mixed-effect regression analysis, setting with DSI2 as the objective variable, demonstrated that age (β= -0.130, p< 0.05), BMI (β= -2.06, p< 0.05), Modic changes (Type1 β= -2.70, p<0.01) were independent contributors to disc degeneration. The segments C4/5 and C7/T1 were less prone to disc degeneration (C4/5: β=1.37, p<0.001; C7/T1: β= 2.63, p<0.001) and the history of diabetes (β=5.31, p<0.01) was associated with high DSI2.(p<0.01) CONCLUSIONS: The present study provides valuable insights for identifying risk factors in degenerative cervical conditions utilizing the DSI2. The DSI2 method emerges as a promising alternative for future disc research, excelling in the detection of subtle progressions of degeneration and distinguishing itself from the subjective Pfirrmann grading system.

Pengaruh Model PjBL Terhadap Hasil Belajar Siswa Kelas VIII pada Mata Pelajaran Bahasa Indonesia di MTs Muhammadiyah Padang Panjang

This study aims to determine the influence of the project-based learning model on Indonesian subjects in grade VIII at MTS Muhammadiyah Padang Panjang. This research was carried out with a quantitative research method in the form of a Quasi Experiment. There were 70 students as a sample in class VIII consisting of 35 people in the experimental class and 35 people in the control class. The data collection technique used is a test at the beginning and at the end of Indonesian learning. The data analysis techniques are normality tests, homogeneity tests, and hypothesis tests with the t-test method. The results of the study show that the application of the Project Based Learning (PjBL) learning model has an effect on the learning outcomes of grade VIII students, as evidenced by the t-test value that has been carried out using Microsoft Excel in this study of 9.395 which is greater than the ttable 1.668 at the significance level of α 0.05, meaning that Ha is accepted and Ho is rejected. There is a significant difference between the average learning outcomes of students using the PjBL learning model. Therefore, it can be concluded that the application of the Project Based Learning model has an effect on student learning outcomes in Indonesian subject grade VIII MTS Kauman Muhammadiyah Padang Panjang

Efektivitas Penggunaan Media Video Animasi Terhadap Hasil Belajar Siswa pada Mata Pelajaran IPA Kelas VIII SMP Negeri 3 Pariaman

Student learning outcomes are still low, especially in science subject grade VIII at SMP Negeri 3 Pariaman. This is because the media used by teachers in the learning process is still less varied, teachers use media in the form of printed books in which there are pictures that are difficult for students to understand. Therefore, this study aims to determine the effectiveness of the use of animated video media on student learning outcomes in science subject grade VIII at SMP Negeri 3 Pariaman. This type of research is quantitative research with an experimental approach in the form of a quasi experiment. The sample selected was class VIII.3 as a control class with 31 people and class VIII.5 as an experimental class with 31 people. This research was conducted on science subjects with human respiratory system material. The data processing used was a normality test, a homogeneity test, and a hypothesis test using the independent test method of t-test samples, with a significant level of ∝&lt;0.05. The results showed that there was a difference in learning outcomes, the experimental class with an average score of 70.48, compared to the control class with an average score of 60.38. Based on the results of the t-test calculation, t count = 2.987 while t table with a significant level ∝0.05 = 2.0003. When compared, the t calculation &gt; t table is 2.987 &gt; 2.0003. Which means that H1 is accepted, so that the effective animation video media is significantly applied to the learning outcomes of grade VIII students in science subjects at SMP Negeri 3 Pariaman

Penerapan Direct Method dalam Meningkatkan Prestasi Belajar Peserta Didik pada Mata Pelajaran Bahasa Arab Kelas 1C MTs di Pondok Pesantren Daarul Rahman Jakarta

This research is motivated by the problem of low grades in Arabic language learning subjects in class 1C MTs Daarul Rahman Islamic Boarding School, South Jakarta. The research method used is Classroom Action Research (PTK), data collection techniques with observation, oral and written tests, documentation. In this study, the subjects were students of class 1C MTs Daarul Rahman Islamic Boarding School, South Jakarta in the 2022/2023 school year consisting of 40 students. The object in this study is the improvement of students' learning achievement in Arabic language subjects using the direct method of class 1C MTs Daarul Rahman Islamic Boarding School, South Jakarta. The increase in students' learning achievement in Arabic language subjects has increased, it can be seen from each cycle that changes have occurred. In the pre-cycle the results were 62%, increased in cycle 1 with a result of 66%, and in cycle 2 increased with a result of 73%. From the learning activities that have been carried out, the learning achievement of students' Arabic language has increased and has reached the predetermined success criteria, it shows that the direct method is successful in improving students' Arabic language in class 1C MTs Daarul Rahman Islamic Boarding School, South Jakarta.

Validating scores from the short form of the Music Self-Perception Inventory (MUSPI-S) with seventh- to ninth-grade school students in Germany

The Music Self-Perception Inventory-Short (MUSPI-S) is a theoretically based instrument consisting of 28 items with subscales that assess music self-concept globally and in six specific areas. The present study sought to validate a German translation of the MUSPI-S using a sample of 444 secondary school students. In addition to participants’ scores from the German translation of the MUSPI-S, associated data included demographic background variables, self-reported school grades in various subjects, and interest in the school subject of music. Confirmatory factor analyses supported the hypothesized factor structure and measurement model for MUSPI-S scores. Latent factor correlations among MUSPI-S subscale scores and correlations of these scores with school grades and interest in the school subject of music aligned well with theoretical expectations and previous research. Findings also provided evidence for strict measurement invariance of scores in the German MUSPI-S across subgroups of gender, school year (i.e., grade level), and musical activity. MUSPI-S subscale factor-level means did not reliably differ among seventh-, eighth-, and ninth-grade students but favored females over males and musically active over non-active students on nearly all subscales. Overall, this evidence supports the use of the German translation of the MUSPI-S in assessing a wide range of important self-perceived musical abilities for research and practical assessment purposes.

Effectiveness of hybrid simulation training on medical student performance in whole-task consultation of cardiac patients: The ASSIMILATE EXCELLENCE randomized waitlist-controlled trial

BackgroundAssessment of comprehensive consultations in medicine, i.e. a complete history, physical examination, and differential diagnosis, is regarded as authentic tests of clinical competence; however, they have been shown to have low reliability and validity due to variability in the real patients used and subjective examiner grading. In the ASSIMILATE EXCELLENCE study, our aim was to assess the effect(s) of expert tuition with hybrid simulation using a simulated patient wearing a novel auscultation vest, i.e. a hybrid simulated patient, and repeated peer grading using scoring checklists on student learning, performance, and acumen in comprehensive consultations of patients with valvular heart disease.MethodsASSIMILATE EXCELLENCE was a randomized waitlist-controlled trial with blinded outcome assessment undertaken between February 2021 and November 2021. Students at the Royal College of Surgeons in Ireland in either the second or third year of the four-year graduate-entry medical degree programme were randomized to a hybrid simulation training or waitlist control group and undertook three consultation assessments of three different clinical presentations of valvular heart disease (cases: C1–C3) using hybrid simulation. Our primary outcome was the difference in total score between and within groups across time; a secondary outcome was any change in inter-rater reliability across time. Students self-reported their proficiency and confidence in comprehensive consultations using a pre- and post-study survey.ResultsIncluded were 68 students (age 27.6 ± 0.1 years; 74% women). Overall, total score was 39.6% (35.6, 44.9) in C1 and increased to 63.6% (56.7, 66.7) in C3 (P < .001). On intergroup analysis, a significant difference was observed between groups in C2 only (54.2 ± 7.1% vs. 45.6 ± 9.2%; P < .001), a finding that was mainly driven by a difference in physical examination score. On intragroup analysis, significant improvement in total score across time between cases was also observed. Intraclass correlation coefficients for each pair of assessors were excellent (0.885–0.996 [0.806, 0.998]) in all cases. Following participation, students’ confidence in comprehensive consultation assessments improved, and they felt more prepared for their future careers.ConclusionsHybrid simulation-based training improves competence and confidence in medical students undertaking comprehensive consultation assessment of cardiac patients. In addition, weighted scoring checklists improve grading consistency, learning through peer assessment, and feedback.Trial registrationClinicalTrials.gov Identifier: NCT05895799

Beyond English Instruction: A multistate analysis of Lau’s unfulfilled promise of access to core content

ABSTRACT The Lau v. Nichols Supreme Court case specifies two core responsibilities of schools – and rights for students – with regard to students classified as English learners (ELs): 1) opportunities to learn English; and 2) equitable access to grade-level content. Yet 50 years since Lau’s passage, students’ right to content may not be being upheld. Indeed, students classified as ELs may be fully excluded from classes in one or more content areas, a phenomenon called exclusionary tracking. Drawing on longitudinal, student-level data from Oregon and Michigan, we examined the prevalence of EL exclusionary tracking in grades 9–12, how it varied by subject area and grade, and the structural, organizational, and demographic predictors of exclusionary tracking. We found that many students classified as ELs were disproportionately excluded from content compared to their non-EL peers, with the largest exclusion in English language arts and science and important variation in exclusionary patterns across states and grades. Multiple factors predicted exclusionary tracking, including English proficiency level, disability status, and bilingual program participation. We discuss implications for policy and practice at the school, district, and state levels.

Representation in Brazilian classrooms: racial matching between students and teachers and school performance

ABSTRACT This study aims to analyze the impact of racial matching between teacher and student on the academic performance of middle school students in Brazil. The data comes from an educational evaluation survey carried out by the Joaquim Nabuco Foundation – Ministry of Education of Brazil (FUNDAJ 2020), which followed the same cohort of students in the sixth and seventh years of public middle schools, between the years of 2017 and 2018. To address to the potential source of endogeneity, we use FUNDAJ panel data to estimate student fixed effects models, which makes it possible to compare students who have one race-matched and one non-race-matched teacher within the same subject in the two years of data. The results show that, when placed in a situation of racial equality with their Portuguese and Mathematics teachers, Black students will present better grades in both subjects, by about 30% of their average grade. The results also show evidence of heterogeneity, with stronger effects in female students.

Pengaruh Kartu Huruf Terhadap Kemampuan Membaca Permulaan Siswa pada Mata Pelajaran Bahasa Indonesia Kelas II di Sekolah Dasar

This study aims to determine the effect of the use of letter card media on students' initial reading ability in Indonesian Language subject grade II in elementary school. This research is a quantitative research with an experimental research method with a quasi experiment type. The sample of this study was taken using a saturated sampling technique consisting of two classes, namely class II A with 20 students as a control class without using letter cards and class II B with 20 students as an experimental class using letter card media. The data collection technique used in this study is a performance test (initial reading test) using pretest and posttest. The results of the research from both classes, namely in the pretest, had an average value (Mean) of the experimental class of 52.50 and the control class of 49.69. At the time of the posttest, the average score (Mean) of the experimental class was 80.94 and the control class was 59.69. The results of the hypothesis show that the tcount value &gt; the table is 5,146 &gt; 1,684 which means that H0 is rejected and H1 is accepted. So, the hypothesis states that the letter card media has an effect on students' initial reading ability in Indonesian subjects grade II at UPT SDN 060816 Medan.

DIURNAL PREFERENCES AND SCHOOL ACHIEVEMENT IN SECONDARY SCHOOL PUPILS

Diurnal preferences, also known as chronotypes, are individual differences in biological rhythms that influence physical and mental activity during certain parts of the day. This study investigates the relationship between diurnal preferences and school achievement in students in vocational engineering subjects, with a focus on the practical implications for educational strategies. The research population comprised 209 (100%) pupils from a vocational engineering school. We identified chronotypes (morning, evening and neutral chronotypes) using the Morning and Evening Types Questionnaire - The Morningness-Eveningness Questionnaire (MEQ) (Horne, Östberg, 1976). We assessed school achievement (study results) by the arithmetic mean of school grades in vocational engineering subjects. The results showed that pupils with the morning chronotype performed significantly better in school achievement than those with the evening chronotype (p = 0.015). These findings underscore the need to consider individual biological rhythms in educational strategies.

Visualization of Scleral Flap Patency in Glaucoma Filtering Blebs Using OCT

PurposeTo investigate the use of anterior segment-optical coherence tomography (AS-OCT) to visualise the aqueous outflow pathway and patency of the scleral flap in glaucoma filtration surgery blebs. DesignCross-sectional study Subjects205 filtering blebs of 112 patients with glaucoma who had undergone trabeculectomy (Trab, n = 97) or deep sclerectomy surgery (DS, n = 108) with/without mitomycin-C (MMC). MethodsSwept source AS-OCT raster slices were used to image the Trab and DS blebs in sagittal and coronal planes using a standardised protocol. Bleb appearances were classified into four categories based on the scleral flap and sclerostomy/TDW appearance; A—sclerostomy/TDW not visible, B—sclerostomy/TDW visible but scleral flap indiscriminate from sclera, C—scleral flap distinct but edges adherent to surrounding sclera, D—scleral flap edges non adherent to surrounding sclera. Surgical outcomes were classified into complete success (CS; IOP ≤18mmHg with no medications), qualified success (IOP ≤18 with medications) and failure (IOP>18mmHg). ResultsThe proportions of complete success, qualified success and failure in the Trab and DS cohorts were 45.0% and 29.6%, 33.0% and 31.5%, and 22.0% and 38.9% respectively, with a median post-operative follow up of 8.4 years (SD 7.9, IQR 3.2-9.0). In qualified success and failed blebs, category C (Trab, 53.7%; DS, 52.5%) accounted for the majority of scleral flap appearances, followed by categories A and B. Category D (86.0%; 71.9%) accounted for the majority of appearances in Trab and DS blebs with complete success. There was a significantly greater proportion of MMC use in categories C and D compared to categories A and B in both Trab (p < 0.0001) and DS (p = 0.02) cohorts, demonstrating the association of intraoperative MMC use with increased patency of the scleral flap. ConclusionSwept source AS-OCT may be used to visualise the position and patency of the sclerostomy/TDW and scleral flap in relation to surrounding structures in both sagittal and coronal planes. While free scleral flap edges are primarily correlated with MMC use, it may also correlate with surgical success. AS-OCT may be used to complement subjective bleb grading at the slit-lamp in the assessment of filtering blebs.

Epigenetic regulation of Nrf2-Mediated angiogenesis in diabetic foot ulcer progression: Role of histone deacetylases

Nuclear factor E2-related factor 2 (Nrf2), a redox-sensitive transcription factor, regulates proangiogenic mediators, and antioxidant and detoxification enzymes. However, hitherto its regulation in the progression of DFU was poorly examined. The regulation of Nrf2 has been reported to be affected by various factors, including histone deacetylase (HDACs) and DNA methylation. The present study aimed to profile all classes of HDACs and correlate them with Nrf2 and angiogenic markers in the tissue biopsies of different grades of DFU patients (n = 20 in each grade). The gene expression profile of Nrf2 and its downstream targets, angiogenic markers, and all classes of HDACs were assessed using qPCR. Spearman's correlation was performed to analyze the correlation of HDACs with Nrf2 and its downstream targets along with angiogenic markers. We observed a progressive decrease in the gene expression of Nrf2 and angiogenic markers such as VEGF, HIF-1α, and SDF-1α and also an increase in the TSP-2 expression in different grades of DFU. In parallel, a significant downregulation of HDAC2/8 and SIRT1/2/4 has been observed in various grades of DFU subjects. On the other hand, HDAC1/3/4/11 and SIRT3/5/6/7 showed upregulation in different grades of DFU and the maximum increase was observed in Grade 3 patients. A significant negative correlation between Nrf2 and HDAC4, angiogenic markers, and HDAC4 suggested the pivotal role of the HDAC4-regulated Nrf2-mediated angiogenesis among DFU subjects. We have generated a first line of evidence on the epigenetic regulation of Nrf2 and its correlation with angiogenesis in the progression of diabetic foot ulcers.

Subjective grade of apprehension during the pivot-shift test reflects patient-reported outcomes more than conventional pivot-shift test grade after ACL reconstruction.

To investigate whether the pivot-shift test reflects patient-reported outcomes 1 year after anterior cruciate ligament (ACL) reconstruction based on a multicentre prospective cohort study. This study included patients who underwent primary ACL reconstruction using the hamstring tendons. The pivot-shift test grades were determined according to the International Knee Documentation Committee (IKDC) form as 0, 1+, 2+ or 3+. In addition, patients' subjective apprehension during the pivot-shift test were classified as 0 (no-apprehension), 1+ (mild-apprehension), 2+ (moderate-apprehension) or 3+ (severe-apprehension). In this study, a positive pivot-shift test was defined as grade 1+ or higher. A total of 837 patients were enroled in this study. One year postoperatively, there was no significant difference in the Knee injury and Osteoarthritis Outcome Score (KOOS), IKDC score, Lysholm knee scale and Tegner activity scale between the positive (118 patients) and negative (719 patients) groups of the conventional IKDC grading of the pivot-shift test. However, when divided into two groups based on the apprehension grading of the pivot-shift test after surgery, the postoperative scores were significantly lower in the apprehension-positive group (114 patients) than those in the apprehension-negative group (723 patients) on the Tegner activity scale and KOOS Symptom, Sports/Rec and Quality of Life subscales. Patients' subjective apprehension during the pivot-shift test after ACL reconstruction was significantly associated with the postoperative Tegner activity scale and three subscales of the KOOS. However, there was no association between the conventional IKDC grading of the pivot-shift test and any patient-reported outcomes postoperatively. Level II.

Robust, credible, and interpretable AI-based histopathological prostate cancer grading.

Prostate cancer (PCa) is among the most common cancers in men and its diagnosis requires the histopathological evaluation of biopsies by human experts. While several recent artificial intelligence-based (AI) approaches have reached human expert-level PCa grading, they often display significantly reduced performance on external datasets. This reduced performance can be caused by variations in sample preparation, for instance the staining protocol, section thickness, or scanner used. Another limiting factor of contemporary AI-based PCa grading is the prediction of ISUP grades, which leads to the perpetuation of human annotation errors. We developed the prostate cancer aggressiveness index (PCAI), an AI-based PCa detection and grading framework that is trained on objective patient outcome, rather than subjective ISUP grades. We designed PCAI as a clinical application, containing algorithmic modules that offer robustness to data variation, medical interpretability, and a measure of prediction confidence. To train and evaluate PCAI, we generated a multicentric, retrospective, observational trial consisting of six cohorts with 25,591 patients, 83,864 images, and 5 years of median follow-up from 5 different centers and 3 countries. This includes a high-variance dataset of 8,157 patients and 28,236 images with variations in sample thickness, staining protocol, and scanner, allowing for the systematic evaluation and optimization of model robustness to data variation. The performance of PCAI was assessed on three external test cohorts from two countries, comprising 2,255 patients and 9,437 images. Using our high-variance datasets, we show how differences in sample processing, particularly slide thickness and staining time, significantly reduce the performance of AI-based PCa grading by up to 6.2 percentage points in the concordance index (C-index). We show how a select set of algorithmic improvements, including domain adversarial training, conferred robustness to data variation, interpretability, and a measure of credibility to PCAI. These changes lead to significant prediction improvement across two biopsy cohorts and one TMA cohort, systematically exceeding expert ISUP grading in C-index and AUROC by up to 22 percentage points. Data variation poses serious risks for AI-based histopathological PCa grading, even when models are trained on large datasets. Algorithmic improvements for model robustness, interpretability, credibility, and training on high-variance data as well as outcome-based severity prediction gives rise to robust models with above ISUP-level PCa grading performance.

P-215 Prospective validation of the EMBRYOAID software for AI-based evaluation of embryos on the 5th day after fertilization during the in vitro procedure - multi-centre study

Abstract Study question Is AI-based evaluation of embryos as effective in achieving pregnancy as the standard assessment performed by an experienced embryologist? Summary answer AI-based assessment of blastocysts may result in comparable pregnancy rates as the standard assessment performed by an experienced embryologist. What is known already Standard clinical practice in the IVF procedure includes morphological assessment of blastocysts based on visual evaluation following Gardner scale. However, this subjective grading process is susceptible to variability dependent on the professionals’ experience and knowledge, leading to potential inconsistencies in selecting embryos for transfer. Recently, there has been a suggestion that artificial intelligence (AI) algorithms could enhance the predictability of treatment outcomes and many AI-based software applications have been introduced to the procedure in many IVF centers. Nevertheless, there are very few prospective evaluations of the real-life implementation of the novel technologies. Study design, size, duration It is an ongoing, randomized, prospective, multicenter, international study performed in four investigation centers since November 2023. The duration of the study is scheduled for one year. Participants/materials, setting, methods The first stage of the evaluation comprises a randomized selection of a patient meeting the inclusion criteria to one of the groups: test or control group. The next step includes a selection of the embryo for implantation. For the control group, the experienced embryologist performs the standard selection of embryos as per normal clinical practice following the Gardner scale. For the study group, the embryologist selects the embryo for transfer indicated by the EMBRYOAID application. Main results and the role of chance Currently, there have been 149 patients recruited in the study and 160 cycles with 638 embryos have been entered in the EMBRYOAID software for AI-based evaluation. Test group of 80 patients comprises 87 cycles with 346 embryos. Preliminary results of the prospective study conducted in real-life settings show encouraging outcomes in relation to the idea that AI-supported embryo evaluation may be as effective in regards to obtaining pregnancy as a standard clinical assessment performed by experienced professionals. Nevertheless, the sample size is not yet sufficient to achieve statistical significance. Therefore, further data gathering will be conducted and the study hypothesis will be furthermore examined. Limitations, reasons for caution The sample size is still insufficient to reach statistical significance and the study shows the preliminary results which will be further verified on a larger patient group. Wider implications of the findings Results of a prospective, randomized trial conducted in several international clinics may enhance the trend to introduce more objective, bias-free AI-based tools into the embryology labs. Trial registration number EMBRYO National Center for Research and Development nr POIR.01.01.01-00-1631/20-00; ERC Consolidator Grant TUgbOAT no 772346