Assessment System Research Articles

The standardized training and assessment system for magnetically controlled capsule gastroscopy (with video)

Background and Aim To explore the feasibility of a standardized training and assessment system for magnetically controlled capsule gastroscopy (MCCG). Methods The results of 90 trainees who underwent the standardized training and assessment system of the MCCG at the First Affiliated Hospital of Xi’an Jiaotong University from May 2020 to November 2023 was retrospectively analyzed. The trainees were divided into three groups according to their medical backgrounds: doctor, nurse, and non-medical groups. The training and assessment system adopted the ‘7 + 2’ mode, seven days of training plus two days of theoretical and operational assessment. The passing rates of theoretical, operational, and total assessment were the primary outcomes. Satisfaction and mastery of the MCCG was checked. Results Ninety trainees were assessed; theoretical assessment’s passing rates in the three groups were 100%. The operational and total assessment passing rates were 100% (25/25), 97.92% (47/48), and 94.12% (16/17), for the doctor, nurse, and non-doctor groups respectively, with no significant difference (χ2 = 1.741, p = 0.419). No bleeding or perforation occurred during the procedure. Approximately, 96.00% (24/25), 95.83% (46/48), and 94.12% (16/17) of the doctor, nurse and non-medical groups anonymously expressed great satisfaction, respectively, without statistically significant difference (χ2 = 0.565, p = 1.000). The average follow-up time was 4–36 months, and 87 trainees (96.67%) had mastered the operation of the MCCG in daily work. Conclusions Standardized training and assessment of magnetically controlled capsule endoscopists is effective and feasible. Additionally, a strict assessment system and long-term communication and learning can improve teaching effects.

A novel proposed classification system for rock slope stability assessment

The present study introduces “rock slope instability score (RSIS)” a novel classification system for assessing rock slope stability. It takes into account geological and geotechnical parameters, as well as the impact of human activities and triggering parameters, which have become more frequent due to climate change and few of them have been ignored in existing classifications. The study focuses on rock slopes of various lithologies from the Indian Himalayas. The development of this new classification system is based on the examination of 81 different rock slopes from various states of the Indian Himalayas. Extensive field surveys, rock sampling, geotechnical laboratory tests, and ground measurements have been conducted at the various slope sites to establish a comprehensive scoring system for the stability assessment. The distributions of weightage to each parameter have been considered, corresponding to its degree of impact in causing slope instability. Sensitivity analysis of all defined parameters of RSIS system has revealed that the majority of the parameters exhibit a strong positive correlation, with Pearson correlation coefficients ranging from 0.74 to 0.61. However, two parameters, namely discontinuity dip and the relationship between slope & discontinuity direction, gives moderate relationship with correlation coefficient values of 0.48 and 0.41, respectively. To avoid any designer biasness in the system, several individuals gathered data set at different times. The proposed classification system has demonstrated a strong correlation with the actual slope condition, and it is quite promising. The outcome of RSIS classification for studied 81 slopes classified 2 slopes under stable condition, 21 slopes as partially stable, 44 as unstable, and 14 as completely unstable.

Do progression rates of initial and moderate caries lesions and sound surfaces of primary teeth increase significantly after 7 years?

Initial caries lesions in primary teeth have presented a low progression rate after 2 years, but it could be higher in longer follow-ups. To evaluate the progression rates of sound surfaces and initial and moderate caries lesions after 7 years. This prospective 7-year cohort study included 639 preschool children aged 1-5 years in 2010. In 2017, 449 children were reassessed (70.3% retention rate). Dental caries was collected using the International Caries Detection and Assessment System (ICDAS) in both assessments. Incidence rate (IR) per 100 surface-years estimated the progression rates of sound surfaces and initial and moderate lesions for worse conditions. Cox regression with shared frailty evaluated the possible risk factors. IR was 1.0% for sound surfaces, 2.8% and 4.2% for ICDAS scores 1 and 2, respectively, and about 17.0% for moderate lesions. The most significant risk factor for the progression was the presence of cavitated lesions in other teeth. The type of surface and tooth also influenced the outcome. The progression rate of initial caries lesions in primary teeth remains low even after 7 years, but cavitated caries lesions in other teeth increase this risk. Moderate lesions demonstrate a higher risk of progression when compared to sound surfaces and initial caries lesions.

Student Assessment in Formal Education: Nepali Community School Teachers’ Perspectives

The present secondary level English curriculum of Grade 9 and 10 in Nepal has made the provision of 25 marks internal assessment system as part of summative evaluation. In this context, this study examines the existing internal assessment practices adopted by the English language teachers in the Secondary Education Examination of the community schools in Nepal. Employing the qualitative phenomenological research design, five secondary level English language teachers were selected purposively as research participants. Semi-structured interviews and participant observation were used as tools for collecting data. The data were analyzed inductively as content analysis using the internal assessment criteria of participation, listening, speaking, and score from terminal examinations as determined by the curriculum as part of summative evaluation. The result was interpreted through the perspective of Vygotsky’s (1978) zone of proximal development and the theory of scaffolding in relation to the assessment for learning, assessment as learning, and assessment of learning. The prominence of assessment of learning as the dominant practice has resulted in the marginalization of the other two purposes of assessment. The findings of the study highlight the need for a more balanced approach that encompasses assessment for learning and assessment as learning, ensuring a comprehensive and holistic evaluation of students’ progress and development.

Evaluating student performance assessment methods in Objective Structured Clinical Exam: perspectives and comparisons.

This study aims to evaluate how student performance and perspectives changed when the Objective Structured Clinical Exam (OSCE) assessment system was changed from a composite score to discipline-specific grading at the Harvard School of Dental Medicine. The retrospective study population consisted of all students (n=349) who completed three OSCEs (OSCE 1, 2, and 3) as part of the predoctoral program during the years 2014-2023. Data on the students' OSCE scores were obtained from the Office of Dental Education, and data on students' race/ethnicity and gender were obtained from their admissions data. The likelihood of a student failing the OSCE after the assessment system change significantly increased with an adjusted odds ratio of 20.12. After the change, the number of failed subjects per student decreased with an adjusted mean ratio of 0.48. Students perceived the OSCE as being less useful after the change. Independent of the grading change, OSCEs 1 and 2 were seen as more useful compared to OSCE 3, which is administered in the last year of the Doctor of Dental Medicine program. The discipline-specific nature of the new assessment system helps focus on specific areas of remediation, rather than blanket remediation used previously, in order to isolate the actual areas of deficiency and to focus remediation efforts so that students can align their learning needs appropriately.Therefore, although the actual number of fails identified increased for the course, the assessment change has allowed for more directed, actionable information to be gained from the OSCE to prepare students to work toward competency standards.

Resin infiltration versus fluoride varnish for visual improvement of white spot lesions during multibracket treatment. A randomized-controlled clinical trial

AimsThis study aimed to evaluate the visual improvement of resin infiltration of white spot lesions (WSL) during orthodontic treatment with the multibracket appliance (MBA) compared to fluoride varnish.MethodsPatients aged 12–17 years with at least one WSL with an International Caries Detection and Assessment System (ICDAS) score of 1–2 during an active MBA treatment were included and randomized to receive either resin infiltration (Icon) or fluoride application (Flairesse). Standardized digital images were obtained before, one-day, one-week, one-month, three-months and six-months after treatment using a DSLR camera and a matching polarization filter. A grey reference card was used for color standardization. A Matlab routine was used to measure the color difference between adjacent healthy enamel and treated WSL. The independent-samples t-test was used for intergroup and paired-samples t-test for intragroup comparison.ResultsImages of 116 teeth from 36 patients were analyzed. The ΔE for the “Icon” treated WSL was smaller (T1ICON = 5.0 ± 1.4) than in the fluoride group (T1Fluoride = 8.4 ± 3.2). Caries infiltration significantly improved the aesthetic appearance of WSL (p < 0.001), which remained satisfactory at six months (T5ICON = 5.2 ± 1.6).ConclusionWSL infiltration management during orthodontic treatment was superior to topical fluoridation in not only arresting the enamel lesions but also significantly improving the aesthetic appearance of demineralized regions around the brackets.Clinical relevanceWSL treatment in orthodontic patients is usually initiated after debonding. Research has shown that the earlier WSL is treated, the better the aesthetic outcome. There is limited data on the efficacy of resin infiltration of WSL during orthodontic treatment.

Ambient floor vibration sensing advances the accessibility of functional gait assessments for children with muscular dystrophies

Muscular dystrophies (MD) are a group of genetic neuromuscular disorders that cause progressive weakness and loss of muscles over time, influencing 1 in 3500–5000 children worldwide. New and exciting treatment options have led to a critical need for a clinical post-marketing surveillance tool to confirm the efficacy and safety of these treatments after individuals receive them in a commercial setting. For MDs, functional gait assessment is a common approach to evaluate the efficacy of the treatments because muscle weakness is reflected in individuals’ walking patterns. However, there is little incentive for the family to continue to travel for such assessments due to the lack of access to specialty centers. While various existing sensing devices, such as cameras, force plates, and wearables can assess gait at home, they are limited by privacy concerns, area of coverage, and discomfort in carrying devices, which is not practical for long-term, continuous monitoring in daily settings. In this study, we introduce a novel functional gait assessment system using ambient floor vibrations, which is non-invasive and scalable, requiring only low-cost and sparsely deployed geophone sensors attached to the floor surface, suitable for in-home usage. Our system captures floor vibrations generated by footsteps from patients while they walk around and analyzes such vibrations to extract essential gait health information. To enhance interpretability and reliability under various sensing scenarios, we translate the signal patterns of floor vibration to pathological gait patterns related to MD, and develop a hierarchical learning algorithm that aggregates insights from individual footsteps to estimate a person’s overall gait performance. When evaluated through real-world experiments with 36 subjects (including 15 patients with MD), our floor vibration sensing system achieves a 94.8% accuracy in predicting functional gait stages for patients with MD. Our approach enables accurate, accessible, and scalable functional gait assessment, bringing MD progressive tracking into real life.

Online Exam Portal

An online test is one that is conducted via the internet or an intranet utilizing a computer system. It is a web-based exam system. It works well as a mass education evaluation solution. Our system for online exams is built on a Browser/Server architecture. The multiple choice questions that are fed into the system are examined and automatically graded by the system. Even while it is comfortable, the classic pen and paper exam format has drawbacks in the current digital learning environment. IT students find these limits even more noticeable because they are used to using internet resources and platforms. In response, this proposal suggests creating an efficient, user-friendly, and safe online assessment system especially for IT students. This project goes beyond practicality. It increases assessment quality with interesting formats, empowers students with freedom, and promotes efficiency with quicker administration and grading. Teachers receive insightful data-driven information for bettering their curricula. In the end, it welcomes the digital age and uses cutting-edge evaluation techniques to get IT students ready for success

Adaptive, Externalizing, and Internalizing Behavior of Children with Prenatal Alcohol Exposure: A Comparison of Three Parent-Report Questionnaires

ABSTRACT This study compared the Behavior Assessment System for Children-Third Edition (BASC-3) to the Child Behavior Checklist (CBCL) and the Vineland Adaptive Behavior Scales-Third Edition (VABS-3) in children with and without histories of prenatal alcohol exposure. Data were collected from Collaborative Initiative on Fetal Alcohol Spectrum Disorders Phase 4 sites. Caregivers rated their child’s behavior using three questionnaires: BASC-3, CBCL, and VABS-3. BASC-3 Adaptive Skills, Externalizing Problems, and Internalizing Problems scores were correlated with comparable scores from the CBCL (Externalizing and Internalizing Problems) and VABS-3 (Adaptive Skills) both within and across groups. Sensitivity, specificity, and positive and negative predictive values were calculated for the BASC-3. BASC-3 sensitivity rates were 78.1%, 80.5%, and 47.0% and specificity rates were 79.4%, 80.4%, and 81.5% for Adaptive Skills, Externalizing Problems, and Internalizing Problems, respectively. Positive predictive values were 87.1%, 88.0%, and 81.9% and negative predictive values were 67.0%, 69.8%, and 46.3% for Adaptive Skills, Externalizing Problems, and Internalizing Problems, respectively. Results replicated previous reports of behavioral and adaptive difficulties in children with prenatal alcohol exposure. These findings provide support for using the BASC-3 in this population.

The impact of artificial intelligence big data technology on the development of media economy information security

With the rapid development of Artificial Intelligence (AI) and Big Data (BD), they provide people with new ways and tools in information acquisition, processing and dissemination. The purpose of this study is to deeply discuss the influence of AI and BD technologies on the development of Information Security (InfoSec) in media economy, and analyze the opportunities and challenges it brings. Firstly, the evaluation system of the influence of BD technology on the development of InfoSec, a media enterprise, is constructed. Then, this study discusses the development mode of the multilateral platform of media economy supported by BD technology. Finally, taking S company and X platform as examples, this study analyses the influence of BD technology on the development of InfoSec and the development mode of media economy supported by BD technology. The research results show that with the support of BD technology, the proportion of InfoSec products in enterprises has reached 0.2426, and the InfoSec score of S company has reached 77.74, reaching a high level. The profit margin of digital network media is three times that of traditional media. The number of users of multilateral digital media economic platform X has increased by 21%, and its turnover has increased by 54%. AI and BD technologies have brought opportunities and challenges to the InfoSec development of media economy. While applying these technologies, it is necessary to take effective measures to protect users’ privacy and strengthen the information review and verification mechanism to ensure the sustainable development of media economy. The uniqueness of this study lies in the construction of a comprehensive BD technology impact assessment system and the discussion of the development model of multilateral media economic platform, which provides a powerful reference and guidance for media enterprises. In addition, this study also reveals the positive influence of BD technology on InfoSec and the development of media economy, which provides beneficial enlightenment for the future development of media industry. In response to the challenges of privacy and InfoSec, this study puts forward important policy and practical suggestions to ensure the sustainable growth of media economy and the protection of users’ rights and interests. Therefore, this study has important contribution and innovative value in both theory and practice.

Promotion incentives, economic growth targets and industrial land supply: evidence from China

ABSTRACT This study examines the impact of officials’ promotion incentives on the industrial land supply and explores the mediating role of economic growth targets, which are greatly influenced by local leaders. Using the panel data of 257 prefecture-level cities across China from 2007 to 2019, we identify the influence of officials’ promotion incentives on industrial land supply using a two-way fixed-effects model and then examine the mediating role played by the setting of economic growth targets using a mediating-effects model. The estimated results indicate that the promotion incentives of local leaders and the supply of industrial land by local governments follow a significant inverted U-shaped relationship, and that the economic growth targets play a partial mediating role. Heterogeneity analysis shows that the impact of promotion incentives for local leaders on industrial land supply is significantly heterogeneous due to differences in the age of local leaders and the economic development across different regions. The findings are important for improving China’s assessment system of officials, formulating economic growth targets, and optimizing the allocation of urban industrial land.

Multi-modal recommender system for predicting project manager performance within a competency-based framework

The evaluation of performance using competencies within a structured framework holds significant importance across various professional domains, particularly in roles like project manager. Typically, this assessment process, overseen by senior evaluators, involves scoring competencies based on data gathered from interviews, completed forms, and evaluation programs. However, this task is tedious and time-consuming, and requires the expertise of qualified professionals. Moreover, it is compounded by the inconsistent scoring biases introduced by different evaluators. In this paper, we propose a novel approach to automatically predict competency scores, thereby facilitating the assessment of project managers' performance. Initially, we performed data fusion to compile a comprehensive dataset from various sources and modalities, including demographic data, profile-related data, and historical competency assessments. Subsequently, NLP techniques were used to pre-process text data. Finally, recommender systems were explored to predict competency scores. We compared four different recommender system approaches: content-based filtering, demographic filtering, collaborative filtering, and hybrid filtering. Using assessment data collected from 38 project managers, encompassing scores across 67 different competencies, we evaluated the performance of each approach. Notably, the content-based approach yielded promising results, achieving a precision rate of 81.03%. Furthermore, we addressed the challenge of cold-starting, which in our context involves predicting scores for either a new project manager lacking competency data or a newly introduced competency without historical records. Our analysis revealed that demographic filtering achieved an average precision of 54.05% when dealing with new project managers. In contrast, content-based filtering exhibited remarkable performance, achieving a precision of 85.79% in predicting scores for new competencies. These findings underscore the potential of recommender systems in competency assessment, thereby facilitating more effective performance evaluation process.

Predicting suicidality with small sets of interpretable reward behavior and survey variables

AbstractThe prediction of suicidal thought and behavior has met with mixed results. This study of 3,476 de-identified participants (4,019 before data exclusion) quantified the prediction of four suicidal thought and behavior (STB) variables using a short reward/aversion judgment task and a limited set of demographic and mental health surveys. The focus was to produce a simple, quick and objective framework for assessing STB that might be automatable, without the use of big data. A balanced random forest classifier performed better than a Gaussian mixture model and four standard machine learning classifiers for predicting passive suicide ideation, active suicide ideation, suicide planning and planning for safety. Accuracies ranged from 78% to 92% (optimal area under the curve between 0.80 and 0.95) without overfitting, and peak performance was observed for predicting suicide planning. The relative importance of features for prediction showed distinct weighting across judgment variables, contributing between 40% and 64% to prediction per Gini scores. Mediation/moderation analyses showed that depression, anxiety, loneliness and age variables moderated the judgment variables, indicating that the interaction of judgment with mental health and demographic indices is fundamental for the high-accuracy prediction of STB. These findings suggest the feasibility of an efficient and highly scalable system for suicide assessment, without requiring psychiatric records or neural measures. The findings suggest that STB might be understood within a cognitive framework for judgment with quantitative variables whose unique constellation separates passive and active suicidal thought (ideation) from suicide planning and planning for safety.

Modified scoring system for the quantitative assessment of histological regression in peritoneal carcinomatosis after pressurized intraperitoneal aerosol chemotherapy: A pilot study

Modified scoring system for the quantitative assessment of histological regression in peritoneal carcinomatosis after pressurized intraperitoneal aerosol chemotherapy: A pilot study

Variables affecting new drug prices in South Korea’s pricing system

Objective: The price of pharmaceuticals is important from the economic and industrial perspectives but as well as patients’ access to treatment. This study aimed to analyze the variables affecting the prices of new drugs in South Korea’s pricing system.Methods: Data on 192 new drugs listed in South Korea from 2012 to 2022 were collected from the official website of the Health Insurance Review and Assessment Service. The independent variables included drugs for severe diseases, alternatives, number of patients, number of advanced 7 countries listed, budget impact, and listing period. The dependent variables included annual treatment cost and the price ratio to the advanced 7 country’s average adjusted price. Descriptive statistics of variables, linear correlations between quantitative independent and dependent variables, and associations between independent and dependent variables were analyzed.Results: The mean annual treatment cost and price ratio to the advanced 7 country’s average adjusted price were higher for drugs for severe diseases and those with no alternatives. Annual treatment cost and price ratio to the advanced 7 country’s average adjusted price were negatively correlated with the number of patients and positively correlated with the number of advanced 7 countries listed. Annual treatment cost was affected by the variables drugs for severe diseases, alternatives, number of patients, number of advanced 7 countries listed, and budget impact. The price ratio to the advanced 7 country’s average adjusted price was affected by drugs for severe diseases, alternatives, and the number of patients.Conclusion: This study revealed the effect of different variables on the prices of new drugs in South Korea, allowing for the development of a more effective assessment system to evaluate the prices of new drugs while ensuring profitability for pharmaceutical companies, sustainability of public insurance, and accessibility to drugs by patients.

A real-time virtual outing using virtual reality for a hospitalized terminal cancer patient who has difficulty going out: a case report

Objective: Even if hospitalized terminal cancer patients wish to go out, it is sometimes difficult for them to realize this because of various symptoms. We have been providing a virtual outing experience using virtual reality (VR) for terminal cancer patients who have difficulty going out, and have often received requests to “talk with people in the virtual outing,” but there is a problem that a large time lag occurs in conversation in a VR space under the general Internet environment. However, with the advent of systems that enable high-speed, low-latency communications, real-time communication is now possible even in VR spaces. Thus, we aimed to explore the feasibility of implementing the real-time virtual outing.Methods: The patient’s preferred virtual outing was to his daughter’s new home. The study operator used a 360° video real-time sharing system to broadcast the view of the daughter’s home. The patient experienced the images using a VR head-mounted display in his room. The patient’s wife, son, daughter, and grandson participated in this delivery using a laptop computer from a dayroom in the hospital, and his daughter’s husband participated using the 360° video real-time sharing system from the daughter’s home with the researcher. Before and after the virtual outing, changes in symptoms and emotions were assessed using the Edmonton Symptom Assessment System Revised Japanese version and the Numerical Rating Scale for headache, dizziness, pleasure, and satisfaction. In addition, we collected the patients’ impressions of the virtual outing.Results: The patient was a male in his early 70s. After approximately 30 min of real-time virtual outings, “tiredness, drowsiness, depression, and wellbeing” were improved and “pleasure, and satisfaction” were increased, while no side effects or worsening of symptoms were observed. In addition, it was observed from the patient’s comments that he felt a sense of presence, as if he were her home.Discussion: The patient and his family could enjoy smooth conversation without time lag even in the VR space. Therefore, it was suggested that real-time virtual outings using VR could help realize the wishes of hospitalized terminal cancer patients who have difficulty going out as a new approach.

Construction of a sustainable design competency assessment system for fashion designers in China

Construction of a sustainable design competency assessment system for fashion designers in China

Developing a smart green supplier risk assessment system integrating natural language processing and life cycle assessment based on AHP framework: An empirical study

Global carbon reduction drives the transformations of corporations, emphasizing carbon and environmental impact within supply chains. A critical challenge in risk management is converting unstructured data into quantifiable information, and ruining the conversion often leads to ineffective risk assessments. While artificial intelligence is increasingly used in supply chain risk management, previous studies seldom integrate text analysis for risk extraction and lack accurate risk assessment methods. This study pioneers an intelligent green supplier risk assessment system integrating natural language processing (NLP) and life cycle assessment (LCA) based on an analytic hierarchy process (AHP) framework. The proposed approach utilizes NLP keyword extraction to identify and assess risk and uses LCA to uncover environmental risks, minimizing negative impacts. The text classification model attains 81.7 % accuracy, ensuring a trustworthy risk assessment system. The proposed method could significantly improve risk analysis efficiency, foster sustainable procurement, and elevate enterprise competitiveness in sustainable business practices.

Early identification of macrophage activation syndrome secondary to systemic lupus erythematosus with machine learning

ObjectiveThe macrophage activation syndrome (MAS) secondary to systemic lupus erythematosus (SLE) is a severe and life-threatening complication. Early diagnosis of MAS is particularly challenging. In this study, machine learning models and diagnostic scoring card were developed to aid in clinical decision-making using clinical characteristics.MethodsWe retrospectively collected clinical data from 188 patients with either SLE or the MAS secondary to SLE. 13 significant clinical predictor variables were filtered out using the Least Absolute Shrinkage and Selection Operator (LASSO). These variables were subsequently utilized as inputs in five machine learning models. The performance of the models was evaluated using the area under the receiver operating characteristic curve (ROC-AUC), F1 score, and F2 score. To enhance clinical usability, we developed a diagnostic scoring card based on logistic regression (LR) analysis and Chi-Square binning, establishing probability thresholds and stratification for the card. Additionally, this study collected data from four other domestic hospitals for external validation.ResultsAmong all the machine learning models, the LR model demonstrates the highest level of performance in internal validation, achieving a ROC-AUC of 0.998, an F1 score of 0.96, and an F2 score of 0.952. The score card we constructed identifies the probability threshold at a score of 49, achieving a ROC-AUC of 0.994 and an F2 score of 0.936. The score results were categorized into five groups based on diagnostic probability: extremely low (below 5%), low (5–25%), normal (25–75%), high (75–95%), and extremely high (above 95%). During external validation, the performance evaluation revealed that the Support Vector Machine (SVM) model outperformed other models with an AUC value of 0.947, and the scorecard model has an AUC of 0.915. Additionally, we have established an online assessment system for early identification of MAS secondary to SLE.ConclusionMachine learning models can significantly improve the diagnostic accuracy of MAS secondary to SLE, and the diagnostic scorecard model can facilitate personalized probabilistic predictions of disease occurrence in clinical environments.

Assessment of dental and periodontal indices and Streptococcus mutans virulence in fragile X syndrome patients.

Fragile X syndrome (FXS) is the most common cause of hereditary genetic disorder in a single gene characterised by intellectual disability. Behavioural features such as autism, hyperactivity and anxiety disorder may be present. Biofilm development and pathogenicity of Streptococcus mutans may be altered because FXS renders the dental approach and oral hygiene more complex. The purpose of this study was to compare the levels of transcripts for VicRK and CovR of S. mutans isolated from FXS patients with the levels of transcripts for VicRK and CovR of standard strain ATCC, using a quantitative polymerase chain reaction (qPCR). The caries experience index was assessed by the International Caries Detection and Assessment System (ICDAS), Periodontal Condition Index (PCI) and Invasive Dental Treatment Need Index (INI). The clinical index findings revealed a high rate of caries cavities and bleeding on probing of FXS patients. When VicRK and CovR transcript levels were compared with the reference strain, Fragile X patients were found to have significantly higher values. The present study demonstrated that FXS patients have more adverse clinical conditions, with increased biofilm accumulation and virulence. When combined with behavioural abnormalities, these patients become even more vulnerable to dental caries.