Consensus Diagnosis Research Articles

Design and methodology of the harmonized diagnostic assessment of dementia for the longitudinal aging study in India: Wave 2.

The rising burden of dementia calls for high-quality data on cognitive decline and dementia onset. The second wave of the Harmonized Diagnostic Assessment for the Longitudinal Aging Study in India (LASI-DAD) was designed to provide longitudinal assessments of cognition and dementia in India. All Wave 1 participants were recruited for a follow-up interview, and a refresher sample was drawn from the Longitudinal Aging Study in India, a nationally representative cohort of Indians aged 45 and older. Respondents underwent a battery of cognitive tests, geriatric assessments, and venous blood collection. Their health and cognitive status were also assessed through an interview with a close family member or friend. Clinical consensus diagnosis was made based on the Clinical Dementia Rating®, and comprehensive data on risk factors of dementia were collected, including neurodegenerative biomarkers, sensory function, and environmental exposures. A total of 4635 participants were recruited between 2022 and 2024 from 22 states and union territories of India, accounting for 97.9% of the population in India. The response rate was 84.0%, and 71.5% of the participants provided venous blood specimen. LASI-DAD provides rich new data to study cognition, dementia, and their risk factors longitudinally in a nationally representative sample of older adults in India. Longitudinal cognitive data, together with longitudinally assessed biomarker data and novel data on sensory function and environmental exposures, provide a unique opportunity to establish associations between risk factors and biologically defined cognitive aging phenotypes.

Combined Pediatric Rheumatology/Dermatology Clinics: Benefits and Challenges.

Integrated care models, like combined rheumatology/dermatology clinics (RDCs), facilitate efficient coordination between specialists and provide comprehensive care. Given the limited literature on pediatric RDC logistics, outcomes, benefits and, challenges, we comprehensively characterized our patient cohort at the UCSF Benioff Children's Hospital RDC and surveyed pediatric dermatologists participating in RDCs. We retrospectively reviewed 71 patients new to the UCSF Pediatric RDC between September 2017 and September 2023. A survey was distributed in 2024 to 17 dermatologists in North America, each representing a unique pediatric RDC. 69% of patients (49/71) were female. Seventeen (24%) presented without a known diagnosis; the first RDC visit established a diagnosis for 7 of them (41%). Of patients with a previously established diagnosis, initial RDC evaluation confirmed it in 52 (96%) and revised it for 2 (4%). The most encountered diagnoses were linear morphea (33%), lupus (23%), and psoriasis (13%). New systemic therapy was prescribed for 23% of patients, and additional work-up was recommended via skin biopsy (8%) and imaging (28%). Survey results revealed all pediatric RDCs include trainees, but only 59% (10/17) receive administrative support. All agreed that RDCs are valuable for patient care and most (15/17, 88%) felt that the RDC was a valuable use of their time. Pediatric RDCs are valuable for consensus diagnosis, streamlined evaluation, and management of complex patients. Though clinical and administrative support for RDCs is generally poor, RDCs are valuable to patients, a good use of time for clinicians, and offer educational opportunities for team members.

The Usefulness of the Regression-Based Normed SKT Short Cognitive Performance Test in Detecting Cognitive Impairment in a Community Sample.

Background: The SKT is a short cognitive performance test designed to assess impairments in memory and cognitive abilities such as attention and speed of information processing. In 2019, new regression-based norms for the English version of the SKT were calculated. This study has two aims: to establish valid cut-offs for distinguishing between no cognitive impairment, mild cognitive impairment (MCI), and dementia (1) and to cross-validate the new norms for detecting MCI and dementia in a community sample of older adults with clinical diagnoses (2). Methods: The validation sample included 143 older adults (mean age = 87.7, SD = 3.55) from the Sydney Memory and Aging Study (MAS Study). Participants were classified as having normal cognition, MCI, or dementia solely based on a consensus diagnosis; in addition, three tests (SKT, Mini-Mental State Examination (MMSE), and Addenbrooke's Cognitive Examination III (ACE-III)) to measure cognitive impairment were applied. Sensitivity and specificity for all three tests, as well as bivariate correlations, were calculated. Results: The sensitivity of the SKT for the differentiation of cognitive impairment (MCI or dementia) from normal cognition was 80.6%. The convergence between the SKT and the consensus diagnoses was 70.3% for all three diagnostic groups. All correlations between the three tests and the consensus diagnosis were significant (p < 0.01). Conclusions: In sum, it can be stated that the SKT is a valid tool for detecting early stages of cognitive impairment, performing very well in discriminating between no cognitive impairment and cognitive impairment (MCI or dementia).

Adjudication of Kidney Biopsy Histopathology to Establish Consensus Diagnosis of Tubulointerstitial Nephritis

Adjudication of Kidney Biopsy Histopathology to Establish Consensus Diagnosis of Tubulointerstitial Nephritis

The Clinical Utility of Large Language Models in Diagnosing Neurocognitive Disorders among NACC Participants

Abstract Objective Our study aimed to investigate ChatGPT’s ability to diagnose neurocognitive disorders in older adults based on neuropsychological interviews and test results and compare its accuracy with neuropsychologist consensus diagnosis. Methods We prompted ChatGPT-4 to provide provisional diagnoses (normal changes, mild cognitive impairment, or dementia) for each case. We also asked ChatGPT to diagnose the underlying etiology. We evaluated interrater reliability (IRR) with Cohen’s kappa and a chi-square test. Receiver operating characteristic (ROC) curves and area-under-the-curve (AUC) values were computed to explore measures predicting diagnostic agreement. Results Participants were 15,048 older adults (Mage = 69.13, 56.7% female) assessed in Alzheimer’s Disease Core Centers across the United States. For cognitive diagnoses, Cohen’s kappa demonstrated fair agreement (κ = 0.42; p &amp;lt; 0.001). The chi-square test [χ2 (6) = 7896.51, p &amp;lt; 0.001] revealed a significant and strong association (Cramer’s V = 0.51, p &amp;lt; 0.001) between ChatGPT and clinicians’ diagnoses. For the underlying etiology, Cohen’s kappa demonstrated fair agreement on specific diagnoses (κ = 0.38; p &amp;lt; 0.001). The chi-square test [χ2 (24) = 5353.04, p &amp;lt; 0.001] revealed a significant and strong association (Cramer’s V = 0.30, p &amp;lt; 0.001) between ChatGPT and clinicians’ diagnoses. ROC curves demonstrate that no variables predicted diagnostic agreement at above chance. Conclusion Our findings demonstrate the potential clinical utility of integrating LLMs into neuropsychology. While significant IRR was found between ChatGPT and the neuropsychologist diagnosis, further research is needed prior to the adoption of LLMs into clinical practice, given ongoing developments of artificial intelligence in the field of medicine.

A - 133 The Clinical Utility of Large Language Models in Diagnosing Neurocognitive Disorders among NACC Participants

Abstract Objective Our study aimed to investigate ChatGPT’s ability to diagnose neurocognitive disorders in older adults based on neuropsychological interviews and test results and compare its accuracy with neuropsychologist consensus diagnosis. Methods We prompted ChatGPT-4 to provide provisional diagnoses (normal changes, mild cognitive impairment, or dementia) for each case. We also asked ChatGPT to diagnose the underlying etiology. We evaluated interrater reliability (IRR) with Cohen’s kappa and a chi-square test. Receiver operating characteristic (ROC) curves and area-under-the-curve (AUC) values were computed to explore measures predicting diagnostic agreement. Results Participants were 15,048 older adults (Mage = 69.13, 56.7% female) assessed in Alzheimer’s Disease Core Centers across the United States. For cognitive diagnoses, Cohen’s kappa demonstrated fair agreement (κ = 0.42; p &amp;lt; 0.001). The chi-square test [χ2 (6) = 7896.51, p &amp;lt; 0.001] revealed a significant and strong association (Cramer’s V = 0.51, p &amp;lt; 0.001) between ChatGPT and clinicians’ diagnoses. For the underlying etiology, Cohen’s kappa demonstrated fair agreement on specific diagnoses (κ = 0.38; p &amp;lt; 0.001). The chi-square test [χ2 (24) = 5353.04, p &amp;lt; 0.001] revealed a significant and strong association (Cramer’s V = 0.30, p &amp;lt; 0.001) between ChatGPT and clinicians’ diagnoses. ROC curves demonstrate that no variables predicted diagnostic agreement at above chance. Conclusion Our findings demonstrate the potential clinical utility of integrating LLMs into neuropsychology. While significant IRR was found between ChatGPT and the neuropsychologist diagnosis, further research is needed prior to the adoption of LLMs into clinical practice, given ongoing developments of artificial intelligence in the field of medicine.

B - 142 Reason to Forget Use of (Most) Digit Span Validity Measures in Aging Clinical Samples

Abstract Objective The Digit Span (DS) subtest has survived every iteration of the Wechsler Adult Intelligence Scale (WAIS), and the reliable digit span (RDS forward+backward) is an established embedded performance validity test (PVT). The only known DS meta-analysis drew near equivalency between the WAIS-R and WAIS-III RDS and age-corrected scaled score (ACSS) validity cutoffs, recommending use of either. The WAIS-IV included a new DS sequencing subtest. Alternate and enhanced RDS measures, adding sequencing, were derived. However, aging samples often perseverate on sequencing. The aims of this study are to confirm and update the faulty use of the enhanced RDS in the aging, establish that use of the previously recommended DS ACSS cutoff (now including sequencing) is similarly faulty, and update all DS PVT cutoff specificities in a clinical aging sample. Method Memory Clinic data were taken from 350 individuals with neuropsychologist-neurologist consensus diagnoses including 111 individuals with early Alzheimer’s disease (ad), 181 with mild cognitive impairment (MCI; 99 amnestic; 82 non-amnestic) and 58 with subjective cognitive complaints (SCC). Results Most DS embedded PVTs (e.g., ACSS&amp;lt;6, Enhanced RDS &amp;lt; 11) present with poor specificity in aging clinical populations (e.g., Χ2 (3350) = 26.331,p = &amp;lt;0.001), while the traditional RDS (&amp;lt; 6) excludes sequencing and retains the best relative specificity (81–95%), as ad performs worst on sequencing (&amp;lt;0.001). Conclusions While prior research favored the DS ACSS in older individuals, this study provided support for the traditional RDS in a memory clinic population. Future directions include corroborating these findings using standalone PVTs and conducting an updated DS meta-analysis.

Low Intake of Total Antioxidant Nutrients as a Risk Factor for Incident Dementia in Older Adults: The Shanghai Aging Study

Introduction: Previous longitudinal studies reported the impact of antioxidant nutrients (ANs) on cognitive impairment in the older population, but the conclusions were inconsistent. This study aimed to verify the hypothesis that dietary intake of total AN was associated with incident dementia among older individuals. Methods: Community residents without dementia aged ≥60 years were prospectively followed up for an average of 5.2 years in the Shanghai Aging Study. At baseline, daily intakes of total dietary AN (the sum of carotene, vitamin C, vitamin E, lutein, and flavonoids) and energy were calculated based on an interviewer-administered food frequency questionnaire measuring the dietary intake over the past 1 year for each participant. A battery of neuropsychological tests was used to evaluate cognitive function, and a consensus diagnosis of dementia was made according to the DSM-IV criteria at baseline and follow-up. Results: Among 1,550 dementia-free participants, 135 (8.7%) incident dementia cases were identified during the average of 5.2 years of follow-up. Participants with low AN intake (<112 mg/day) had a significantly higher risk of incident dementia than those with high AN intake (≥112 mg/day) (hazard ratio 1.87, 95% confidence interval 1.26–2.77) after adjusting for age, gender, education, obesity, APOE-ε4, hypertension, diabetes, depression, baseline Mini-Mental State Examination score, and total energy intake. The significant association of total AN intake with incident dementia was only found in individuals ≥70 years. Conclusion: Low total AN intake may be a risk factor for incident dementia among older adults. Maintaining sufficient AN intake may be beneficial against age-related cognitive decline.

Weakly supervised deep learning image analysis can differentiate melanoma from naevi on haematoxylin and eosin-stained histopathology slides.

The broad histomorphological spectrum of melanocytic pathologies requires large data sets to develop accurate and generalisable deep learning (DL)-based diagnostic pathology classifiers. Weakly supervised DL promotes utilisation of larger training data sets compared to fully supervised (patch annotation) approaches. To evaluate weakly supervised DL image classifiers for discriminating melanomas from naevi on haematoxylin and eosin (H&E)-stained pathology slides. A representative H&E slide for 260 naevi and 260 melanomas from mucocutaneous sites at one tertiary institution was digitized. Clinicopathological features were recorded for each case including thickness and histological subtype. Whole-slide or whole-tissue section labels were applied. The ground truth was established by consensus diagnosis from two pathologists. Multiple-instance learning models, Trans-MIL, CLAM and DTFD-MIL were evaluated at 10×, 20× and 40× magnifications using stratified fivefold Monte Carlo cross-validation, with 80/10/10 splits for training/validation/test groups, to predict melanoma from naevus. Heatmaps were generated to understand model performance. Naevi cases were younger (median age: 51 years; melanoma median age: 71.5 years), with more balanced sex distribution (males: 48.8%, melanoma male subgroup: 64.2%). The most frequent histological subtypes of naevi and melanomas were dysplastic compound (n = 99, 38.1%) and superficial spreading (n = 124, 47.7%), respectively. Average AUC (±1 SD) for Trans-MIL, CLAM and DTFD-MIL across test groups were 0.9952 ± 0.006, 0.9925 ± 0.0052 and 0.9708 ± 0.0328, at 20× magnification, respectively. Performance of the models varied according to the magnification used. Heatmaps from the two best performing models, Trans-MIL and CLAM, generally indicated attention on appropriate tissue regions for interpretation. Weakly supervised DL on pathological slides of common mucocutaneous melanocytic tumours provides highly accurate diagnostic value for discrimination of melanomas and naevi. External validation and further assessment on less frequently occurring histologic subtypes and borderline cases using this method is required.

Resting-state EEG predicts cognitive decline in a neuropathologically diagnosed longitudinal community autopsied cohort

ObjectiveTo assess correlative strengths of quantitative electroencephalography (qEEG) and visual rating scale EEG features on cognitive outcomes in only autopsied cases from the Arizona Study of Neurodegenerative Disorders (AZSAND). We hypothesized that autopsy proven Parkinson Disease will show distinct EEG features from Alzheimer's Disease prior to dementia (mild cognitive impairment). BackgroundCognitive decline is debilitating across neurodegenerative diseases. Resting-state EEG analysis, including spectral power across frequency bins (qEEG), has shown significant associations with neurodegenerative disease classification and cognitive status, with autopsy confirmed diagnosis relatively lacking. MethodsBiannual EEG was analyzed from autopsied cases in AZSAND who had at least one rsEEG (>1 min eyes closed±eyes open). Analysis included global relative spectral power and a previously described visual rating scale (VRS). Linear mixed regression was performed for neuropsychological assessment and testing within 2 years of death (n = 236, 594 EEG exams) in a mixed linear regression model. ResultsThe cohort included cases with final clinicopathologic diagnoses of Parkinson's disease (n = 73), Alzheimer disease (n = 65), and tauopathy not otherwise specified (n = 56). A VRS score of 3 diffuse or frequent generalized slowing) over the study duration was associated with an increase in consensus diagnosis cognitive worsening at 4.9 (3.1) years (HR 2.02, CI 1.05–3.87). Increases in global theta power% and VRS were the most consistently associated with large regression coefficients inversely with cognitive performance measures. ConclusionResting-state EEG analysis was meaningfully related to cognitive performance measures in a community-based autopsy cohort. EEG deserves further study and use as a cognitive biomarker.

Drug burden index of people ageing with intellectual disability and cognitive complaints attending a specialist memory service.

Medications with sedative or anticholinergic properties should be prescribed with caution in those with cognitive complaints. This is particularly relevant in people ageing with an intellectual disability (ID). Higher drug burden index (DBI) scores are associated with increased frailty and falls and reduced quality of life in older people and increased risk of adverse effects (daytime somnolence, constipation) in those with ID. While previous studies have shown that the ID population has higher rates of drug burden and a higher propensity to be prescribed an antipsychotic than the general population, the degree of burden has not been assessed specifically in those with ID and cognitive complaints. We assessed drug burden in a cohort of sequential referrals to a national memory service for people with ID. All patients were referred for assessment of cognitive complaints (self-reported or caregiver-reported problems with memory or cognition). DBI was calculated individually for each participant, and the impact of aetiology of ID, level of ID, age, psychiatric/neurological comorbidities and diagnostic outcome on DBI scores was assessed. The study population was 58.6% female with a median age of 55years and aetiology of ID was Down syndrome (DS) in 71.3%. Consensus diagnosis was Alzheimer's dementia in 40.2%, mild cognitive impairment in 29.9% and cognitively unimpaired from baseline in 25.3%. Medication use was high with 95.4% taking medications, with a median number of medications of 4 (interquartile range 4) and a rate of polypharmacy (≥5 medications) of 51.7%. Overall, 65.5% were exposed to sedative or anticholinergic medications with 39.1% exposed to a clinically significant DBI score >1. Those with psychiatric comorbidities, non-DS aetiology or epilepsy were significantly more likely to have a DBI score >1. People with ID and incipient cognitive complaints have a high level of drug burden, which concerningly exceeds that of the general population.

GLIM criteria validation and reliability in critically ill patients with cancer: A prospective study.

The present study aims to assess the interrater reliability of the Global Leadership Initiative on Malnutrition (GLIM) criteria, a framework to provide a consensus diagnosis of malnutrition. We also aimed to investigate its concurrent and predictive validity in the context of patients with cancer admitted to the intensive care unit (ICU). Individuals aged ≥19 years with cancer who were admitted to the ICU within 48 h of their initial hospital admission were included. Nutrition status was assessed with the Nutritional Risk Screening 2002, the Subjective Global Assessment (SGA), and the GLIM criteria. Interrater reliability was assessed by the kappa test (>0.80). The SGA served as the established benchmark for assessing concurrent validity. To evaluate predictive validity, the occurrence of mortality within 30 days was the outcome, and Cox regression models were applied. A total of 212 patients were included: 66.9% were at nutrition risk, and 45.8% were malnourished according to the SGA. According to the GLIM criteria, 68.4% and 66% were identified as malnourished by evaluators 1 and 2, respectively (κ = 0.947; P < 0.001). The GLIM combination incorporating weight loss and the presence of inflammation exhibited sensitivity (82.4%) and specificity (92%). In the multivariate Cox regression models, most GLIM combinations emerged as independent predictors of complications. The GLIM criteria demonstrated satisfactory interrater reliability, and the combination involving weight loss and the presence of inflammation exhibited noteworthy sensitivity and specificity. Most GLIM combinations emerged as independent predictors of 30-day mortality.

Hand motor dysfunction is associated with both subjective and objective cognitive impairment across the dementia continuum.

Motor dysfunction is an important feature of early-stage dementia. Gait provides a non-invasive biomarker across the dementia continuum. Gait speed and rhythm aid risk stratification of incident dementia in subjective cognitive impairment (SCI) and associate with cognitive domains in mild cognitive impairment (MCI) and dementia. However, hand movement analysis, which may be more accessible, has never been undertaken in SCI, and rarely in MCI or dementia. We aimed to address this gap and improve understanding of hand motor-cognitive associations across the dementia continuum. 208 participants were recruited: 50 with dementia, 58 MCI, 40 SCI and 60 healthy controls. Consensus diagnoses were made after comprehensive gold-standard assessments. A computer key-tapping test measured frequency, dwell-time, rhythm, errors and speed. Associations between key-tapping and cognitive domains and diagnoses were analysed using regression. Classification accuracy was measured using Area under Receiver-Operating-Characteristic curves. Hand frequency and speed were associated with memory and executive domains (P≤.001). Nondominant hand rhythm was associated with all cognitive domains. Frequency, rhythm and speed were associated with SCI, MCI and dementia. Frequency and speed classified ≥94% of dementia, and ≥88% of MCI, from controls. Rhythm of nondominant hand classified ≥86% of dementia and MCI and 69% of SCI. Our findings show hand motor dysfunction occurs across the dementia continuum and, similar to gait, associates with executive and memory domains, and with cognitive diagnoses. Key-tapping performance differentiated dementia and MCI from healthy controls. More research is required before recommending key-tapping as a non-invasive motor biomarker of cognitive impairment.

Artificial Intelligence-Based Histopathological Subtyping of High-Grade Serous Ovarian Cancer

Four subtypes of ovarian high-grade serous carcinoma (HGSC) have previously been identified, each with different prognoses and drug sensitivities. However, the accuracy of the classification depended on the assessor’s experience. This study aimed to develop a universal algorithm for HGSC-subtype classification using deep learning techniques. An artificial intelligence (AI)-based classification algorithm, which replicates the consensus diagnosis of pathologists, was formulated to analyze the morphological patterns and tumor-infiltrating lymphocyte counts for each tile extracted from whole slide images of ovarian HGSC available in The Cancer Genome Atlas (TCGA) dataset. The accuracy of the algorithm was determined using the validation set from the Japanese Gynecologic Oncology Group 3022A1 (JGOG3022A1) and Kindai and Kyoto University (Kindai/Kyoto) cohorts. The algorithm classified the four HGSC-subtypes with mean accuracies of 0.933, 0.910, and 0.862 for the TCGA, JGOG3022A1, and Kindai/Kyoto cohorts, respectively. To compare Mesenchymal Transition (MT) with non-MT groups, overall survival analysis was performed in the TCGA dataset. The AI-based prediction of HGSC-subtype classification in TCGA cases showed that the MT group had a worse prognosis than the non-MT group (p = 0.017). Furthermore, Cox proportional hazard regression analysis identified AI-based MT subtype classification prediction as a contributing factor along with residual disease after surgery, stage, and age. In conclusion, a robust AI-based HGSC-subtype classification algorithm was established using virtual slides of ovarian HGSC.

Consensus definition and diagnostic criteria for neonatal encephalopathy-study protocol for a real-time modified delphi study.

'Neonatal encephalopathy' (NE) describes a group of conditions in term infants presenting in the earliest days after birth with disturbed neurological function of cerebral origin. NE is aetiologically heterogenous; one cause is peripartum hypoxic ischaemia. Lack of uniformity in the terminology used to describe NE and its diagnostic criteria creates difficulty in the design and interpretation of research and complicates communication with families. The DEFINE study aims to use a modifiedDelphi approach to form a consensus definition for NE, and diagnostic criteria. Directed by an international steering group, we will conduct a systematic review of the literature to assess the terminology used in trials of NE, and with their guidance perform an online Real-time Delphi survey to develop a consensus diagnosis and criteria for NE. A consensus meeting will be held to agree on the final terminology and criteria, and the outcome disseminated widely. A clear and consistent consensus-based definition of NE and criteria for its diagnosis, achieved by use of a modifiedDelphi technique, will enable more comparability of research results and improved communication among professionals and with families. The terms Neonatal Encephalopathy and Hypoxic Ischaemic Encephalopathy tend to be used interchangeably in the literature to describe a term newborn with signs of encephalopathy at birth. This creates difficulty in communication with families and carers, and between medical professionals and researchers, as well as creating difficulty with performance of research. The DEFINE project will use a Real-time Delphi approach to create a consensus definition for the term 'Neonatal Encephalopathy'. A definition formed by this consensus approach will be accepted and utilised by the neonatal community to improve research, outcomes, and parental experience.

The Expression of PRAME as an Aid for Diagnosis and Evaluation of Histologic Margins of Intraepidermal Cutaneous Melanoma in Xeroderma Pigmentosum Patients.

Xeroderma Pigmentosum (XP) is a genetic disorder characterized by photosensitivity, dyschromia, and high risk of skin cancer. From a clinical and histologic view, it can be difficult to diagnose cutaneous melanoma (CM) in XP patients and to define its resection margins. We aimed to study the role of PRAME (PReferentially Expressed Antigen in MElanoma) in differentiating intraepidermal CM from superficial atypical melanocytic proliferation of uncertain significance (SAMPUS) and evaluating the histological margins of CMs. We included XP patients. melanocitic and nonmelanocytic lesions with adjacent skin, and, as control groups, sun-damaged skin from non-XP individuals. Melanocytic lesions with a consensus diagnosis were grouped into CM, SAMPUS, or benign. The selected samples were PRAME-immunoshistochemically stained, and the ratio between immuno-positive cells/mm was recorded, according to Olds and colleagues for intraepidermal lesions. Lezcano and colleagues' method was used for intradermal lesions. Clinical data from XP patients were reviewed. All 9 patients were alive and well at the study closure, even those who developed melanoma metastases. Positive/diffuse PRAME expression was found in 29% (7/24) of intraepidermal CMs and 20% (1/5) SAMPUS samples. All 103 XP control samples and 24 adjacent lesions skin of non-XP patients were PRAME negative. This was a single-center and retrospective study, using a relatively small sample, limiting our conclusions. In XP patients' lesions, PRAME expression could help in the setting of challenging melanocytic tumors and surgical margins evaluation. It is also possible that the method can avoid overdiagnosis and, consequently, more aggressive treatment recommendation in unequivocal CM cases.

Strength together: examining risk and protective factors associated with dementia and cognitive impairment in Aboriginal and Torres Strait Islander peoples through harmonisation of landmark studies

BackgroundRates of dementia for Aboriginal and Torres Strait Islander peoples are three to five times greater compared to non-Indigenous Australians, with earlier age of onset. However, the risk and protective factors that drive these higher rates vary across existing cohort studies, with minimal findings on the role of vascular risk factors beyond stroke. Harmonisation of data across studies may offer greater insights through enhanced diversity and strengthened statistical capabilities. This study aims to combine three landmark cohort studies of Aboriginal and Torres Strait Islander participants to better understand the determinants of cognitive health and dementia.Methods/designThree cohort studies - the Kimberley Healthy Adults Project (KHAP, N = 363), Koori Growing Old Well Study (KGOWS, N = 336) and Torres Strait Dementia Prevalence Study (TSDPS, N = 274) - share a similar research methodology with demographic, medical history, psychosocial factors, cognitive tests and consensus clinical diagnoses of cognitive impairment and dementia. Associations between risk and protective factors of interest and the presence of dementia and/or cognitive impairment diagnoses will be evaluated by univariable and multivariable logistic regression in a harmonised cross-sectional cohort of 898 participants. Factors associated with incident dementia and/or cognitive impairment will be assessed in a subset of KHAP (n = 189) and KGOWS participants (n = 165) who were available in longitudinal follow-up, after exclusion of those with baseline dementia or cognitive impairment. Analyses in relation to outcome measure of death or dementia will be conducted to account for the competing risk of death. Logistic regression will be used to evaluate the association between the individual components of the 16-component Kimberley Indigenous Cognitive Assessment (KICA) tool and the presence of dementia and cognitive impairment determined by independent consensus diagnoses. Multivariable binary logistic regression will be used to adjust for the effect of confounding variables. Results will be reported as odds ratios (OR) with 95% confidence intervals (95% CI).DiscussionGreater understanding of risk and protective factors of dementia and cognitive impairment relevant to Aboriginal and Torres Strait Islander peoples may improve approaches across the life course to delay cognitive decline and reduce dementia risk.

Diagnosis of methamphetamine-induced psychotic disorder: Findings of an expert consensus panel.

We define criteria for methamphetamine-induced psychotic disorder (MIPD) to aid in accurate and reliable diagnosis. An expert panel was recruited and engaged in an iterative consensus process. A literature search supported this work. The a priori level for consensus was considered ≥80% of voting panellists. The final expert panel included 22 physicians from different backgrounds and practice environments. The panel produced two consensus diagnoses: (1) acute MIPD and (2) persisting MIPD, which is further separated into subacute and chronic timeframes. Although certain characteristics differentiate methamphetamine-induced psychosis shortly after use, identification of persisting MIPD depends largely on a history of symptom onset. All respondents voted in the final round, and both criteria were fully endorsed by 91% (20/22) of respondents. Panellists further recommended next steps in validation and research on this topic. These diagnostic criteria aid clinicians in differentiating methamphetamine-induced psychotic symptoms from psychosis because of other psychiatric disorders and can guide future studies. Future research might examine these criteria's prognostic significance, interrater reliability and acceptability including among persons in recovery. This work is a necessary and vital step in advancing the science of methamphetamine addiction treatment.

제1기 자치경찰위원회 운영 평가 및 법제도적 개선방향에 대한 小考

On January 1, 2021, the autonomous police system was implemented in Korea, and local autonomy was implemented in the field of security following general administration and education administration. In terms of decentralization, it was expected that the essential purpose of local autonomy would be realized by providing customized policing services based on the characteristics of the region and the will of the residents, and the democracy, decentralization and resident orientation of police activities would be strengthened. In the second half of 2020, the unified autonomous police model bill was completely revised and enacted through a sudden policy change in the dualized autonomous police model, which was previously discussed, and the institutional basis was established with the leading role of the National Police Agency in the situation of lack of preparation period. In the meantime, the term of the first autonomous police commissioners, who have played a pivotal role in the settlement and development of the autonomous police system, has expired and is now preparing for the formation of a new second autonomous police committee. At this point, it is expected that it will provide implications for the stable development of the autonomous police system as well as the preparation of the second autonomous police committee to clarify the current status of the autonomous police system and legal and institutional problems and to present concrete suggestions for future improvement directions. In organizing this paper, I basically referred to various literature materials such as publication data, research papers and media reports of the National Police Agency and the municipal autonomous police committee. In order to grasp the reality of the operation of the system and to find out the effective improvement direction of the legal system, I also listened to the vivid opinions and suggestions for improvement through direct interviews with some autonomous police committee members and police related NGOs such as autonomous crime prevention groups. Since the implementation of the autonomous police system, mutual cooperation between the city and provincial offices and the city and provincial police agencies has worked closely in the autonomous police affairs by securing the linkage between local administration and security administration centered on the autonomous police committees in cities and provinces across the country. Various policing policies have been established and implemented to reflect the will and participation of residents in the police administration and to provide policing services suitable for local specificity. The responsibility of the heads of local governments for local security has been increased by cities and provinces across the country, and the budget for projects needed to carry out local police affairs has also been increased. However, despite many developments and achievements, there has been a constant need to supplement the essential limitations of the current autonomous police system, low awareness of the autonomous police, and the promotion of mutual cooperation with the autonomous police committee and the national police. More in-depth discussions are needed in that the introduction of the dualization model of the autonomous police and the financial burden of the state are related to the maintenance of security at the national level and the allocation of the national budget. It is hoped that the police system development committee under the Prime Minister's Office will make systematic and careful decisions based on national consensus and careful financial analysis and diagnosis so that the total amount of national security will not be damaged in the rapidly changing domestic and overseas security environment.

Validation of the PediBIRN-7 clinical prediction rule for pediatric abusive head trauma

BackgroundThe PediBIRN-7 clinical prediction rule incorporates the (positive or negative) predictive contributions of completed abuse evaluations to estimate abusive head trauma (AHT) probability after abuse evaluation. Applying definitional criteria as proxies for AHT and non-AHT ground truth, it performed with sensitivity 0.73 (95 % CI: 0.66–0.79), specificity 0.87 (95 % CI: 0.82–0.90), and ROC-AUC 0.88 (95 % CI: 0.85–0.92) in its derivation study. ObjectiveTo validate the PediBIRN-7's AHT prediction performance in a novel, equivalent, patient population. Participants and settingsConsecutive, acutely head-injured children <3 years hospitalized for intensive care across eight sites between 2017 and 2020 with completed skeletal surveys and retinal exams (N = 342). MethodsSecondary analysis of an existing, cross-sectional, prospective dataset, including assignment of patient-specific estimates of AHT probability, calculation of AHT prediction performance measures (ROC-AUC, sensitivity, specificity, predictive values), and completion of sensitivity analyses to estimate best- and worst-case prediction performances. ResultsApplying the same definitional criteria, the PediBIRN-7 performed with sensitivity 0.74 (95 % CI: 0.66–0.81), specificity 0.77 (95 % CI: 0.70–0.83), and ROC-AUC 0.83 (95 % CI: 0.78–0.88). The reduction in ROC-AUC was statistically insignificant (p = .07). Applying physicians' final consensus diagnoses as proxies for AHT and non-AHT ground truth, the PediBIRN-7 performed with sensitivity 0.73 (95 % CI: 0.66–0.79), specificity 0.87 (95 % CI: 0.82–0.90), and ROC-AUC 0.90 (95 % CI: 0.87–0.94). Sensitivity analyses demonstrated minimal changes in rule performance. ConclusionThe PediBIRN-7's overall AHT prediction performance has been validated in a novel, equivalent, patient population. Its patient-specific estimates of AHT probability can inform physicians' AHT-related diagnostic reasoning after abuse evaluation.