```xml
<?xml version="1.0" encoding="UTF-8" standalone="yes"?>
<ns3:query_definition xmlns:ns2="http://www.i2b2.org/xsd/cell/crc/psm/1.1/" xmlns:ns4="http://www.i2b2.org/xsd/cell/crc/psm/analysisdefinition/1.1/" xmlns:ns3="http://www.i2b2.org/xsd/cell/crc/psm/querydefinition/1.1/">
    <query_name>CT Reports@12:34:18</query_name>
    <query_timing>ANY</query_timing>
    <specificity_scale>0</specificity_scale>
    <panel>
        <panel_number>1</panel_number>
        <panel_timing>ANY</panel_timing>
        <panel_accuracy_scale>100</panel_accuracy_scale>
        <invert>0</invert>
        <total_item_occurrences>1</total_item_occurrences>
        <item>
            <hlevel>2</hlevel>
            <item_name>CT Reports</item_name>
            <item_key>\\i2b2_REP\i2b2\Reports\CT Reports\</item_key>
            <item_icon>LAE</item_icon>
            <tooltip>i2b2 \ Reports \ CT Reports</tooltip>
            <class>ENC</class>
            <item_is_synonym>false</item_is_synonym>
        </item>
        <item>
            <hlevel>5</hlevel>
            <item_name>TIMED URINE ALBUMIN/CREAT RATIOMP (LOINC:13705-9)</item_name>
            <item_key>\\i2b2_LABS\i2b2\Labtests\LAB\(LLB16) Chemistry\(LLB30) Urine Chemistries Timed\UTALBCRE\LOINC:13705-9\</item_key>
            <item_icon>LA</item_icon>
            <tooltip>Labtests \ Chemistry \ Urine Chemistries Timed \ Timed Urine MALB/CRE Ratio (Group:UTALBCRE) \ Timed urine albumin/creat ratiomp (LOINC:13705-9)</tooltip>
            <class>ENC</class>
            <constrain_by_value>
                <value_operator>EQ</value_operator>
                <value_constraint>6</value_constraint>
                <value_unit_of_measure>ratio</value_unit_of_measure>
                <value_type>NUMBER</value_type>
            </constrain_by_value>
            <item_is_synonym>false</item_is_synonym>
        </item>
    </panel>
</ns3:query_definition>

```

I want to find all CT Reports with a specificity scale of 0 and a panel timing of ANY, and within that panel, I want to include a specific item named "TIMED URINE ALBUMIN/CREAT RATIOMP (LOINC:13705-9)" with a class of ENC, icon LA, and a tooltip of "i2b2 \ Reports \ CT Reports" and a constrain value of 6, unit of measure as ratio, value type as number, and a synonym of false.