Sufficient Validity Research Articles

Harnessing artificial intelligence for efficient systematic reviews: A case study in ecosystem condition indicators

Effective evidence synthesis is important for the integration of scientific research into decision-making. However, fully depicting the vast mosaic of concepts and applications in environmental sciences and ecology often entails a substantial workload. New Artificial Intelligence (AI) tools present an attractive option for addressing this challenge but require sufficient validation to match the vigorous standards of a systematic review. This article demonstrates the use of generative AI in the selection of relevant literature as part of a systematic review on indicators of ecosystem condition. We highlight, through the development of an optimal prompt to communicate inclusion and exclusion criteria, the need to describe ecosystem condition as a multidimensional concept whilst also maintaining clarity on what does not meet the criteria of comprehensiveness. We show that, although not completely infallible, the GPT-3.5 model significantly outperforms traditional literature screening processes in terms of speed and efficiency whilst correctly selecting 83 % of relevant literature for review. Our study highlights the importance of precision in prompt design and the setting of query parameters for the AI model and opens the perspective for future work using language models to contextualize complex concepts in the environmental sciences. Future development of this methodology in tandem with the continued evolution of the accessibility and capacity of AI tools presents a great potential to improve evidence synthesis through gains in efficiency and possible scope.

Validity of a Smartphone App to Objectively Monitor Performance Outcomes in Degenerative Cervical Myelopathy: Preliminary Findings From a Longitudinal Observational Study

Background Developing new clinical measures for degenerative cervical myelopathy (DCM) is an AO Spine RECODE-DCM research priority. Difficulties detecting DCM, and changes in DCM, cause diagnostic and treatment delays in clinical settings and heightened costs in clinical trials due to elevated recruitment targets. Digital outcome measures can tackle these challenges due to their ability to measure disease remotely, repeatedly, and more economically. Objective The study aims to assess the validity of MoveMed, a battery of performance outcome measures performed using a smartphone app, in the measurement of DCM. Methods A prospective observational study in decentralized secondary care was performed in England, United Kingdom. Validity and risk of bias were assessed using criteria from the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) manual. Each MoveMed outcome was compared with 2 patient-reported comparators, with a priori hypotheses of convergence or divergence tested against consensus thresholds. The primary outcome was the correlation coefficient between the MoveMed outcome and the patient-reported comparators. The secondary outcome was the percentage of correlations that aligned with the a priori hypotheses. The comparators used were the patient-derived modified Japanese Orthopaedic Association score and the World Health Organization Quality of Life Brief Version questionnaire. Thresholds for convergence or divergence were set at ≥0.3 for convergence, <0.3 for divergence, and >0/<0 for directionality. Results A total of 27 adults aged 60 (SD 11) years who live with DCM and possess an approved smartphone were included in a preliminary analysis. As expected, MoveMed tests of neuromuscular function correlated most with questionnaires of neuromuscular function (≥0.3) and least with questionnaires of quality of life (<0.3). Furthermore, directly related constructs correlated positively to each other (>0), while inversely related constructs correlated negatively (<0). Overall, 74% (67/90) and 47% (8/17) of correlations (unidimensional and multidimensional, respectively) were in accordance with hypotheses. No risk-of-bias factors from the COSMIN Risk of Bias checklist were recorded. Overall, this was equivalent to “very good” quality evidence of sufficient construct validity in DCM. Conclusions MoveMed outcomes and patient-reported questionnaires converge and diverge in accordance with expectations. These findings support the validity of the MoveMed tests in an adult population living with DCM. Criteria from COSMIN provide “very good” quality evidence to support this.

Development and Psychometric Evaluation of the Lifestyle Medicine Health Behavior Scale.

Purpose. The purpose of this study was to develop and validate a scale to measure health behavior across the six pillars of lifestyle medicine: sleep, social connectedness, physical activity, nutrition, substance use, and stress management. A pilot study (n = 94) investigated the construct, convergent, and content validity and reliability of the Lifestyle Medicine Health Behavior (LMHB) scale. Based on the pilot study results and literature, the scale was revised for further psychometric evaluation. Methods. A sample (n = 399) of participants completed the LMHB scale. Confirmatory factor analysis was used to assess construct validity. Face validity was assessed using qualitative feedback. Reliability was assessed using Cronbach's alpha. Results. The final model included five latent dimensions and one observed to represent each of the distinct pillars in lifestyle medicine. The open-ended response item elicited preponderance of positive feedback (∼80%); the scale was perceived as easy to understand and complete. Overall, the scale was reliable (α = 0.84). Conclusion. The LMHB scale assesses health behaviors across all six lifestyle medicine pillars, addressing each one systematically and individually. The scale had sufficient validity and reliability to measure health behaviors in this sample of adults. This is the first lifestyle medicine survey instrument to evaluate content, face, and construct validity and reliability.

Testing the convergent validity, domain generality, and temporal stability of selected measures of people’s tendency to explore

Given the ubiquity of exploration in everyday life, researchers from many disciplines have developed methods to measure exploratory behaviour. There are therefore many ways to quantify and measure exploration. However, it remains unclear whether the different measures (i) have convergent validity relative to one another, (ii) capture a domain general tendency, and (iii) capture a tendency that is stable across time. In a sample of 678 participants, we found very little evidence of convergent validity for the behavioural measures (Hypothesis 1); most of the behavioural measures lacked sufficient convergent validity with one another or with the self-reports. In psychometric modelling analyses, we could not identify a good fitting model with an assumed general tendency to explore (Hypothesis 2); the best fitting model suggested that the different behavioural measures capture behaviours that are specific to the tasks. In a subsample of 254 participants who completed the study a second time, we found that the measures had stability across an 1 month timespan (Hypothesis 3). Therefore, although there were stable individual differences in how people approached each task across time, there was no generalizability across tasks, and drawing broad conclusions about exploratory behaviour from studies using these tasks may be problematic. The Stage 1 protocol for this Registered Report was accepted in principle on 2nd December 2022 https://doi.org/10.6084/m9.figshare.21717407.v1. The protocol, as accepted by the journal, can be found at https://doi.org/10.17605/OSF.IO/64QJU.

The The development and psychometric properties of the Chiang Mai Aphasia Screening Test for stroke

Background: The aphasia screening test detects language and speech impairments, clarifying individuals’ language and speech abilities before administering a standardized aphasia diagnosis test. Objective: This study aimed to develop and validate an aphasia screening test for suspected cerebrovascular accident (CVA) patients with communication difficulties. Materials and methods: The study underwent two phases: developing and assessing psychometric properties. Five experts established content validity across receptive language, expressive language, reading, and writing. The Chiang Mai Aphasia Screening Test (CMAST) was evaluated on 14 CVA patients with and 14 without aphasia. Results: The content validity showed item-objective congruence ranging from 0.80 to 1.00. Sensitivity and specificity were 96.30% and 69%, respectively, with a maximum Youden’s Index at 65.30% and a cut-off point of 43 points. Concurrent validity was high (phi coefficient =0.67), and significant score differences (p<0.001) in construct validity confirmed the tool’s ability to distinguish aphasic from non-aphasic patients. Inter-rater reliability (ICC=0.99) and internal consistency (Cronbach’s alpha =0.97, 95% CI 0.95-0.98) were observed. Conclusion: The CMAST, comprising 45 items, exhibits sufficient validity and reliability for screening individuals suspected of aphasia due to CVA.

Patient-reported outcome measures for medication treatment satisfaction: a systematic review of measure development and measurement properties

BackgroundMedication Treatment Satisfaction (M-TS) from the patients’ perspective is important for comprehensively evaluating the effect of medicines. The extent to which current patient-reported outcome measures (PROMs) for M-TS are valid, reliable, responsive, and interpretable remains unclear. To assess the measurement properties of existing PROMs for M-TS and to highlight research gaps.MethodsUsing PubMed, Embase (Ovid), Cochrane library (Ovid), IPA (Ovid), PsycINFO, Patient-Reported Outcome and Quality of Life Questionnaires biomedical databases, and four Chinese databases, we performed a systematic search for studies addressing the development and validation of PROMs for M-TS. Based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guideline, pairs of reviewers independently assessed the measurement properties of the PROMs and rated the quality of evidence on the measurement properties of each PROM. (The Open Science Framework registration: https://doi.org/10.17605/OSF.IO/8S5ZM).ResultsThis review identified 69 PROMs for M-TS in 114 studies (four generic, 32 disease-specific, and 33 drug-specific) of which 60 were intended for adults. All provided limited or no information regarding interpretability. Most demonstrated appropriate construct validity including convergent validity (39/69) and discriminative or known-groups validity (40/69) (high to moderate quality of evidence). Only a few provided evidence of sufficient content validity (8/69), structural validity (13/69), and internal consistency (11/69). Of 38 PROMs reporting test–retest reliability, results in 24 provided evidence of satisfactory test–retest reliability (18 with high to moderate, 6 with low to very low quality of evidence). Few PROMs reported responsiveness (16/69). Two generic PROMs (Treatment Satisfaction Questionnaire for Medication initial Version 1.4, TSQM-1.4; Treatment Satisfaction with Medicines Questionnaire, SATMED-Q) and one drug-specific PROM (Insulin Treatment Satisfaction Questionnaire, ITSQ) demonstrated both satisfactory validity and reliability.ConclusionsMost existing PROMs for M-TS require further exploration of measurement properties. Reporting guidelines are needed to enhance the reporting quality of the development and validation of PROMs for M-TS.

The Value of Human Epididymal Protein 4, Carcinoembryonic Antigen and Alpha-Fetoprotein in the Early Diagnosis of Cervical Cancer

Objectives: This research aimed to unveil the value of human epididymal protein 4 (HE4), carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) in the early diagnosis of cervical cancer. Design: This was a clinical study. Participants: Sixty patients with cervical cancer stage IA-IIA (early stage cervical cancer group), 60 patients with cervical intraepithelial neoplasia (CIN) (disease control group), and 60 healthy women who had passed the physical examination (healthy control group) were selected. Setting: The review was conducted in a Jiaxing First Hospital. Methods: Sixty patients with cervical cancer stage IA-IIA (early stage cervical cancer group), 60 patients with CIN (disease control group), and 60 healthy women who had passed the physical examination (healthy control group) were selected. The expression levels of serum HE4, CEA, and AFP in the three groups were detected, and the correlation between the levels of serum HE4, CEA, and AFP and the clinicopathological characteristics of patients with early stage cervical cancer were analyzed, and the receiver operating characteristic (ROC) curves were plotted to identify the value of the single and triple tests of serum HE4, CEA, and AFP for the early stage diagnosis of cervical cancer. Results: The levels of serum HE4, CEA, and AFP in the early stage cervical cancer group were higher than those in the disease control and the healthy control groups (p < 0.05). The levels of serum HE4, CEA, and AFP were related to the FIGO stage as well as the histological grading of patients with early stage cervical cancer (p < 0.05). The results of the ROC curves revealed that the AUC areas of HE4, CEA, and AFP for single as well as triple diagnosis of patients with early stage cervical cancer were 0.725, 0.679, 0.663, and 0.811, respectively, and the AUC of the three combined tests was markedly higher than that of HE4, CEA, AFP single test (p < 0.05). Limitations: There is a lack of larger sample sizes to test whether the combined HE4, CEA, and AFP detection has sufficient validity at the individual level and there are not enough serum samples in this study to perform circulating HPV-DNA detection and compare it with the levels of serum markers. Conclusion: The combination of HE4, CEA, and AFP has good clinical reference value analysis in the auxiliary diagnosis of early stage cervical cancer, and it is worthy of further validation and popularization.

Understanding Emotions in Adolescents: Validation of the Indonesian Version of the Adolescent Alexithymia Scale

Adolescence, marked by significant changes, often leads to emotional tension and instability associated with alexithymia. This study aimed to validate the Indonesian version of the Adolescent Alexithymia Scale, hypothesizing that its internal structure was unidimensional. Participants included 70 adolescents aged 13 to 18 years (M_age = 16.44; SD = 1.44). Data were collected using the Indonesian version of the Adolescent Alexithymia Scale, consisting of 24 items representing the four alexithymia indicators. The results revealed that the scale has a unidimensional internal structure, with 11 valid items, and sufficient validity and reliability coefficients. These items collectively represent the four main characteristics of alexithymia. The most dominant indicator is the difficulty in identifying and distinguishing between feelings and emotional bodily sensations. This research implies that this scale needs to be tested on different populations and in different contexts.

Spiritual Leadership Scale: Theoretical Foundations and Empirical Validation in the Context of Turkish Employees.

The objective of this study was twofold: firstly, to develop a novel scale for measuring the concept of spiritual leadership, and secondly, to evaluate the psychometric properties of this scale. The principal objective was to facilitate the assessment of spiritual leadership on the part of managerial personnel. In the course of the research, a three-stage process was undertaken. In the initial phase, the theoretical underpinnings of the concept were established through a comprehensive review of the spiritual leadership literature, and an item pool was constructed. In the second stage, exploratory factor analysis (EFA) was employed to ascertain the factor structure of the scale. In the third stage, confirmatory factor analysis (CFA) was employed to corroborate the identified structure and criterion validity analysis was conducted. The EFA results indicated that the scale exhibited a single-factor structure. The CFA results demonstrated that the model exhibited good fit indices, thereby confirming the single-factor structure. In the reliability analyses, the internal consistency coefficient (Cronbach's alpha) of the scale was 0.988, which indicated a high level of reliability. These findings collectively demonstrate that the spiritual leadership scale possesses sufficient validity and reliability.

Factors associated with dischargehome in older patients admitted to emergency department observation units: Lookingfor a predictive scale.

The selection of patients who are going to be admitted to an emergency department observation unit (EDOU) is essential for the good management of these units, intended fundamentally to avoid unnecessary hospitalization of patients. This is especially important when dealing with older patients. It would be important to know what factors are associated with discharge home and to have a clinical predictive scale that appropriately selects older patients who are going to be admitted to an EDOU. A retrospective cross-sectional study was conducted of all patients ≥65 years of age assisted in 48 Spanish Emergency Departments for 7 consecutive days and were admitted to the EDOU. Demographics-functional, vital signs data and initial laboratory results were analyzed to investigate its association with discharge home and develop and validate a prediction model for discharge home from EDOU. Multivariable logistic regression was performed to develop a prediction model, and a scoring system was created. Among 5457 patients admitted to the EDOU from the emergency room, 2508 (46%) patients were discharged home, and 2949 (54%) were admitted to the hospital. Five variables were strongly associated with discharge home: the absence of fever (adjusted OR: 3.61, 95% CI:1.53-8.54), Glasgow Coma Scale score of 15 points (2.80, 1.63-4.82), absence of tachypnea (2.51, 1.74-3.64) or leukocytosis (2.07, 1.70-2.52) and oxygen saturation >94% (2.00, 1.64-2.43). The final model achieved an area under the receiver operating characteristic curve of 0.648 (IC95% = 0.627-0.668) in the development cohort and 0.635 (0.614-0.656) in the validation cohort. There are factors associated with a greater probability of discharge home of older patients admitted to EDOUs. Prediction at the individual level remains elusive, as the best model obtained in this study did not have sufficient validity to be applied in the clinical setting.

Validation of the Persistent Somatic Symptom Stigma Scale for Healthcare Professionals

ObjectivePersistent somatic symptoms (PSS) describe recurrent or continuously occurring symptoms such as fatigue, dizziness, or pain that have persisted for at least several months. These include single symptoms such as chronic pain, combinations of symptoms, or functional disorders such as fibromyalgia or irritable bowel syndrome. While many studies have explored stigmatisation by healthcare professionals towards people with PSS, there is a lack of validated measurement instruments. We recently developed a stigma scale, the Persistent Somatic Symptom Stigma scale for Healthcare Professionals (PSSS-HCP). The aim of this study is to evaluate the measurement properties (validity and reliability) and factor structure of the PSSS-HCP. Study Design and SettingThe PSSS-HCP was tested with 121 healthcare professionals across the United Kingdom to evaluate its measurement properties. Analysis of the factor structure was conducted using principal component analysis. We calculated Cronbach’s alpha to determine the internal consistency of each (sub)scale. Test re-test reliability was conducted with a sub-sample of participants with a two-week interval. We evaluated convergent validity by testing the association between the PSSS-HCP and the Medical Condition Regard Scale (MCRS) and the influence of social desirability using the short form of the Marlowe Crowne Social Desirability Scale (MCSDS). ResultsThe PSSS-HCP showed sufficient internal consistency (Cronbach’s alpha = 0.84) and sufficient test-retest reliability, intraclass correlation = 0.97 (95% CI 0.94 to 0.99, p<0.001). Convergent validity was sufficient between the PSSS-HCP and the MCRS, and no relationship was found between the PSSS-HCP and the MCSDS. A three factor structure was identified (othering, uneasiness in interaction, non-disclosure) which accounted for 60.5% of the variance using 13 of the 19 tested items. ConclusionThe PSSS-HCP can be used to measure PSS stigmatisation by healthcare professionals. The PSSS-HCP has demonstrated sufficient internal consistency, test-retest reliability, convergent validity and minimal influence of social desirability bias. The PSSS-HCP has demonstrated potential to measure important aspects of stigma and provide a foundation for stigma reduction intervention evaluation.

Assessing the Effectiveness of Automatic Speech Recognition Technology in Emergency Medicine Settings: A Comparative Study of Four AI-powered Engines.

Cutting-edge automatic speech recognition (ASR) technology holds significant promise in transcribing and recognizing medical information during patient encounters, thereby enabling automatic and real-time clinical documentation, which could significantly alleviate care clinicians' burdens. Nevertheless, the performance of current-generation ASR technology in analyzing conversations in noisy and dynamic medical settings, such as prehospital or Emergency Medical Services (EMS), lacks sufficient validation. This study explores the current technological limitations and future potential of deploying ASR technology for clinical documentation in fastpaced and noisy medical settings such as EMS. In this study, we evaluated four ASR engines, including Google Speech-to-Text Clinical Conversation, OpenAI Speech-to-Text, Amazon Transcribe Medical, and Azure Speech-to-Text engine. The empirical data used for evaluation were 40 EMS simulation recordings. The transcribed texts were analyzed for accuracy against 23 Electronic Health Records (EHR) categories of EMS. The common types of errors in transcription were also analyzed. Among all four ASR engines, Google Speech-to-Text Clinical Conversation performed the best. Among all EHR categories, better performance was observed in categories "mental state" (F1 = 1.0), "allergies" (F1 = 0.917), "past medical history" (F1 = 0.804), "electrolytes" (F1 = 1.0), and "blood glucose level" (F1 = 0.813). However, all four ASR engines demonstrated low performance in transcribing certain critical categories, such as "treatment" (F1 = 0.650) and "medication" (F1 = 0.577). Current ASR solutions fall short in fully automating the clinical documentation in EMS setting. Our findings highlight the need for further improvement and development of automated clinical documentation technology to improve recognition accuracy in time-critical and dynamic medical settings.

Grit y responsabilidad social en estudiantes con Educación 4.0 y proyectos de Aprendizaje y Servicios

In this study, we aimed to evaluate the effectiveness of an enhanced Education 4.0 proposal incorporating Service Learning (SL) among university students. A quantitative research was conducted with a sample of 30 students from Universidad de Aconcagua (Chile) during the period from April to June 2024. Data were collected using questionnaires with sufficient validity and reliability; the first instrument assessed Grit on the 12-item Grit-O scale with scores ranging from 1 to 5, with 5 being the highest level, and the second instrument measured social responsibility from 1 to 6, with 6 as the maximum value. The results indicate that the use of Education 4.0 along with Service Learning showed a significant increase in social responsibility, rising from 4.96 to 5.37 (p&lt;0.05), and a slight increase in Grit, from 4.36 to 4.41, achieving better outcomes than students who only used Education 4.0. The findings suggest that Education 4.0 with Service Learning projects is a more effective methodology than Education 4.0 alone for increasing Grit and social responsibility among university students.

Psychometric properties of the newly developed self-report environmental determinants of health questionnaire (EDH-Q): development and validation

BackgroundThe environmental determinants of health (EDH) have a significant impact on people’s physical, mental, and social wellbeing. Everyone needs access to environmental resources of all types, including food, materials, and energy, to survive. Currently, no valid and reliable instrument exists for evaluating individuals’ perceived levels of EDH. Hence, the purpose of this study was to develop and validate the environmental determinants of health questionnaire (EDH-Q) among undergraduate students in Nigeria.MethodWe conducted a cross-sectional survey among undergraduate students in Nigeria to assess the psychometric properties of the newly developed Environmental Determinants of Health Questionnaire (EDH-Q). Respondents were selected using a convenience sampling approach to evaluate their perceptions of environmental determinants of health. The Content Validity Index (CVI) and Face Validity Index (FVI) were calculated to ascertain the scale’s content validity and response process validity, respectively. Additionally, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), composite reliability (CR), average variance extracted (AVE), Cronbach’s alpha, and intraclass correlation coefficient (ICC) were computed to assess the scale’s construct validity.ResultsThe study involved 300 respondents in the EFA (males 55.7%, females 44.3%) and 430 respondents in the CFA (males 54.0%, females 46.0%). In the EFA, two constructs were identified (the natural environment and the built environment). The EFA model was able to explain 63.57% of the total cumulative variance, and the factor correlation was 0.671. The whole scale Cronbach’s alpha value was 0.947, while the two constructs’ Cronbach’s alpha values were 0.918 (natural environment) and 0.935 (built environment). In the CFA, six pairs of error covariances were included between items within the same construct to improve the fit indices of the initial proposed measurement model. The final re-specified measurement model showed that the EDH-Q, which has two constructs and 18 items, has adequate construct validity (CFI = 0.948, TLI = 0.938, SRMR = 0.046, RMSEA = 0.052, and RMSEA p-value = 0.344). The CRs were 0.845 (natural environment) and 0.854 (built environment). The ICCs were 0.976 (natural environment) and 0.970 (built environment).ConclusionThe results show that the newly created EDH-Q has sufficient construct validity and may be utilized to assess participants’ perceptions of their level of EDH. Researchers should examine this instrument in populations with different age ranges and other demographic characteristics, as the present study only applied it to undergraduate students who may share similar characteristics.

Patient safety and healthcare quality of U.S. laboratory developed tests (LDTs) in the AI/ML era of precision medicine.

This policy brief summarizes current U.S. regulatory considerations for ensuring patient safety and health care quality of genetic/genomic test information for precision medicine in the era of artificial intelligence/machine learning (AI/ML). The critical role of innovative and efficient laboratory developed tests (LDTs) in providing accurate diagnostic genetic/genomic information for U.S. patient- and family-centered healthcare decision-making is significant. However, many LDTs are not fully vetted for sufficient analytic and clinical validity via current FDA and CMS regulatory oversight pathways. The U.S. Centers for Disease Control and Prevention's Policy Analytical Framework Tool was used to identify the issue, perform a high-level policy analysis, and develop overview recommendations for a bipartisan healthcare policy reform strategy acceptable to diverse precision and systems medicine stakeholders.

Real-World Data and Real-World Evidence in Healthcare in the United States and Europe Union.

The use of real-world data (RWD) for healthcare decision-making is complicated by concerns regarding whether RWD is fit-for-purpose or is of sufficient validity to support the creation of credible RWE. An efficient mechanism for screening the quality of RWD is needed as regulatory agencies begin to use real-world evidence (RWE) to inform decisions about treatment effectiveness and safety. First, we provide an overview of RWD and RWE. Data quality frameworks (DQFs) in the US and EU were examined, including their dimensions and subdimensions. There is some convergence of the conceptual DQFs on specific assessment criteria. Second, we describe a list of screening criteria for assessing the quality of RWD sources. The curation and analysis of RWD will continue to evolve in light of developments in digital health and artificial intelligence (AI). In conclusion, this paper provides a perspective on the utilization of RWD and RWE in healthcare decision-making. It covers the types and uses of RWD, data quality frameworks (DQFs), regulatory landscapes, and the potential impact of RWE, as well as the challenges and opportunities for the greater leveraging of RWD to create credible RWE.

Kidney diseases: News from the KDIGO guidelines

The KDIGO Update 2024 was supplemented by new "Clinical Practice Points", which were derived from the current evidence but are not necessarily comprehensively proven by prospective controlled studies. The most significant change in the Update 2024 for Lupus nephritis concerns the recommendations for induction therapy for lupus nephritis classes III and IV. The basis is still high-dose glucocorticoid treatment and the use of hydroxychloroquine. The 2 new developments in the 2024 Update concerning ANCA-associated nephritis are based on the studies on the use of the C5a receptor inhibitor Avacopan and the increasing data on induction protocols with reduced glucocorticoid dosage. Due to the inconsistency and variability of the conditions under which blood pressure measurements are carried out in practice, an international consensus statement was issued which defines 4 steps to achieve sufficient validity of the measurement results. CKD-MBD Controversies Conference 2023: The update for CKD-MBD, which was discussed in the Controversies Conference 2023, is in progress and has not been released yet. However, there were no serious contradictions between the 2023 data and the 2017 guidelines - the risk assessment regarding calcium-containing phosphate binders may have been put into perspective.

Validity of Cardiopulmonary Exercise Testing for Assessing Aerobic Capacity in Neuromuscular Diseases

ObjectivesTo determine the content validity of cardiopulmonary exercise testing (CPET) for assessing peak oxygen uptake (VO2peak) in neuromuscular diseases (NMD). DesignBaseline assessment of a randomized controlled trial. SettingAcademic hospital. ParticipantsEighty-six adults (age: 58.0±13.9 y) with Charcot-Marie-Tooth disease (n=35), postpolio syndrome (n=26), or other NMD (n=25). InterventionNot applicable. Main Outcome MeasuresWorkload, gas exchange variables, heart rate, and ratings of perceived exertion were measured during CPET on a cycle ergometer, supervised by an experienced trained assessor. Muscle strength of the knee extensors was assessed isometrically with a fixed dynamometer. Criteria for confirming maximal cardiorespiratory effort during CPET were established during 3 consensus meetings of an expert group. The percentage of participants meeting these criteria was assessed to quantify content validity. ResultsThe following criteria were established for maximal cardiorespiratory effort: a plateau in oxygen uptake (VO2plateau) as the primary criterion, or 2 of 3 secondary criteria: (1) peak respiratory exchange ratio (RERpeak) ≥1.10 (2), peak heart rate ≥85% of predicted maximal heart rate; and (3) peak rating of perceived exertion (RPEpeak) ≥17 on the 6-20 Borg scale. These criteria were attained by 71 participants (83%). VO2plateau, RERpeak ≥1.10, peak heart rate ≥85%, and RPEpeak ≥17 were attained by 31%, 73%, 69%, and 72% of the participants, respectively. Peak workload, VO2peak, and knee extension muscle strength were significantly higher, and body mass index was lower (all P<.05), in participants with maximal cardiorespiratory effort than other participants. ConclusionsMost people with NMD achieved maximal cardiorespiratory effort during CPET. This study provides high quality evidence of sufficient content validity of VO2peak as a maximal aerobic capacity measure. Content validity may be lower in more severely affected people with lower physical fitness.

Validation of the Chinese orthostatic discriminant and Severity Scale (ODSS) for detection of orthostatic intolerance syndrome

BackgroundOrthostatic intolerance (OI) is the inability to tolerate orthostatic stress during any postural change. The etiology of OI varies, and methods to obtain a specific diagnosis and plan appropriate treatment are important. The tools available within the Chinese context to swiftly identify orthostatic intolerance syndrome (OIS) are currently limited. MethodsPatients with OI symptoms were included in this study and categorized into two groups based on the results of the supine-to-stand test. Those with abnormal test results were assigned to the OIS group, while those with normal test results were placed in the non-OIS group. We evaluated the internal consistency and predictive value of the Chinese Orthostatic Discriminant and Severity Scale (ODSS) by comparing patients’ scores with their physiological measurements collected during orthostatic stress tests and the results of other available questionnaires, including the orthostatic Symptom Questionnaire and Orthostatic Grading Scale (OGS). ResultsPatients with OIS scored significantly higher on all three questionnaires and showed significant differences in autonomic responses during orthostatic stress tests compared with non-OIS patients. Receiver operating characteristic curve analysis showed that the orthostatic score from the ODSS had moderate predictive value for the supine test (area under the curve [AUC] = 0.754). Further subgroup analysis revealed that the orthostatic score from the ODSS had uniquely high specificity and sensitivity for identifying patients with orthostatic hypotension with abnormal cerebral blood flow (OH–U, AUC = 0.919). ConclusionsWe conclude that the Chinese version of the ODSS has sufficient reliability and validity to distinguish patients with OIS and could possibly be used as a diagnostic tool for OH–U patients. Thus, the Chinese ODSS offers a beneficial screening tool for quickly assessing whether patients have OIS that requires further clinical assessment.

Development of a social commerce scale: exploratory and confirmatory factor analysis using structural equation modelling

PurposeThis paper aims to propose an instrument for measuring social commerce among entrepreneurs from the USA, Mexico and Colombia.Design/methodology/approachThe methodological design was quantitative, explanatory, observational and transversal, where a sample of 1,644 entrepreneurs from the USA (n = 525), Mexico (n = 608) and Colombia (n = 510) was obtained. For the validation and reliability of the instruments, a structural equation model (SEM) was developed for the three studies carried out. Regarding the goodness and adjustment indices of the SEM in the three countries, they turned out to be acceptable.FindingsThrough the results obtained in the three studies carried out, it has been verified that the instrument of social commerce in its two factors: Marketing and Market Participation, has sufficient validity and statistical reliability. Likewise, it has been verified that both the manifest variables and the latent variables of the construct show a significant relationship between the three studies carried out in different populations.Research limitations/implicationsThe findings obtained in the presented study contribute to entrepreneurs, leaders and managers of the business sector to improve the entrepreneurial project through marketing and market participation of the product and service, as well as the business unit that seeks to position itself in the market. Likewise, it helps entrepreneurs to understand analytically and systematically the constructs that social commerce is made up of, which will help entrepreneurial leaders reduce or control their risk when considering social commerce in their entrepreneurship, achieving the success of the entrepreneurial project through its positioning in the market considering marketing and market participation as main factors of social commerce.Originality/valueThe findings are relevant and of great value to the literature because at present there is not enough research that is focused on the variables analysed related to social commerce in the contexts of the USA, Mexico and Colombia. The relevance of the present scale in comparison to others proposed by the literature is that the proposed scale is focused on entrepreneurs who seek to be more successful through the positioning of their business unit, product or service in the market through the market participation. It is achieved through marketing strategies. Another contribution provided by the present study lies in the methodological robustness of the scale and its analysis, comparing it with studies in three leading entrepreneurship countries in Latin America, comparing the validity and reliability as well as the goodness of fit indices of the proposed model in each of the studies. They were significant and very similar, so the proposed scale is of great value and usefulness in the literature.