High-capacity MIMO visible light communication integrated into mini-LED LCDs.

Visible light communication (VLC) can be integrated into a liquid crystal display (LCD) by modulating its backlight while normally showing pictures. Received by ordinary cameras, such integrated display and communication (IDAC) systems are promising for the Internet of Things and Metaverse. However, in the premise of unaffected display function, the capacity of current IDAC systems is limited, with data rates of very few kbps. This work proposes a new architecture: multiple-input, multiple-output (MIMO) VLC integrated into a mini-LED LCD, whose many backlight segments act as multiple transmitters. A camera utilizes the rolling shutter effect with independent pixel columns to form multiple outputs. The communication capacity is thus significantly multiplied by the backlight column number. In addition, local dimming, which is favorable for an LCD's contrast and power consumption, is exploited to achieve efficient signal modulation. We built a mini-LED LCD prototype with 8-by-20 backlight segments for experimental verification. The backlight segments multiplex a video-rate signal for local dimming and a high-frequency (∼34 kHz) signal modulated through multi-pulse position modulation (MPPM) for VLC. By taking photographs with a camera 1.1 m away from the screen, a record-high rate of 201.6 kbps (approximately ten times faster than current IDAC systems) was experimentally achieved with a bit error rate satisfying the forward error correction. Improved image contrast due to local dimming was also observed.

Structural Diversity in Ga/In-Hydroxamate Metal-Organic Materials.

Developing metal-organic materials (MOMs) with chemical robustness is a prerequisite to exploring their intriguing properties and applications. As part of a continuing effort to construct robust MOMs featuring chelated building units, here we introduce a "bent" thiophene-2,5-dihydroxamate ligand with multiple intrinsic conformations when it is used as a chelating linkage. This approach should further diversify the coordination chemistry in hydroxamate-based MOM structures without compromising the stability. In combination with Group 13 metals Ga/In to ensure homoleptic metal vertices, we report the successful crystallization of four MOMs with diverse structures and dimensionalities: SUM-81 as a 0D metal-organic polyhedron (MOP), SUM-82 as a 2D MOF with an fes topology, SUM-83 and SUM-84 as distinct 1D coordination polymers with shapes mimic stairs and mesh tubes, respectively. As these structures indeed contain the aforementioned different ligand conformations and combinations thereof, these results expand our understanding of the coordination chemistry of hydroxamates. To demonstrate the potential applicability of hydroxamate-chelated robust MOMs, the permanently porous SUM-81 MOP was successfully incorporated in a series of mixed matrix membranes for CO2/N2 separation, showing impressive performances.

A strong nonequilibrium bound for sorting of cross-linkers on growing biopolymers.

Understanding the role of nonequilibrium driving in self-organization is crucial for developing a predictive description of biological systems, yet it is impeded by their complexity. The actin cytoskeleton serves as a paradigm for how equilibrium and nonequilibrium forces combine to give rise to self-organization. Motivated by recent experiments that show that actin filament growth rates can tune the morphology of a growing actin bundle cross-linked by two competing types of actin-binding proteins [S. L. Freedman et al., Proc. Natl. Acad. Sci. U.S.A. 116, 16192-16197 (2019)], we construct a minimal model for such a system and show that the dynamics of a growing actin bundle are subject to a set of thermodynamic constraints that relate its nonequilibrium driving, morphology, and molecular fluxes. The thermodynamic constraints reveal the importance of correlations between these molecular fluxes and offer a route to estimating microscopic driving forces from microscopy experiments.

Prenatal exposure to environmental toxins and comprehensive dental findings in a population cohort of children.

Environmental toxins are known to have many impacts on growth and development in humans, starting in utero. Alterations in amelogenesis, caused by chemical and physical trauma that occur during the antenatal, perinatal and postnatal time periods, may result in developmental defects in deciduous and permanent tooth enamel, as demonstrated in animal studies. These defects can be clinically visible and result in a variety of morphological and functional problems in the dentition. Since enamel does not remodel after formation, it may serve as a permanent record of insults during organ development.Our primary purpose was to investigate any possible relationship between intrauterine exposure to endocrine disrupting chemicals (phenols and phthalates) and developmental defects in enamel in children, while also accounting for fluoride exposure. Our secondary purpose was to report descriptively on findings from comprehensive dental examinations performed on 356 children that were drawn from the general paediatric population. A cohort of children from the Utah Children's Project (N = 356) that had full medical exams, comprehensive medical and family histories and available biospecimens were given extraoral and intraoral examinations. They also completed an oral health questionnaire. Standardized intraoral photographs were taken of the teeth and viewed by standardised examiners and the dental observations were recorded for a full inventory of findings, including: tooth morphology, caries, restorations, colorations, attrition, erosion, fractures and hypomineralization. Perinatal maternal urine samples were assessed for the concentration of fluoride, phenols and phthalates, including bisphenol A (BPA).Pairwise statistical analyses were done to correlate the dental findings with one another and with the presence of environment chemicals found in the urine samples. Hypomineralization was the most common finding (96% of children; 37% of deciduous teeth, 42% of permanent teeth), consistent with molar incisor hypomineralization (MIH) described in other human populations. No consistent correlations were seen between dental findings and the presence of phenols and phthalates in prenatal urine, but the number of samples available for the assessment was limited (n = 35).In conclusion, we found a high proportion of dental hypomineralization in a population based paediatric cohort, but did not find an association with prenatal exposure to phenols and phthalates.

Giant Gateable Osmotic Power Generation from a Goldilocks Two-Dimensional Polymer.

Generating electricity from a salinity gradient, known as osmotic power, provides a sustainable energy source, but it requires precise nanoscale control of membranes for maximum performance. Here, we report an ultrathin membrane, where molecule-specific short-range interactions enable giant gateable osmotic power with a record high power density (2 kW/m2 for 1 M∥1 mM KCl). Our membranes are charge-neutral two-dimensional polymers synthesized from molecular building blocks and operate in a Goldilocks regime that simultaneously maintains high ionic conductivity and permselectivity. Molecular dynamics simulations quantitatively confirm that the functionalized nanopores are small enough for high selectivity through short-range ion-membrane interactions and large enough for fast cross-membrane transport. The short-range mechanism further enables reversible gateable operation, as demonstrated by polarity switching of osmotic power with additional gating ions.

Real-time computer-generated integral imaging light field displays: revisiting the point retracing rendering method from a signal processing perspective.

Integral imaging light field displays (InIm-LFDs) can provide realistic 3D images by showing an elemental image array (EIA) under a lens array. However, it is always challenging to computationally generate an EIA in real-time with entry-level computing hardware because the current practice that projects many viewpoints to the EIA induces heavy computations. This study discards the viewpoint-based strategy, revisits the early point retracing rendering method, and proposes that InIm-LFDs and regular 2D displays share two similar signal processing phases: sampling and reconstructing. An InIm-LFD is demonstrated to create a finite number of static voxels for signal sampling. Each voxel is invariantly formed by homogeneous pixels for signal reconstructing. We obtain the static voxel-pixel mapping through arbitrarily accurate raytracing in advance and store it as a lookup table (LUT). Our EIA rendering method first resamples input 3D data with the pre-defined voxels and then assigns every voxel's value to its homogeneous pixels through the LUT. As a result, the proposed method reduces the computational complexity by several orders of magnitude. The experimental rendering speed is as fast as 7 to 10 ms for a full-HD EIA frame on an entry-level laptop. Finally, considering a voxel may not be perfectly integrated by its homogeneous pixels, called the sampling error, the proposed and conventional viewpoint-based methods are analyzed in the Fourier domain. We prove that even with severe sampling errors, the two methods negligibly differ in the output signal's frequency spectrum. We expect the proposed method to break the long-standing tradeoff between rendering speed, accuracy, and system complexity for computer-generated integral imaging.

Compact dual-focal augmented reality head-up display using a single picture generation unit with polarization multiplexing.

The augmented reality head-up display (AR-HUD) attracts increasing attention. It features multiple focal planes to display basic and AR information, as well as a wider field of view (FOV). Using two picture generation units (PGUs) to create dual-focal AR-HUDs leads to expanded size, increased cost, and reduced reliability. Thus, we previously proposed an improved solution by dividing one PGU into two partitions that were separately imaged into two virtual images with an optical relay system. However, the resolution of the PGU was halved for either virtual image. Regarding the drawbacks, this paper proposes a dual-focal AR-HUD using one PGU and one freeform mirror. Either virtual image utilizes the full resolution of the PGU through polarization-multiplexing. By performing optical design optimization, high image quality, except for the distortion, is achieved in an eyebox of 130 by 60 mm for far (10 m, 13° by 4°) and near (2.5 m, 10° by 1°) images. Next, we propose a distortion correction method by directly inputting the distorted but clear images acquired in the design stage into the real HUD with an inversed optical path. The proposed optical architecture enables a compact system volume of 9.5 L, close to traditional single-focal HUDs. Finally, we build an AR-HUD prototype, where a polarizing reflective film and a twisted nematic liquid crystal cell achieve polarization-multiplexing. The expected image quality of the two virtual images is experimentally verified.

Light field displays with computational vision correction for astigmatism and high-order aberrations with real-time implementation.

Vision-correcting near-eye displays are necessary concerning the large population with refractive errors. However, varifocal optics cannot effectively address astigmatism (AST) and high-order aberration (HOAs); freeform optics has little prescription flexibility. Thus, a computational solution is desired to correct AST and HOA with high prescription flexibility and no increase in volume and hardware complexity. In addition, the computational complexity should support real-time rendering. We propose that the light field display can achieve such computational vision correction by manipulating sampling rays so that rays forming a voxel are re-focused on the retina. The ray manipulation merely requires updating the elemental image array (EIA), being a fully computational solution. The correction is first calculated based on an eye's wavefront map and then refined by a simulator performing iterative optimization with a schematic eye model. Using examples of HOA and AST, we demonstrate that corrected EIAs make sampling rays distributed within ±1 arcmin on the retina. Correspondingly, the synthesized image is recovered to nearly as clear as normal vision. We also propose a new voxel-based EIA generation method considering the computational complexity. All voxel positions and the mapping between voxels and their homogeneous pixels are acquired in advance and stored as a lookup table, bringing about an ultra-fast rendering speed of 10 ms per frame with no cost in computing hardware and rendering accuracy. Finally, experimental verification is carried out by introducing the HOA and AST with customized lenses in front of a camera. As a result, significantly recovered images are reported.

Assessment of Attitudes Toward Initiation of Immediate Adjuvant Chemotherapy for Colon Cancer.

INTRODUCTION: Early initiation of chemotherapy after surgery for colon cancer has survival benefits. Immediate adjuvant chemotherapy (IAC) involves giving chemotherapy during surgical resection and immediately postoperatively. This novel approach has been shown to be safe, eliminating delays in adjuvant treatment that could increase the risk of micro-metastatic spread. The aim of this study was to assess the willingness of the general public to accept IAC. MATERIALS AND METHODS: Between March and April 2021, 800 telephone interviews were conducted with a sample of adult New York State residents. The Survey Research Institute of Cornell University conducted all surveys. Kruskal-Wallis, chi-squared, and Fisher's tests were conducted using R 4.0.2. RESULTS: Three scenarios were presented: (1) receiving IAC resulting in improved survival and quality of life, (2) finishing chemotherapy earlier without survival impact, and (3) finishing chemotherapy earlier but with possible side effects. Respondents with higher education were more likely to accept (1) & (2), males were more likely to accept (2) & (3), higher income respondents were more likely to accept (1) & (3), and those with more work hours were more likely to accept (2). Lastly, 16% responded they would be very or extremely likely, and 52% respondents would be somewhat likely or likely to accept intraoperative chemotherapy, even if it may not be necessary. CONCLUSIONS: Respondents were likely to accept IAC if offered. Given the known risk of delayed adjuvant chemotherapy (AC) in colon cancer, further research is warranted to determine the survival and quality of life (QOL) benefits of IAC.

Machine-Learning-Enabled Ligand Screening for Cs/Sr Crystallizing Separation.

The reprocessing of spent nuclear fuel is critical for the sustainability of the nuclear energy industry. However, several key separation processes present challenges in this regard, calling for continuous research into next-generation separation materials. Herein, we propose a high-throughput screening framework to improve efficiency in identifying potential ligands that selectively coordinate metal cations of interest in liquid wastes that considers multiple key chemical characteristics, including aqueous solubility, pKa, and coordination bond length. Machine-learning models were designed for the fast and accurate prediction of these characteristics by using graph convolution and transfer-learning techniques. Suitable ligands for Cs/Sr crystallizing separation were identified through the "computational funnel", and several top-ranking, nontoxic, low-cost ligands were selected for experimental verification.

Predicting Delayed Shock in Multisystem Inflammatory Disease in Children: A Multicenter Analysis From the New York City Tri-State Region.

OBJECTIVES: Patients with multisystem inflammatory disease in children (MIS-C) are at risk of developing shock. Our objectives were to determine independent predictors associated with development of delayed shock (≥3 hours from emergency department [ED] arrival) in patients with MIS-C and to derive a model predicting those at low risk for delayed shock. METHODS: We conducted a retrospective cross-sectional study of 22 pediatric EDs in the New York City tri-state area. We included patients meeting World Health Organization criteria for MIS-C and presented April 1 to June 30, 2020. Our main outcomes were to determine the association between clinical and laboratory factors to the development of delayed shock and to derive a laboratory-based prediction model based on identified independent predictors. RESULTS: Of 248 children with MIS-C, 87 (35%) had shock and 58 (66%) had delayed shock. A C-reactive protein (CRP) level greater than 20 mg/dL (adjusted odds ratio [aOR], 5.3; 95% confidence interval [CI], 2.4-12.1), lymphocyte percent less than 11% (aOR, 3.8; 95% CI, 1.7-8.6), and platelet count less than 220,000/uL (aOR, 4.2; 95% CI, 1.8-9.8) were independently associated with delayed shock. A prediction model including a CRP level less than 6 mg/dL, lymphocyte percent more than 20%, and platelet count more than 260,000/uL, categorized patients with MIS-C at low risk of developing delayed shock (sensitivity 93% [95% CI, 66-100], specificity 38% [95% CI, 22-55]). CONCLUSIONS: Serum CRP, lymphocyte percent, and platelet count differentiated children at higher and lower risk for developing delayed shock. Use of these data can stratify the risk of progression to shock in patients with MIS-C, providing situational awareness and helping guide their level of care.

Improved outcomes for depressed elder abuse victims with video-delivered psychotherapy during COVID-19.

OBJECTIVE: There is a lack of evidence-based scalable therapies for elder abuse victims, with no current remotely delivered tailored psychotherapy. The purpose of this manuscript is to (a) examine the effectiveness of a brief therapy for depression for elder abuse victims, and (b) to compare remote intervention delivery via phone or video to the traditional in-person delivery. METHOD: PROTECT, Providing Options to Elderly Clients Together, is a brief therapy developed in collaboration with partners at the Department for the Aging (DFTA) of New York City. During the COVID-19 outbreak, PROTECT delivery shifted from in-person to phone or video delivery. Depression severity was tracked using the Patient Health Questionaire-9 (PHQ-9). Reduction in depression severity was evaluated using a linear mixed effects model with non-inferiority test to compare the effectiveness of video vs in-person delivery of PROTECT. RESULTS: PROTECT reduced depression (average 5.15 PHQ-9 points). Video and phone delivery were non-inferior to in-person delivery. The video group completed therapy more quickly than the in-person group and had a more rapid improvement in depression symptoms. CONCLUSIONS: PROTECT therapy delivered remotely reduces depression among diverse elder abuse victims. Video delivery of PROTECT could increase reach and scalability to serve more vulnerable older depressed victims.

Thermodynamic Control of Activity Patterns in Cytoskeletal Networks.

Biological materials, such as the actin cytoskeleton, exhibit remarkable structural adaptability to various external stimuli by consuming different amounts of energy. In this Letter, we use methods from large deviation theory to identify a thermodynamic control principle for structural transitions in a model cytoskeletal network. Specifically, we demonstrate that biasing the dynamics with respect to the work done by nonequilibrium components effectively renormalizes the interaction strength between such components, which can eventually result in a morphological transition. Our work demonstrates how a thermodynamic quantity can be used to renormalize effective interactions, which in turn can tune structure in a predictable manner, suggesting a thermodynamic principle for the control of cytoskeletal structure and dynamics.

Pore condensation and freezing is responsible for ice formation below water saturation for porous particles.

Ice nucleation in the atmosphere influences cloud properties, altering precipitation and the radiative balance, ultimately regulating Earth's climate. An accepted ice nucleation pathway, known as deposition nucleation, assumes a direct transition of water from the vapor to the ice phase, without an intermediate liquid phase. However, studies have shown that nucleation occurs through a liquid phase in porous particles with narrow cracks or surface imperfections where the condensation of liquid below water saturation can occur, questioning the validity of deposition nucleation. We show that deposition nucleation cannot explain the strongly enhanced ice nucleation efficiency of porous compared with nonporous particles at temperatures below -40 °C and the absence of ice nucleation below water saturation at -35 °C. Using classical nucleation theory (CNT) and molecular dynamics simulations (MDS), we show that a network of closely spaced pores is necessary to overcome the barrier for macroscopic ice-crystal growth from narrow cylindrical pores. In the absence of pores, CNT predicts that the nucleation barrier is insurmountable, consistent with the absence of ice formation in MDS. Our results confirm that pore condensation and freezing (PCF), i.e., a mechanism of ice formation that proceeds via liquid water condensation in pores, is a dominant pathway for atmospheric ice nucleation below water saturation. We conclude that the ice nucleation activity of particles in the cirrus regime is determined by the porosity and wettability of pores. PCF represents a mechanism by which porous particles like dust could impact cloud radiative forcing and, thus, the climate via ice cloud formation.

Establishing the Substantial Clinical Benefit in a Non-Shoulder Hand and Upper Extremity Population for the QuickDASH and PROMIS Upper Extremity and Physical Function Computer Adaptive Tests.

PURPOSE: It is unclear what score changes on the abbreviated Disabilities of the Arm, Hand, and Shoulder (QuickDASH), Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) computer adaptive test (CAT), and PROMIS physical function (PF) CAT represent a substantial improvement. We calculated the substantial clinical benefit (SCB) for these 3 instruments in a non-shoulder hand and upper extremity population. METHODS: Adult patients treated between March 2015 and September 2019 at a single academic tertiary institution were identified. The QuickDASH, PROMIS UE CAT v2.0, and PROMIS PF CAT v2.0 scores were collected using a tablet computer. Responses to the QuickDASH both at baseline and follow-up 6 ± 4 weeks later, and a response to the anchor question "Compared to your first evaluation at the University Orthopaedic Center, how would you describe your physical function level now?" were required for inclusion. A second anchor question querying treatment-related improvement was also used. The SCB was calculated using an anchor-based approach comparing the mean change difference between groups reporting no change and a maximal change for both anchor questions. RESULTS: Of 1,119 included participants, the mean age was 48 ± 17 years, 53% were women, and half were recovering from surgery. Score changes between baseline and follow-up were significantly different between groups reporting no improvement and maximal improvement on both anchor questions. The SCB values ranged between 16.9 and 22.8 on the QuickDASH, 5.9 and 7.1 on the UE CAT, and 3.5 and 6.7 on the PF CAT. CONCLUSIONS: These score improvements for the QuickDASH, UE CAT, and PF CAT represent a substantial clinical improvement in a non-shoulder hand and upper extremity population. CLINICAL RELEVANCE: These SCB estimates may assist with the interpretation of outcome scores at a population level.

Safety of endoscopist-directed nurse-administered balanced propofol sedation in patients with severe systemic disease (ASA class III).

BACKGROUND AND AIMS: The safety of endoscopist-directed nurse-administered propofol sedation (EDNAPS) has been demonstrated in low-risk patients (American Society of Anesthesiologists [ASA] class I and II). There are limited data regarding the safety of EDNAPS for endoscopic procedures in ASA class III patients. The purpose of this study was to determine the safety of EDNAPS for routine outpatient endoscopy in this population. METHODS: We retrospectively reviewed all outpatient EGDs and colonoscopies performed with EDNAPS at the University of Utah from January 2015 to November 2018. Exclusion criteria were inpatient procedures, combined procedures, ASA IV or higher, use of continuous or bilevel positive airway pressure at the start of the procedure, or procedures performed by a nongastroenterologist. Major adverse events were defined as intubation or death. Minor adverse events were defined as hypoxia, hypotension, bradycardia, or need for airway interventions. Patients were stratified by procedure type and ASA I/II status and were compared with patients with ASA III status and matched according to age, gender, and the involvement of a fellow in a 3 to 1 fashion. RESULTS: The final sample size was 18,910 colonoscopy procedures (17,205 patients) and 9178 EGD procedures (6827 patients). In both colonoscopy and EGD procedures, there were no major adverse events such as intubation, need for resuscitation, or death. The rates of any airway intervention, jaw thrust, oral nasal airway, or use of positive pressure ventilation were low in both procedure types and not different between ASA I/II and ASA III patients. CONCLUSION: EDNAPS is safe in both ASA I/II and ASA class III patients undergoing routine outpatient endoscopy.

Race reporting and representation in onychomycosis clinical trials: A systematic review.

BACKGROUND: Onychomycosis is the most common nail disease seen in clinical practice. Inclusion of diverse groups in onychomycosis clinical trials subjects is necessary to generalise efficacy data. OBJECTIVES: We aimed to systematically review race and ethnicity reporting and representation, as well as, treatment outcomes in onychomycosis clinical trials. METHODS: A PubMed search for onychomycosis clinical trials was performed in August 2020. Primary clinical trial data were included and post hoc analyses were excluded. Categorical variables were compared using chi-squared and Fisher's exact tests. Statistical significance was set at p < .05. Photos in articles were categorised by Fitzpatrick skin type. RESULTS: Only 32/182 (17.5%) trials reported on race and/or ethnicity and only one trial compared treatment efficacy in different subgroups. Darker skin colours were infrequently depicted in articles. Topical treatment, location with ≥1 US-based site, industry funding type and publication date after 2000 were significantly associated with reporting of racial/ethnic data (p < .05 for all comparisons). LIMITATIONS: Demographics on excluded subjects and methods of recruitment were not available. Assigning Fitzpatrick skin type is inherently subjective. CONCLUSIONS: This study highlights a need for consistent reporting of races and ethnicities of onychomycosis clinical trial participants with subgroup analyses of treatment efficacies.

Preordering of water is not needed for ice recognition by hyperactive antifreeze proteins.

Antifreeze proteins (AFPs) inhibit ice growth in organisms living in cold environments. Hyperactive insect AFPs are particularly effective, binding ice through "anchored clathrate" motifs. It has been hypothesized that the binding of hyperactive AFPs to ice is facilitated by preordering of water at the ice-binding site (IBS) of the protein in solution. The antifreeze protein TmAFP displays the best matching of its binding site to ice, making it the optimal candidate to develop ice-like order in solution. Here we use multiresolution simulations to unravel the mechanism by which TmAFP recognizes and binds ice. We find that water at the IBS of the antifreeze protein in solution does not acquire ice-like or anchored clathrate-like order. Ice recognition occurs by slow diffusion of the protein to achieve the proper orientation with respect to the ice surface, followed by fast collective organization of the hydration water at the IBS to form an anchored clathrate motif that latches the protein to the ice surface. The simulations suggest that anchored clathrate order could develop on the large ice-binding surfaces of aggregates of ice-nucleating proteins (INP). We compute the infrared and Raman spectra of water in the anchored clathrate motif. The signatures of the OH stretch of water in the anchored clathrate motif can be distinguished from those of bulk liquid in the Raman spectra, but not in the infrared spectra. We thus suggest that Raman spectroscopy may be used to probe the anchored clathrate order at the ice-binding surface of INP aggregates.

Minimal Clinically Important Difference of the PROMIS Upper-Extremity Computer Adaptive Test and QuickDASH for Ligament Reconstruction Tendon Interposition Patients.

PURPOSE: To calculate the minimal clinically important difference (MCID) of the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Test (UE CAT) and Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) for ligament reconstruction tendon interposition (LRTI) patients. METHODS: Adult patients treated with LRTI for trapeziometacarpal OA by fellowship-trained hand surgeons between December 2014 and February 2018 at an academic tertiary institution were included. Outcomes were prospectively collected at each visit by tablet computer, including the QuickDASH, PROMIS UE, Pain Interference, Depression, and Anxiety CATs. Inclusion required a response to the anchor question "How much relief and/or improvement do you feel you have experienced as a result of your treatment?" on a 6-option Likert scale, as well as preoperative (≤120 days before surgery) and follow-up (2-26 weeks) outcomes. We calculated MCID both by an anchor-based approach using the mean score of the minimal change group, and with the 0.5 SD method. RESULTS: Of 145 included participants, mean age was 63 ± 8 years and 74% were female. Anchor-based MCID estimates for the total cohort were 4.2 for the PROMIS UE CAT and 8.8 for the QuickDASH. The MCID estimates using the 0.5 SD method were 4.8 and 11.7, respectively. CONCLUSIONS: We propose MCID values of 4.2 to 4.8 for the PROMIS UE CAT and 8.8 to 11.7 for the QuickDASH when powering clinical studies or when assessing improvement among a cohort of patients who have undergone LRTI surgery. CLINICAL RELEVANCE: Minimal clinically important difference estimates are helpful when interpreting clinical outcomes after LRTI and for powering prospective trials.

Establishing the Minimal Clinically Important Difference for the PROMIS Upper Extremity Computer Adaptive Test Version 2.0 in a Nonshoulder Hand and Upper Extremity Population.

PURPOSE: Our primary purpose was to calculate the minimal clinically important difference (MCID) for the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Computer Adaptive Test (CAT) version 2.0 (v2.0) for a nonshoulder hand and upper extremity population. Secondarily, we calculated the PROMIS Physical Function (PF) CAT v2.0 and the abbreviated version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) MCID. METHODS: Adult patients treated by 1 of 5 fellowship-trained hand surgeons between March 2015 and September 2019 at an academic tertiary institution were identified. The PROMIS UE CAT v2.0, PROMIS PF CAT v2.0, and QuickDASH were collected via tablet computer. Inclusion required response to at least 1 of the instruments at both baseline and follow-up (6 ± 4 weeks), and a response to the anchor question: "Compared to your first evaluation at the University Orthopaedic Center, how would you describe your physical function level now?" An additional anchor question assessing treatment-related improvement was also asked. The MCID was calculated using an anchor-based approach using the mean change difference between groups reporting no change and slight change for both anchor questions, and with the 1/2 SD method. RESULTS: Of 2,106 participants, mean age was 48 ± 17 years, 53% were female, and 53% were recovering from surgery. Of these patients, 381 completed the PROMISE UE CAT v2.0, 497 completed the PROMIS PF CAT v2.0, and 2,018 completed the QuickDASH. The score change between baseline and follow-up was significantly different between anchor groups for both anchor-based MCID calculations. Anchor-based MCID values were 3.0 to 4.0 for the UE CAT, 2.1 to 3.6 for the PF CAT, and 10.3 for the QuickDASH. The MCID values per the 1/2 SD method were 4.1, 4.1, and 10.2, respectively. CONCLUSIONS: We propose MCID ranges of 3.0 to 4.1 for the PROMIS UE CAT v2.0, and 2.1 to 4.1 for the PROMIS PF CAT v2.0. The observed QuickDASH MCID values (10.2-10.3) are within the range of previously published values. CLINICAL RELEVANCE: These MCID estimates will aid in interpreting clinical outcomes and in powering clinical studies.