US Grade Research Articles

A Multidisciplinary Assessment of ChatGPT's Knowledge of Amyloidosis: Observational Study.

Amyloidosis, a rare multisystem condition, often requires complex, multidisciplinary care. Its low prevalence underscores the importance of efforts to ensure the availability of high-quality patient education materials for better outcomes. ChatGPT (OpenAI) is a large language model powered by artificial intelligence that offers a potential avenue for disseminating accurate, reliable, and accessible educational resources for both patients and providers. Its user-friendly interface, engaging conversational responses, and the capability for users to ask follow-up questions make it a promising future tool in delivering accurate and tailored information to patients. We performed a multidisciplinary assessment of the accuracy, reproducibility, and readability of ChatGPT in answering questions related to amyloidosis. In total, 98 amyloidosis questions related to cardiology, gastroenterology, and neurology were curated from medical societies, institutions, and amyloidosis Facebook support groups and inputted into ChatGPT-3.5 and ChatGPT-4. Cardiology- and gastroenterology-related responses were independently graded by a board-certified cardiologist and gastroenterologist, respectively, who specialize in amyloidosis. These 2 reviewers (RG and DCK) also graded general questions for which disagreements were resolved with discussion. Neurology-related responses were graded by a board-certified neurologist (AAH) who specializes in amyloidosis. Reviewers used the following grading scale: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. Questions were stratified by categories for further analysis. Reproducibility was assessed by inputting each question twice into each model. The readability of ChatGPT-4 responses was also evaluated using the Textstat library in Python (Python Software Foundation) and the Textstat readability package in R software (R Foundation for Statistical Computing). ChatGPT-4 (n=98) provided 93 (95%) responses with accurate information, and 82 (84%) were comprehensive. ChatGPT-3.5 (n=83) provided 74 (89%) responses with accurate information, and 66 (79%) were comprehensive. When examined by question category, ChatGTP-4 and ChatGPT-3.5 provided 53 (95%) and 48 (86%) comprehensive responses, respectively, to "general questions" (n=56). When examined by subject, ChatGPT-4 and ChatGPT-3.5 performed best in response to cardiology questions (n=12) with both models producing 10 (83%) comprehensive responses. For gastroenterology (n=15), ChatGPT-4 received comprehensive grades for 9 (60%) responses, and ChatGPT-3.5 provided 8 (53%) responses. Overall, 96 of 98 (98%) responses for ChatGPT-4 and 73 of 83 (88%) for ChatGPT-3.5 were reproducible. The readability of ChatGPT-4's responses ranged from 10th to beyond graduate US grade levels with an average of 15.5 (SD 1.9). Large language models are a promising tool for accurate and reliable health information for patients living with amyloidosis. However, ChatGPT's responses exceeded the American Medical Association's recommended fifth- to sixth-grade reading level. Future studies focusing on improving response accuracy and readability are warranted. Prior to widespread implementation, the technology's limitations and ethical implications must be further explored to ensure patient safety and equitable implementation.

Evaluating the Readability of Patient Education Materials for Anterior Vertebral Body Tethering, Distraction-Based Methods, and Posterior Spinal Fusion for the Treatment of Pediatric Spinal Deformity.

The Internet is an important source of information for patients, but its effectiveness relies on the readability of its content. Patient education materials (PEMs) should be written at or below a sixth-grade reading level as outlined by agencies such as the American Medical Association. This study assessed PEMs' readability for the novel anterior vertebral body tethering (AVBT), distraction-based methods, and posterior spinal fusion (PSF) in treating pediatric spinal deformity. An online search identified PEMs using the terms "anterior vertebral body tethering," "growing rods scoliosis," and "posterior spinal fusion pediatric scoliosis." We selected the first 20 general medical websites (GMWs) and 10 academic health institution websites (AHIWs) discussing each treatment (90 websites total). Readability tests for each webpage were conducted using Readability Studio software. Reading grade levels (RGLs), which correspond to the US grade at which one is expected to comprehend the text, were calculated for sources and independent t tests compared with RGLs between treatment types. The mean RGL was 12.1 ± 2.0. No articles were below a sixth-grade reading level, with only 2.2% at the sixth-grade reading level. AVBT articles had a higher RGL than distraction-based methods (12.7 ± 1.6 vs 11.9 ± 1.9, P = 0.082) and PSF (12.7 ± 1.6 vs 11.6 ± 2.3, P = 0.032). Materials for distraction-based methods and PSF were comparable (11.9 ± 1.9 vs 11.6 ± 2.3, P = 0.566). Among GMWs, AVBT materials had a higher RGL than distraction-based methods (12.9 ± 1.4 vs 12.1 ± 1.8, P = 0.133) and PSF (12.9 ± 1.4 vs 11.4 ± 2.4, P = 0.016). Patients' health literacy is important for shared decision-making. Assessing the readability of scoliosis treatment PEMs guides physicians when sharing resources and discussing treatment with patients. Both GMWs and AHIWs exceed recommended RGLs, which may limit patient and parent understanding. Within GMWs, AVBT materials are written at a higher RGL than other treatments, which may hinder informed decision-making and patient outcomes. Efforts should be made to create online resources at the appropriate RGL. At the very least, patients and parents may be directed toward AHIWs; RGLs are more consistent.

Readability of American Society of Metabolic Surgery's Patient Information Publications

IntroductionAppropriate education and information are the keystones of patient autonomy. Surgical societies support this goal through online informational publications. Despite these recommendations, many of these sources do not provide the appropriate level of reading for the average patient. Multiple national organizations, including the AMA and NIH, have recommended that such materials be written at or below a 6th-grade level. We therefore aimed to evaluate the readability of patient information publications provided by the American Society of Metabolic and Bariatric Surgery (ASMBS). MethodsPatient information publications were collected from the ASMBS webpage (https://asmbs.org/patients) and evaluated for readability. Microsoft Office was utilized to calculate Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores. Flesch Reading Ease (FRE) is a 0-100 score, with higher scores equating to easier reading (≥80 = 6th-grade reading level). Flesch-Kincaid Grade Level (FKGL) rates text on a US grade school level. Qualitative and univariate analyses were performed. ResultsEleven patient information publications were evaluated. None of the publications achieved an FRE score of 80 or an FKGL of a 6th-grade reading level. The average FRE score was 35.8 (range 14.9-53.6). The average FKGL score was 13.1 (range 10.1-17.5). The publication with the highest FRE and lowest FKGL (best readability) was that for benefits of weight loss. The brochure with the lowest FRE and highest FKGL (worst readability) was that for Medical Tourism. ConclusionsAlthough the ASMBS patient information publications are a trusted source of patient literature, none of the 11 publications met the recommended criteria for patient readability. Further refinement of these will be needed to provide the appropriate reading level for the average patient.

Comparison of Radiologists and Deep Learning for US Grading of Hepatic Steatosis.

Background Screening for nonalcoholic fatty liver disease (NAFLD) is suboptimal due to the subjective interpretation of US images. Purpose To evaluate the agreement and diagnostic performance of radiologists and a deep learning model in grading hepatic steatosis in NAFLD at US, with biopsy as the reference standard. Materials and Methods This retrospective study included patients with NAFLD and control patients without hepatic steatosis who underwent abdominal US and contemporaneous liver biopsy from September 2010 to October 2019. Six readers visually graded steatosis on US images twice, 2 weeks apart. Reader agreement was assessed with use of κ statistics. Three deep learning techniques applied to B-mode US images were used to classify dichotomized steatosis grades. Classification performance of human radiologists and the deep learning model for dichotomized steatosis grades (S0, S1, S2, and S3) was assessed with area under the receiver operating characteristic curve (AUC) on a separate test set. Results The study included 199 patients (mean age, 53 years ± 13 [SD]; 101 men). On the test set (n = 52), radiologists had fair interreader agreement (0.34 [95% CI: 0.31, 0.37]) for classifying steatosis grades S0 versus S1 or higher, while AUCs were between 0.49 and 0.84 for radiologists and 0.85 (95% CI: 0.83, 0.87) for the deep learning model. For S0 or S1 versus S2 or S3, radiologists had fair interreader agreement (0.30 [95% CI: 0.27, 0.33]), while AUCs were between 0.57 and 0.76 for radiologists and 0.73 (95% CI: 0.71, 0.75) for the deep learning model. For S2 or lower versus S3, radiologists had fair interreader agreement (0.37 [95% CI: 0.33, 0.40]), while AUCs were between 0.52 and 0.81 for radiologists and 0.67 (95% CI: 0.64, 0.69) for the deep learning model. Conclusion Deep learning approaches applied to B-mode US images provided comparable performance with human readers for detection and grading of hepatic steatosis. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Tuthill in this issue.

Lower Back Pain Imaging: A Readability Analysis.

The internet provides access to a myriad of educational health-related resources which are an invaluable source of information for patients. Lower back pain is a common complaint that is discussed extensively online. In this article, we aim to determine if the most commonly accessed articles about lower back pain imaging use language that can be understood by most patients. According to the American Medical Association (AMA) and National Institute of Health (NIH), this corresponds to a sixth-grade reading level. Online searches were conducted from the most commonly used search engine, Google, to assess the present state of readability on radiograph imaging for LBP. Then the top 20 populated URL links from each search were utilized based on "health & fitness" search trendsand click-through rates (CTRs). The readability of various websites was evaluated with WebFX online software that analyzed the unique websites' text when put into reader view on Firefox web browser version 116.0.3 (64-bit). Evaluation occurred via five common readability indices: the Automated Readability Index (ARI), the Coleman Liau Index (CLI), the SMOG index, the Gunning Fog Score Index (GFSI), and the Flesch Kincaid Grade Level Index (FKGLI). In addition, the Flesch Kincaid Reading Ease Index (FKREI) was also used but was excluded from the calculation due to its measuring scale outside of US grade levels. The number of samples was analyzed via health and fitness-specific CTRfrom an open-access database from July 2022 to July 2023. This was used to calculate the number of persons clicking and visiting positional URLs (first URL to the 20th URL) from each unique keyword search and the rational criteria for selecting the first 20 websites for each query. Online material that included LBP imaging information was calculated to have an overall readability score of 10.745 out of the 23 websites obtained from unique searches. The range was a mean readability score of 8 to 14. Notably, 17 websites were excluded from a total of 40 websites due to duplication of the same data (URLs that resulted from both unique searches) and accessibility requiring payment (specifically, an UpToDate link). A readability score of 10.745 refers to an 11th-grade reading level. That is to say, the most commonly visited sites on Google that contain information about lower back pain imaging are, on average, five grade levels higher than the sixth-grade reading level recommended by the AMAand the NIH. Most internet content regarding lower back pain imaging is written at a reading level that is above the recommended limit defined by the AMA and NIH. To improve education about lower back pain imaging and the patient-physician relationship, we recommend guiding patients to online material that contains a reading levelat the sixth-grade level as suggested by the AMA and NIH.

Role of Contrast Enhanced CT in Assessment of Blunt Abdominal Trauma in Comparison to Ultrasonography

Background Clinical examination fails to accurately diagnose many intraabdominal injuries in blunt abdomen and hence there is a well need for a good imaging technique.US and CT satisfy this to a great extent. With minimum technical limitations and a short time for examination US and CT become extremely useful in guiding the trauma surgeon. CECT is a highly useful imaging modality for diagnosis of blunt abdominal trauma. However US can be used as a useful initial modality. US and CT grading were of not much impact in the management of liver trauma, however extremely useful in the decision making of renal trauma and to a lesser extent in splenic injuries. CT is excellent in picking up clinically unsuspected trauma especially involving liver, kidney and bowel. Aim of the Work The aim of this study is to define and compare the role of CE-MDCT and FAST in detection of intraabdominal organs’ injuries and hemoperitoneum. And to highlight the value added by CE- MDCT in hemodynamically stable patients providing an accurate and highly sensitive diagnostic method for blunt abdominal trauma. Patients and Methods A prospective study was done in radio diagnosis department in Al Sherouk Police hospitals, and Zagzaig university hospitals-radiology department – ultrasound and CT units. 12 months, from 1/11/2018 to 1/11/2019. Results In this study CT detected 18 cases of splenic trauma compared to US which detected only 10 cases. Of the 8 additional cases detected on CT two were of grade IV injury and required surgery. CE-MDCT detected100% of splenic injuries confirmed clinically/surgically thus has been the gold standard method of detecting splenic injuries. CT detected 41 cases of haemoperitoneum which is 91% among all the cases of blunt injury to the abdomen. Conclusion CT is a superior diagnositic modality in the diagnosis of abdominal trauma.

The Announcement Effect of Monetary Policy on the Corporate Bond Markets

This study investigates the impact of the central bank’s monetary policy announcements on the perceptions of yield spread in corporate bond markets under the event of extreme events. These results highlight that the coronavirus pandemic has caused a market panic in the global economy. This caused investors to withdraw their money from bond markets, which caused a liquidity crisis in bond markets. The Fed announcements caused statistically significant tightening on US and global investment grades and high-yield corporate bond spreads. The Euro investment grade and high-yield corporate bond spread narrowed when the Fed took additional actions to provide more funds and expanded the buying scope to support market liquidity. These results suggest that forward guidance that emphasizes the Fed’s monetary policy causes stronger information effects.

디지털 문식성 교육을 위한 국어 수업 설계의 원리와 방향

Purpose: This study was conducted to suggest the principles and directions of Korean language classdesign for digital literacy education in order to develop core competencies of the Korean languagedepartment following the release the 2022 revision of the elementary Korean language curriculum. Methods: For this research, the contents system was analyzed, focusing on the 'media' area in the2022 revised elementary Korean language curriculum, and the 'Digital Literacy' of CCSS (CommonCore State Standards) according to the US grade level presented by Hutchison & Colwell (2015)‘Functional teaching and learning cases’, Australia's language curriculum digital literacy educationcontent element analysis, core values of Korean language classes and research on the Korean languageclass process review, and implications related to the 'class design' from previous domestic and foreignstudies related to digital literacy education field. Results: As a result, it was possible to present the basic direction for designing Korean languageclasses that digital literacy education should pursue under the principles of class design from amacroscopic and microscopic perspective for digital literacy education in elementary Korean classesand the core values of Korean classes. Conclusion: The main principles to be considered when designing and operating classes in whichlearners can actively respond to the new establishment of the ‘media’ area and the changes in themedia environment of digital transformation are discussed.

Vesicoureteral Reflux Grading using Different Imaging Techniques (MCUG, NM, and US): A Comparative Study

The aim of this study was to compare the different imaging procedures (micturating cystourethrogram [MCUG], nuclear medicine [NM], and ultrasound [US]) in the evaluation of vesicoureteral reflux (VUR). Methods and Results: A retrospective study was conducted to compare different radiological investigations in the characterization and grading of VUR. In total, 93 patients (53 boys and 40 girls) with a mean age of 2.2 years were referred to the radiology department for exclusion or diagnosis of VUR. Age, sex, the pathway of obstruction, presence of VUR, degree of obstruction with VUR, presence of hydronephrosis, calcification, and grading according to MCUG were the main variables collected for US, NM, and MCUG. Our results show that according to the frequency distribution, MCUG showed a higher sensitivity for detecting VUR and the degree of obstruction than the other imaging tools. US showed a higher sensitivity for the presence of hydronephrosis. The grading of VUR was more effectively detected by MCUG than by US and NM grading. We revealed a statistical association between VUR grades and the gender of a study's population, with a higher frequency of grade 5 in boys than in girls (P=0.037). Grades 3-5 showed higher frequencies in MCUG, in which the younger patients (0–50 weeks old) were more affected by obstruction and VUR than the other age groups. Moderate hydronephrosis was higher in boys than in girls (P=0.006). Conclusion: The grading of VUR is more effectively detected by MCUG than by US and NM grading.

Methods for living guidelines: early guidance based on practical experience. Paper 4: search methods and approaches for living guidelines

ObjectivesTo describe the key features of a continual evidence surveillance process that can be implemented for living guidelines and to outline the considerations and trade-offs in adopting different approaches. Study Design and SettingMembers of the Australian Living Evidence Consortium (ALEC), National Institute of Health and Care Excellence (NICE), and the US GRADE Network (USGN) shared their practical experiences of and approaches to establishing surveillance systems for living guidelines. We identified several common components of evidence surveillance and listed the key features and considerations for each component drawn from case studies, highlighting differences with standard guidelines. ResultsWe developed guidance that covers the initial information needed to support decisions around suitability for living mode and the practical considerations in setting up continual search surveillance systems (search frequency, sources to search, use of automation, reporting the search, ongoing resources, and evaluation). The case studies draw on our experiences with developing guidelines for COVID-19, as well as for other conditions such as stroke and diabetes, and cover a range of practical approaches, including the use of automation. ConclusionThis paper highlights different approaches to continual evidence surveillance that can be implemented in living guidelines.

Methods for living guidelines: early guidance based on practical experience. Paper 1: Introduction

ObjectivesTo introduce methods for living guidelines based on practical experiences by the Australian Living Evidence Consortium (ALEC), the National Institute of Health and Care Excellence (NICE), and the Infectious Diseases Society of America (IDSA), with methodological support from the US Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Network. Study Design and SettingMembers of ALEC, NICE, and the US GRADE Network, convened a working group to share experiences of the methods used to develop living guidelines and outline the key differences between traditional and living guidelines methods. ResultsThe guidance includes the following steps: 1) deciding if the guideline is a priority for a living approach, 2) preparing for living guideline development, 3) literature surveillance and frequency of searching, 4) assessment and synthesis of the evidence, 5) publication and dissemination, and 6) transitioning recommendations out of living mode. ConclusionThis paper introduces methods for living guidelines and provides examples of the similarities and differences in approach across multiple organizations conducting living guidelines. It also introduces a series of papers exploring methods for living guidelines based on our practical experiences, including consumer involvement, selecting and prioritizing questions, search decisions, and methods decisions.

Methods for living guidelines: early guidance based on practical experience. Paper 3: selecting and prioritizing questions for living guidelines

ObjectivesThis article is part of a series on methods for living guidelines, consolidating practical experiences from developing living guidelines. It focuses on methods for identification, selection, and prioritization of clinical questions for a living approach to guideline development. Study Design and SettingMembers of the Australian Living Evidence Consortium, the National Institute of Health and Care Excellence and the US Grading of Recommendations, Assessment, Development and Evaluations Network, convened a working group. All members have expertize and practical experience in the development of living guidelines. We collated methods, documents on prioritization from each organization's living guidelines, conducted interviews and held working group discussions. We consolidated these to form best practice principles which were then edited and agreed on by the working group members. ResultsWe developed best practice principles for (1) identification, (2) selection, and (3) prioritization, of questions for a living approach to guideline development. Several different strategies for undertaking prioritizing questions are explored. ConclusionThe article provides guidance for prioritizing questions in living guidelines. Subsequent articles in this series explore consumer involvement, search decisions, and methods decisions that are appropriate for questions with different priority levels.

Correlation between Ultrasound Grading of Diffuse Fatty Liver Changes with Density of Liver Measured by Computed Tomography Scan

Ultrasound is a good imaging modality for diagnosing and grading fatty liver disease. It is an effective method for quantifying fatty liver alterations since it can be used to estimate mean liver density. Hepatic steatosis is another term for fatty liver. It occurs when the liver becomes clogged with fat. Small levels of fat in the liver are acceptable, but too much might cause health issues. Because considerable alcohol intake causes liver damage, fatty liver is classified as both non-alcoholic fatty liver disease and alcoholic fatty liver disease. The study aims to evaluate the correlation between US grading of fatty liver and computed tomography scan density of the liver, and assessment of the clinical significance of fatty liver changes detected by ultrasound in correlation with patient factors including age, gender, diabetes mellitus, smoking status, alcohol intake, and lipid profile. The collected dataset includes 110 patients that were evaluated by radiologists and diagnosed using Ultrasound and Computed Tomography scan departments at Al-Shaheed General Hospital Baghdad Resafa Health Directorate–Iraq. The experimental results show that the proportion of mates outperformed females by 58.2% and 41.8% respectively. Furthermore, it was noted that 32.7% of patients were diabetics, 66.4% of patients were fat, 25.5% of patients were current smokers, and 6.4% of patients were drinking. Moreover, 40.9% of patients had high s. cholesterol, 57.3% of patients had high s. TG, 14.5% of patients had high LDL, and 41.8% of patients had low HDL. Finally, it was concluded that the mean of liver density of US grades 2 or 3 (27.95) was less than 0 or 1 (35.51). Where, the prevalence of US grades 2 or 3 of fatty liver’s patients increased with increasing of BMI, until reaching 47.9% in obese patients.

Efficacy of standardizing fibrinolytic therapy for parapneumonic effusion.

BackgroundWhile chest tube placement with pleural fibrinolytic medication is the established treatment of pediatric empyema, treatment failure is reported in up to 20% of these children.ObjectiveStandardizing fibrinolytic administration among interventional radiology (IR) physicians to improve patient outcomes in pediatric parapneumonic effusion.Materials and methodsWe introduced a hospital-wide clinical pathway for parapneumonic effusion (1–2 mg tissue plasminogen activator [tPA] twice daily based on pleural US grade); we then collected prospective data for IR treatment May 2017 through February 2020. These data included demographics, co-morbidities, pediatric intensive care unit (PICU) admission, pleural US grade, culture results, daily tPA dose average, twice-daily dose days, skipped dose days, pleural therapy days, need for chest CT/a second IR procedure/surgical drainage, and length of stay. We compared the prospective data to historical controls with IR treatment from January 2013 to April 2017.ResultsSixty-three children and young adults were treated after clinical pathway implementation. IR referrals increased (P = 0.02) and included higher co-morbidities (P = 0.005) and more PICU patients (P = 0.05). Mean doses per day increased from 1.5 to 1.9 (P < 0.001), twice-daily dose days increased from 38% to 79% (P < 0.001) and median pleural therapy days decreased from 3.5 days to 2.5 days (P = 0.001). No IR patients needed surgical intervention. No statistical differences were observed for gender/age/weight, US grade, need for a second IR procedure or length of stay. US grade correlated with greater positive cultures, need for chest CT/second IR procedure, and pleural therapy days.ConclusionInterventional radiology physician standardization improved on a clinical pathway for fibrinolysis of parapneumonic effusion. Despite higher patient complexity, pleural therapy duration decreased. There were no chest tube failures needing surgical drainage.

Worsening trends in self-rated health and correlates in Chinese adolescents in Hong Kong: a population-based panel study from 1999/2000 to 2014/15

ObjectivesTo examine the 15-year secular trends of self-rated health (SRH) and correlates in Chinese adolescents in Hong Kong.DesignA territory-wide population-based panel data study.SettingAnonymised records of the annual health examination from...

Optimizing Readability and Format of Plain Language Summaries for Medical Research Articles: Cross-sectional Survey Study.

BackgroundPlain language summaries (PLSs) are intended to provide readers with a clear, nontechnical, and easily understandable overview of medical and scientific literature; however, audience preferences for specific PLS formats have yet to be fully explored.ObjectiveThis study aims to evaluate the preferred readability level and format for PLSs of medical research articles of different disease states via a web-based survey of audiences of different age groups.MethodsArticles describing phase III clinical trials published in top-level, peer-reviewed journals between May 2016 and May 2018 were identified for 3 chronic disease states representing a range of adult patient age groups: (1) psoriasis, a skin disease representative of younger patients; (2) multiple sclerosis (MS), a neurological disease representative of middle-aged patients; and (3) rheumatoid arthritis (RA), a painful joint disease representative of older patients. Four PLSs were developed for each research article, of which 3 were text-only summaries (written with high, medium, and low complexity) and 1 was an infographic. To evaluate each of the 4 PLS formats, a 20-question open survey (specific to one of the 3 diseases) was sent to a representative sample selected via UK-based patient association websites, Twitter, and Facebook patient groups. A weighted-average calculation was applied to respondents’ ranked preferences for each PLS format.ResultsFor all 3 articles, the weighted-average preference scores showed that infographic (psoriasis 2.91, MS 2.71, and RA 2.78) and medium-complexity text-based PLS (reading age 14-17 years, US Grade 9-11; psoriasis 2.90; MS 2.47; RA 2.77) were the two most preferred PLS formats.ConclusionsAudience preferences should be accounted for when preparing PLSs to accompany peer-reviewed original research articles. Oversimplified text can be viewed negatively, and graphical summaries or medium-complexity text-based summaries appear to be the most popular.Plain Language SummaryPatients and caregivers should have the chance to read about medical research in a format they can understand. However, we do not know much about the formats that people with different illnesses or ages prefer. Researchers wanted to find out more about this. They selected 3 medical articles about illnesses that affect different age groups: psoriasis (younger patients), multiple sclerosis (middle-aged patients), and rheumatoid arthritis (older patients). They created 4 summaries of each article. One was a graphical summary, and the other 3 were words-only summaries of high, medium, and low complexity. Then, the researchers posted surveys on UK patient group websites and Facebook patient groups to ask people what they thought of the summaries. The surveys were taken by 167 people. These people were patients with psoriasis, multiple sclerosis, or rheumatoid arthritis, or their caregivers. Most were women, and about half had a university degree. For each illness, most people preferred the graphical summary. Among the word-only summaries, most people preferred the medium-complexity wording written for a reading age of 14 to 17 years. People felt that the graphical and medium-complexity summaries were clear and concise, while the others used jargon or were too simple. Authors of medical articles should remember these results when writing summaries for patients. More research is needed about the preferences of other people, such as those with other illnesses. (See Multimedia Appendix 1 for the graphical summary of the plain language summary.)

An International Needs Assessment Survey of Guideline Developers Demonstrates Variability in Resources and Challenges to Collaboration between Organizations.

The development of rigorous, high-quality clinical guidelines increases the need for resources and skilled personnel within guideline-producing organizations. While collaboration between organizations provides a unique opportunity to pool resources and save time and effort, the collaboration presents its own unique challenges. To assess the perceived needs and current challenges of guideline producers worldwide related to guideline development and collaboration efforts. Survey questions were developed by the Guidelines International Network and the US GRADE Network, pilot-tested among attendees of a guideline development workshop, and disseminated electronically using convenience and snowball sampling methods. A total of 171 respondents representing 30 countries and more than 112 unique organizations were included in this analysis. The survey included free-response, multiple-choice, and seven-point Likert-scale questions. Questions assessed respondents' perceived value of guidelines, resource availability and needs, guideline development processes, and collaboration efforts of their organization. Time required to develop high-quality systematic reviews and guidelines was the most relevant need (median=7; IQR=5.5-7). In-house resources to conduct literature searches (median=4; IQR=3-6) and the resources to develop rigorous guidelines rapidly (median=4; IQR=2-5) were perceived as the least available resources. Difficulties reconciling differences in guideline methodology (median=6; IQR=4-7) and the time required to establish collaborative agreements (median=6; IQR=5-6) were the most relevant barriers to collaboration between organizations. Results also indicated a general need for improvement in conflict of interest (COI) disclosure policies. The survey identified organizational challenges in supporting rigorous guideline development, including the time, resources, and personnel required. Connecting guideline developers to existing databases of high-quality systematic reviews and the use of freely available online platforms may facilitate guideline development. Guideline-producing organizations may also consider allocating resources to hiring or training personnel with expertise in systematic review methodologies or utilizing resources more effectively by establishing collaborations with other organizations.

Evaluation of the Patients with Antenatal Hydronephrosis Diagnosed Ureteropelvic Junction Obstruction with the Hydronephrosis Severity Score

Objective: Ureteropelvic junction obstruction is the main cause of obstructive antenatal hydronephrosis. Although surgery is the traditional treatment modality, there is still no consensus on surgical indications. We aimed to analyse the patients referred as antenatal hydronephrosis and diagnosed with ureteropelvic junction obstruction with Hydronehprosis Severity Score that has been developed by Babu at al. Method: The patients who were admitted with antenatal hydronephrosis in 2013-2018 and diagnosed as ureteropelvic junction obstruction and followed up in our clinic for at least one year were evaluated. The cases with unilateral hydronephrosis were included. Those with vesicoureteral reflux, horseshoe kidney, hydroureter, ureterovesical junction obstruction were excluded. Renal ultrasonography and nuclear scintigraphy results were re-evaluated. They were grouped as mild (0-4), moderate (5-8) and severe (9-12) based on scoring of three parameters; differantial renal function, drainage curve pattern and US grade. Clinical outcomes were also classified in three groups; resolution (grade 1-no hydronephrosis), persistance (grade 2-3 hydronephrosis) and surgical intervention. The relation between the scores and clinical outcomes were analysed. Results: A total of 57 patients were evaluated. 2 with horseshoe kidney, 4 with vesicoureteralreflux, 7 with bilateral hydronephrosis, 4 with ureteric outlet obstruction, 12 with incomplete records were excluded. Finally, 28 patients were included. Hydronephrosis was resolved in 4 (14.2%), persisted in 5 (17.8%) and surgical intervention was required in 19 (67.8%) patients. 1/5 patients with mild, 15/20 patients with moderate and 3/3 patients with severe HSS underwent surgery. 77.2% of the patients with a total score of ≥6 initially required surgical intervention at their follow-up. Conclusion: HSS may provide a significant predictive value for surgical intervention for the patients classified as “mild” or “severe” at the initial evaluation. In the “moderate” group, the risk increases in the patients with HSS≥6. Existing data should be evaluated with larger case series.

Correlation between Vascular Endothelial Cell Growth Factor (VEGF) and Muscular Ultrasonography Finding in Knee Osteoarthritis

Background: Osteoarthritis (OA) is a degenerative joint disorder affecting articular cartilage that may be associated with synovial inflammation. The vascular endothelial growth factor is implicated in the pathogenesis of OA. This study aimed to assess man serum vascular endothelial growth factor (VEGF) levels in patients with primary knee osteoarthritis (KOA) and to evaluate their correlation with clinical manifestations, physical function and musculoskeletal-ultrasonography findings. Results: This is a case control study conducted on 50 subjects, thirty patients with primary Knee OA recruited from the outpatients’ clinic of the Rheumatology, Rehabilitation and Physical Medicine Department Benha University Hospitals, from November 2018 to November 2019. Twenty age and sex matched apparently healthy adult individuals were also included as a control group. The present study showed a highly statically significant difference (p < 0.0001) between the mean serum levels of VEGF in the patients’ and the control groups being higher in the patients group compared to the control group (<0.001). The current study revealed a strong significant positive correlations of VEGF levels with the presence of Baker’s cysts, cartilage thickness index and color Doppler US grading (p < 0.0001). Significant positive correlations were also reported between VEGA levels (p=<0.001) and WOMAC total and WOMAC sub scores. Conclusions: VEGF serum levels are highly correlated with clinical, functional and musculoskeletal ultrasound severity of KOA. Thus it could be used as a potential biomarker for estimating Knee OA disease status

Supporting English Language Learners' Experiences in the Classroom

I was interested in studying English Language Learners (ELL) and how they are supported.Thus, I looked into how each level (US, Texas, Fort Worth, and McLean 6th Grade Center) supports these students. The support given to English Language Learners at McLean 6th Grade Center is extended time, dictionaries, audio options, differentiated texts, reading aloud, before school help, during lunch help, and after school help. The teachers track English Language Learners’ progress separately and adjust accommodations each six weeks to make sure each student's needs are being met. Based on these supports, I developed a survey that was sent to my students at McLean 6th grade, asking for their opinions on the support they were receiving. This survey would have originally been given in class, but due to the COVID-19 outbreak, the survey took place online. This limited my number of responses. I sent the survey to all 170 students and 51 responded. I then drew conclusions from my research and the survey on the effectiveness of supports offered.