Individual Scores Research Articles

Development of deep learning-based mobile application for the identification of Coccidia species in pigs using microscopic images.

Coccidiosis is a gastrointestinal parasitic disease caused by different species of Eimeria and Isospora, poses a significant threat to pig farming, leading to substantial economic losses attributed to reduced growth rates, poor feed conversion, increased mortality rates, and the expense of treatment. Traditional methods for identifying Coccidia species in pigs rely on fecal examination and microscopic analysis, necessitating expert personnel for accurate species identification. To address this need, a deep learning-based mobile application capable of automatically identifying different species of Eimeria and Isospora was developed. The present study focused on six species, namely, E. debliecki, E. perminuta, E. porci, E. spinosa, E. suis, and Isospora suis, commonly found in pigs of the North Eastern Hill (NEH) region of India. Utilizing a two-stage approach, segmentation of coccidia oocysts in microscopic images using convolutional neural networks (CNNs), followed by species identification by same network was carried out in this work. Resource-efficient models, including EfficientNetB0, EfficientNetB1, MobileNet, and MobileNetV2, within an encoder-decoder architecture were utilized to extract features. Transfer learning was applied to enhance model accuracy during training. Additionally, a marker-controlled watershed algorithm was implemented to separate touching cells, thus reducing misclassification. The results demonstrate that all the developed models effectively segmented/classified Coccidia species, achieving mean Intersection-over-Union (m-IoU) values exceeding 0.92, with individual class IoU scores above 0.90. MobileNetV2 exhibited the highest m-IoU of 0.95, followed by EfficientNetB1 with an m-IoU of 0.94. For classification, MobileNetV2 demonstrated the highest performance, with accuracy, precision, and recall values of 0.93, 0.96, and 0.96, respectively. EfficientNetB1 yielded an accuracy of 0.91. The developed mobile application, tested on new data, achieved an identification accuracy of 91.0 %. These findings highlight the potential of deep learning-based mobile applications in effectively identifying Coccidia species in pigs, thus, providing a promising solution to mitigate reliance on expert personnel and laborious time-consuming experiments in this domain.

Abstract TP138: Life's Essential 8 Among Stroke Survivors

Background: The AHA uses “Life’s Essential 8 (LE8)” to quantify cardiovascular health (CVH). These metrics assess eight essential components of nicotine exposure, sleep duration, physical activity, diet, body mass index, lipid levels, blood glucose, and blood pressure to calculate a CVH score. However, little is known about LE8 scores in patients with history of stroke compared to the general population. Methods: Data was included on individuals aged 18 and older who participated in the National Health and Nutrition Examination Surveys (NHANES) from 2005 to 2018. A LE8 score ranging from 0 (lowest) to 100 (highest) was calculated for all participants. Subscores of 0 to 100 points were also calculated for each of the metrics. The total LE and individual metric scores of participants with a self-reported history of stroke were compared to those who did not. The characteristics of all participants were stratified across age, gender, race/ethnicity, poverty/income ratio (PIR), education level, insurance status, alcohol consumption, high cholesterol, high high density lipoprotein, and histories of hypertension, diabetes, and/or myocardial infarction. Results: 1,019 participants self-reported a history of stroke of 27,670 total participants. When adjusted for age, sex, race/ethnicity, education and PIR, the mean LE8 score was significantly lower in those who reported a history of stroke at (59.2, 95% CI, 57.8-60.5) compared to those who did not (63.8, 95% CI, 63.4-64.2) in those who did not. Stroke survivors had significantly lower mean subscores in 6 of 8 metrics on nicotine exposure (range 66.2-71.5), blood glucose (range 70.8-74.7), physical activity (range 30.8-36.9), diet (range 35.3-40.1), sleep duration (range 73.3-77.7), and blood pressure (range 58-62.4) compared to other participants (p<.001). Conversely, stroke survivors had higher mean lipid subscore (range 66.8-71.6) compared to other participants (range 63.0-64.3). In contrast to general participants who showed improvements over time in smoking, lipid levels, and sleep subscores, stroke survivors did not exhibit significant changes over time in any of these scores. Conclusions: Stroke survivors have inferior overall cardiovascular health and lower total LE8 scores compared to the general population. More intensive and tailored secondary stroke interventions are necessary to ensure improvement in overall cardiovascular health among stroke survivors.

P-1429. Racial Disparities in Childhood Vaccination Rates and Their Association with State-Level Structural Racism

Abstract Background Racial disparities in childhood vaccination rates are well-documented nationally. These disparities may vary across states due to multiple reasons, including vaccine exemptions. A structural racism score is a measure developed to quantify systemic racial disparities across various domains, including segregation, economic status, and incarceration. Notably, structural racism is more pronounced in Northeastern and Midwestern states of the United States. Leveraging recently published Black structural racism scores at the state level, we examined the relationship between structural racism and childhood vaccination rates among non-Hispanic Black and non-Hispanic White children. Methods We analyzed 5-year aggregate vaccination rates (2017-2022) for children aged 19-35 months using data from the US Centers for Disease Control and Prevention National Immunization Survey-Child (NIS-Child). The main outcome was the difference in percentage points between non-Hispanic Black and non-Hispanic White childhood vaccination rates for each state. The childhood vaccination rate was defined by whether children received all recommended vaccines (4+ DTaP/DTP/DT; 3+ polio; 1+ measles-containing vaccine; full series Hib; 3+ Hep B; 1+ varicella at or after 12 months of age; and 4+ PCV). Eleven states were excluded from analysis due to fewer than 30 non-Hispanic Black respondents. We investigated the relationship between state-level structural racism scores for non-Hispanic Black individuals and calculated vaccination rate differences by linear regression analyses. Additionally, we examined the relationship in states that allowed religious exemptions for childhood vaccinations. Results At the state level, higher structural racism scores were associated with greater disparities in childhood vaccination rates between non-Hispanic Black and non-Hispanic White children (Figure 1). Importantly, these associations were significant only in states that allowed religious exemptions for childhood vaccinations (Figure 2, p = 0.046). Conclusion When childhood vaccination exemptions are permitted, state-level structural racism may significantly contribute to the observed racial disparities in vaccination rates among non-Hispanic Black children. Disclosures All Authors: No reported disclosures

Dopamine genetic risk scores and psychiatric symptoms: Interacting risk factors for impulse control behaviours in de novo Parkinson's disease.

Up to 45% of patients with Parkinson's disease (PD) experience impulse control disorders (ICDs), characterized by a loss of voluntary control over impulses, drives or temptations. This study aimed to investigate whether previously identified genetic and psychiatric risk factors interact towards the development of ICDs in PD. A total of 278 de novo PD patients (ICD-free at enrollment) were selected from the Parkinson's Progression Markers Initiative database. ICD presence at baseline and yearly follow-up assessments were evaluated via the Questionnaire for Impulsive-Compulsive Disorders. Symptoms of anxiety and depression at baseline were measured via the State-Trait-Anxiety Inventory and Geriatric Depression Scale, respectively. Furthermore, an individual dopamine genetic risk score was calculated according to polymorphisms in genes coding for dopamine (D1, D2 and D3 receptors and catechol-O-methyltransferase), with higher scores reflecting higher central dopamine neurotransmission. In total, 146 participants (47.5%) developed an ICD with an average onset time of 36 months (range 3-96) from baseline. Results from a Cox proportional hazards model showed a trait anxiety × genetics interaction, suggesting that individuals with both higher baseline trait anxiety scores and higher dopamine genetic risk scores were at increased risk of ICD development. This interaction remained significant after controlling for age, sex and motor symptom severity. Our findings suggest that genetic and psychiatric predictors of impulsivity in PD interact and jointly yield increased ICD risk during the course of the disorder. This implies that early screening of anxiety symptoms in combination with genotyping can be useful to identify those at risk for ICD.

Impact of frailty and comorbidity on initial response to lung cancer screening invitation and low-dose CT screening uptake: Findings from the Yorkshire Lung Screening Trial.

Low-dose computed tomography screening reduces lung cancer-specific mortality in high-risk individuals. Lung cancer risk factors overlap with comorbid diseases, highlighting the significance of frailty and comorbidities for lung cancer screening (LCS). Here, we describe the prevalence of frailty and comorbidity in those invited for LCS and evaluate their associations with response to telephone risk assessment invitation and subsequent uptake of LCS. Analysis was based on the intervention arm of the Yorkshire Lung Screening Trial, where ever-smoked individuals aged 55-80 were invited to telephone risk assessment followed by community-based LCS if at higher risk. The electronic frailty index (eFI) was used to compute individual frailty scores (categorised as fit, mild, moderate and severe) and derive comorbidity data. Of 27,761 individuals invited, 24.1% (n = 6702), 8.5% (n = 2353) and 1.7% (n = 459) had mild, moderate and severe frailty, respectively. Over half responded to the invitation to telephone risk assessment (n = 14,523, 52.5%) with frailty associated with a higher response rate compared to fit individuals: adjusted odds ratio (ORadj) 1.34, 95% confidence interval (CI) 1.26-1.42 for mild frailty; ORadj 1.28, 95%CI 1.16-1.40 for moderate frailty; and ORadj 1.32, 95%CI 1.08-1.61 for severe frailty. Similar patterns were seen with comorbidity counts. After assessment, moderate (ORadj 0.75, 95%CI 0.59-0.96) and severe (ORadj 0.67, 95%CI 0.43-1.04) frailty were associated with reduced screening uptake. The presence of frailty was associated with increased response to LCS invitation. Given the strong association between frailty and reduced life expectancy, these results suggest that people with potentially more life years to be gained from LCS may be less inclined to take part. Further research is needed to explore the interactions between frailty and LCS decision-making to inform future invitation strategies.

Assessment of the association between coronary artery blockage and periodontal health status in patients undergoing coronary angiography: a cross-sectional study.

Growing evidence suggests a potential link between periodontal disease and the development of atherosclerosis, positioning periodontal disease as a possible risk factor for cardiovascular diseases (CVD). This study aimed to evaluate periodontal status in patients with coronary artery disease (CAD) by measuring the Periodontal Inflamed Surface Area (PISA) score in individuals undergoing coronary angiography. In this cross-sectional study, 300 patients scheduled for coronary angiography at K.S. Hegde Medical Hospital, Mangalore, India, were recruited. Comprehensive medical and dental histories were obtained prior to the procedure. The PISA score was calculated using standardized periodontal measurements. Patients were categorized into three groups based on angiographic findings: no coronary artery blockage, blockage in one or more vessels with <50% stenosis, and blockage in one or more vessels with ≥50% stenosis. Additional subgroup analyses were conducted for single-, double-, and triple-vessel disease. A p-value of <0.05 was considered statistically significant. A significant increase in PISA scores was observed in patients with ≥50% coronary artery stenosis compared to those with <50% stenosis and no stenosis. However, the extent of vessel obstruction appeared independent of the degree of periodontal destruction. This study suggests that periodontal disease may act as a pro-atherogenic factor in the context of CAD, potentially contributing to the progression of atherosclerosis rather than being a direct causative agent. These findings underscore the importance of considering oral health in cardiovascular risk assessment and management for patients with coronary artery disease.

Cardiovascular autonomic neuropathy is associated with SLEDAI in patients with systemic lupus erythematosus.

As a prevalent and severe complication of systemic lupus erythematosus (SLE), cardiovascular autonomic neuropathy (CAN) has garnered increasing attention. Reports suggested that CAN may be related to the disease activity of SLE. This study aims to explore whether Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) is associated with CAN and to evaluate its diagnostic value for CAN. Altogether, 144 patients with SLE from the Rheumatology Department of Nanjing Drum Tower Hospital were included. Each patient underwent assessment with the SLEDAI and cardiovascular reflex tests (CARTs). Patients were classified into three groups: non-CAN, early-CAN and diagnosed-CAN based on the CARTs results. The relationship of CARTs and SLEDAI were analyzed using SPSS 26.0. After being divided into three groups, there were significant differences in SLEDAI among them. With increasing SLEDAI score (P < 0.05), both CARTs scores and four individual parameters score increased significantly, both before and after adjusting for influencing factors (P < 0.05). Besides, in Logistic regression analysis, it identified that SLEDAI as an independent risk factor for CAN (OR = 1.227, 95%CI = 1.143-1.316, P < 0.001). Finally, after accounting for the influence of glucocorticoids, a significant positive correlation between CARTs and SLEDAI remained (P < 0.05). As the gold standard in the diagnosing CAN, CARTs and four parameters are significantly correlated with SLEDAI. Furthermore, SLEDAI is also an independent risk factors for its development. In conclusion, this research demonstrated that SLEDAI is a dependable indicator for the onset and progression of CAN. Key Points • This study is the first to demonstrate a strong association between SLEDAI and cardiovascular autonomic neuropathy, identifying SLEDAI as a risk factor for CAN in SLE patients. • This study offers a convenient and rapid method for the clinical evaluation of CAN in SLE patients, providing significant value in assessing cardiovascular complications.

Specific symptomatology profile associated with treatment resistant depression: A multicentric study from the Group for the Study of Resistant Depression with a focus on sex.

Clinical predictors of treatment-resistant depression could improve treatment strategies. Depressive symptom profiles at baseline are potential outcome predictors, but little evidence is available, and sex-specific profiles have been scarcely investigated. Baseline symptom scores of 1294 patients with major depressive disorder were assessed by the Montgomery-Åsberg depression rating scale (MADRS) as part of a multicenter study by the "Group for the Studies of Resistant Depression". Treatment outcomes were assessed according to the MADRS after ≥4 weeks of naturalistic treatment. We tested if individual MADRS item scores at baseline were associated with treatment outcome in the whole sample and in sex-stratified subgroups. A specific baseline symptom profile was associated with non-response in the whole sample. In particular, apparent and reported sadness, reduced sleep, lassitude, inability to feel, and pessimistic thoughts were the only MADRS items that scored higher at baseline in patients with subsequent lack of response. In the sex-stratified analysis, females showed a similar profile overall, however they showed higher baseline levels of inner tension, inability to feel, and pessimistic thoughts compared to males, and these symptoms were associated with lack of response in females but not in males. Neurovegetative symptoms were poorly predictive. Overall baseline severity related to poor response. This is a post-hoc analysis. The naturalistic design of the study with a retrospective assessment is potential limitations. A specific baseline symptom profile characterized by higher sadness, reduced sleep and anhedonic features may be indicative of poor treatment outcome. Females showed a distinctive baseline profile associated with poor response.

Clinical Impact of Neoadjuvant Therapy for Resectable Pancreatic Ductal Adenocarcinoma: A Single-Center Retrospective Study.

Neoadjuvant therapy is recommended for treating resectable pancreatic ductal adenocarcinoma (PDAC); however, its appropriate use in patients with resectable PDAC remains debatable. This study aimed to identify independent poor prognostic factors and evaluate the clinical significance of neoadjuvant therapy in patients with resectable PDAC. We retrospectively reviewed consecutive patients diagnosed with resectable PDAC at our institute between January 2003 and December 2022. We analyzed poor prognostic factors at the time of diagnosis in patients who underwent upfront surgery using the Cox proportional hazards model for overall survival (OS). The prognostic score was calculated by adding the individual prognostic factor scores. Overall, 359 patients were included in this study, with 308 patients undergoing upfront surgery and the remaining 51 patients receiving neoadjuvant therapy. The R0 resection rate was significantly higher in the neoadjuvant therapy group (70.6%) than in the upfront surgery group (64.0%). Multivariate analysis in the upfront surgery group revealed the following independent poor prognostic factors: tumor size ≥35mm, serum albumin level ≤.5g/dL, neutrophil-to-lymphocyte ratio ≥3.5, carbohydrate antigen 19-9 level ≥250U/mL, and Duke pancreatic monoclonal antigen type 2 level ≥750U/mL. Among patients with prognostic scores of 0-1 (n=263), the intention-to-treat OS did not significantly differ between the neoadjuvant therapy and upfront surgery groups. Among those patients with a prognostic score of ≥2 (n=96), the neoadjuvant therapy group had significantly longer intention-to-treat OS than the upfront surgery group. Prognostic score-based stratification can help identify patients who could benefit from neoadjuvant therapy.

P0648 The Safety and Effects of a Dual-Strain Probiotic Versus Placebo on Fatigue in Patients with Ulcerative Colitis

Abstract Background Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) characterised by chronic mucosal inflammation of the colon. Patients with IBD may have higher fatigue scores compared to non-IBD controls [1] with up to 41% reporting fatigue as a debilitating symptom [2]. Previous clinical trials have demonstrated anti-inflammatory properties of Bifidobacterium longum 35624® in people with UC [3], and increased energy/vitality with Bifidobacterium longum 1714® in a healthy population [4]. However, studies of this dual combination of strains have not been conducted in people with IBD. Methods This single-centre, randomised, double-blind, placebo-controlled trial investigated the safety, tolerance and effect on fatigue of 12-weeks’ intervention with a dual-strain probiotic containing B. longum strains 35624 and 1714 (probiotic) versus an identical placebo. Fatigue (IBD Fatigue Self-Assessment Scale Section II; IBD-F-II), fecal calprotectin and plasma C-reactive protein (CRP) values were measured at baseline and 12 weeks. Safety and tolerance were measured with by monitoring of adverse events throughout the study period. Results 59 participants completed the study (probiotic n=30; placebo n=29)(Table 1). There was a statistically significant reduction in IBD-F-II scores at 12 weeks compared to baseline in both the probiotic (p=0.0003) and placebo (p&amp;lt;0.0001) groups, with no significant difference between groups (p=0.398)(Table 2). There were no significant changes in calprotectin or CRP from baseline to week 12 in the probiotic (p=0.80 and p=0.27) or placebo (p=0.76 and p=0.47) groups. No adverse events were thought to be related to the intervention. Conclusion The findings of this study showed statistically significant improvements in fatigue scores in individuals with UC following 12 weeks of probiotic and placebo intervention respectively, which may be suggestive of a high placebo response in the UC population. Contrary to previous clinical findings showing improvements to plasma CRP with B. longum 35624 in people with UC [3], significant changes in inflammatory markers were not observed in the present study. This study also provides evidence to show that a combination of B. longum 35624 and 1714 was safe and well-tolerated by UC patients. Additional analysis investigating the effect of the probiotic intervention on the gut microbiome is warranted. Further studies conducted in a larger sample are required to better understand the placebo response in the UC population.

Dual Biological Role and Clinical Impact of De Novo Chromatin Activation in Chronic Lymphocytic Leukemia.

Previous studies have reported that chronic lymphocytic leukemia (CLL) shows a de novo chromatin activation pattern as compared to normal B cells. Here, we explored whether the level of chromatin activation is related to the clinical behavior of CLL. We identified that in some regulatory regions, increased de novo chromatin activation is linked to clinical progression whereas, in other regions, it is associated with an indolent course. We next developed two prognostic scores for progressive and indolent disease, respectively, calculated a single score representing the balance between them, and further generated surrogate scores based on gene and protein expression of the target genes. The balance score outperformed the clinical impact of the two individual scores, as it seemed to capture the prognostic information provided by each of them. Biologically, CLLs with higher balance score showed increased activation of TNF-α/NF-κB and mTOR signaling pathways. Regulatory programs related to progression were predominantly activated in the lymph node microenvironment, whereas those linked to indolent disease appeared to be microenvironment-independent. Finally, we thoroughly validated the balance score as a powerful and independent quantitative prognostic factor for time to first treatment across independent CLL cohorts and data modalities such as chromatin, transcriptome or proteome data. Our findings support the concept that de novo acquisition of chromatin changes in CLL cells plays a dual biological role, and that the balance between pro-progression and pro-indolence is a strong independent determinant of CLL prognosis.

P0567 Use of a convolutional neural network to quantify and predict ulcerative colitis disease endoscopic activity and histological outcomes

Abstract Background There is considerable inter-user variability in endoscopic and histologic scoring of the severity of ulcerative colitis (UC). The aim of this study was to create and train an artificial intelligence algorithm to predict the severity of UC using endoscopic videos. Methods This prospective cohort study recruited UC patients undergoing flexible sigmoidoscopy or colonoscopy between October 2023 and September 2024. The endoscopic examination was recorded from the splenic flexure to the anus. The videos were segmented into 3 second tubelets, and poor quality videos excluded. Objective disease activity was quantified by an experienced IBD gastroenterologist (by determining individual endoscopic Mayo Scores- eMS), and corresponding biopsies were scored according to the Nancy Histologic Index (NHI) by one of three gastrointestinal histopathologists. The dataset was divided into a training dataset (38 patients, 88% of video data) and a test dataset (6 patients, 12% of data), stratified by disease severity and equipment source. Two video vision transformer models were trained to recognise Mayo and NHI respectively, and their performance in differentiating disease activity from remission, and accuracy in determining endoscopic and histologic severity scores were evaluated. Standard diagnostic accuracy measures were used to calculate the models’ ability to detect and quantitate UC disease activity and included area under the receiver operating characteristic curve (AUROC), binary and multi-class accuracy, sensitivity, specificity, and precision. Results 53 patients were recruited, and after exclusions a total of 44 were included in the final analysis. 30 patients had endoscopic activity and 30 patients had histological activity. The resultant eMS and NHI showed moderate correlation (R=0.72). For eMS, the accuracy of the model was excellent and had an AUROC of 0.98 in identifying disease activity (eMS≥1), with accuracy, sensitivity, specificity, and precision of 92%, 86%, 96%, 93% respectively. Multiclass accuracy was 87%, with a macro F1 score of 0.85. For NHI, the model was highly accurate in detecting histopathologic activity (NHI≥1), with AUROC of 0.95, accuracy, sensitivity, specificity, precision at 89%, 92%, 86%, 85% respectively. However, it was less robust in predicting specific NHI scores, with multiclass accuracy at 69%, and a macro F1 score of 0.41. Conclusion We developed an AI algorithm that is able to reliably predict endoscopic and histologic disease activity for patients with UC, and accurately differentiate those patients from those in remission. This may reduce clinician reliance on biopsies to determine disease activity, and have far-reaching implications in UC disease assessment. References Hashash JG, Yu Ci Ng F, Farraye FA, Wang Y, Colucci DR, Baxi S, Muneer S, Reddan M, Shingru P, Melmed GY. Inter- and Intraobserver Variability on Endoscopic Scoring Systems in Crohn's Disease and Ulcerative Colitis: A Systematic Review and Meta-Analysis. Inflamm Bowel Dis. 2024 Mar 28:izae051. doi: 10.1093/ibd/izae051 Marchal-Bressenot A, Salleron J, Boulagnon-Rombi C, et al. Development and validation of the Nancy histological index for UC. Gut 2017;66:43-49.

Analyzing the cancer mortality-to-incidence ratios and health expenditures in the aging population: a 20-year comparative study across high-income countries

BackgroundThe global burden of cancer is expected to increase by 60% over the next two decades, largely due to population aging. The study aims to examine the association between cancer mortality-to-incidence ratios (MIR) with healthcare expenditures (HE), and human development index score for individuals 70 years old or older.MethodThis is an epidemiological study using publicly available data from the Global Burden of Disease (GBD) for six over the years 1990–2019. A generalized linear model was employed to examine the association between MIR, and health expenditures and health development index score.ResultsIncluded countries showed a statistically significant negative association between MIR and both HE, and HE, indicating that higher HDI and HE are associated with decreased MIR with the highest decrease was for China, the coefficient for HDI is −1.29 (95% CI: –1.35 to −1.24, p &amp;lt; 0.0001), the coefficient for HE is −0.103 (95% CI: –0.17 to −0.03, p &amp;lt; 0.0001). There are variations exist in MIRs between high and low health expenditure countries for each cancer type.ConclusionThe study reveals a significant impact of HE and HDI on cancer outcomes in older adults. Variations between high and low HE nations highlight potentially improved cancer outcomes in high HE countries. Considering the anticipated growth in the aging population worldwide, a rise in cancer cases is expected among older individuals. The implications are profound, suggesting an impending strain on healthcare systems, particularly in nations with a high proportion of elderly and low health expenditures.

P0260 Scoring indices grading radiologic disease activity severity on magnetic resonance imaging strongly reflect clinical healing of Crohn’s perianal fistulas

Abstract Background Magnetic resonance imaging (MRI) is the gold-standard for evaluating Crohn’s perianal fistulas. Multiple scoring indices to grade radiologic disease activity severity have been established, with limited comparative data and a lack of consensus regarding which index correlates most accurately with clinical findings. In a prospective MRI series, we explored the relationship between established radiologic indices and clinical healing. Methods Serial MRI scans from 60 adults with Crohn’s perianal fistulas enrolled in a prospective study were acquired. The prospective study evaluated the efficacy of a protocolised treatment strategy optimising care delivery at a single tertiary centre. Patients had ≥12 months follow-up with serial MRI performed annually. Each MRI scan had a paired physical examination, with clinical healing defined as the absence of externally draining perianal fistulas and no seton. MRI scans were reviewed by a specialist radiologist blinded to clinical findings. Radiologic disease activity severity was graded using the Van Assche Index (VAI), Magnetic Resonance Index for Assessing Fistulas in Patients with Crohn’s Disease (MAGNIFI-CD) and Fibrosis Score (FS). The primary endpoint was the relationship between radiologic indices and clinical healing. Secondary endpoints included the optimal index scores for clinical healing and the relationship between individual scoring criteria and clinical healing. Results A total of 135 MRI scans were acquired. All patients had baseline imaging, with 88% and 37% having serial imaging at 1 and 2 years, respectively. The median interval between baseline and final MRI was 16 months. Clinical healing significantly correlated with less severe radiologic disease activity, reflected by lower VAI (OR 0.70, P&amp;lt;0.001), lower MAGNIFI-CD (OR 0.76, P&amp;lt;0.001) and higher FS (OR 3.14, P&amp;lt;0.001). On ROC curve analysis, all radiologic indices exhibited a similarly high degree of correlation with clinical healing; AUROC of 0.91, 0.84 and 0.92, respectively (Figure 1). The optimal index scores for clinical healing were VAI ≤6 (sensitivity 83%, specificity 94%, AUROC 0.88), MAGNIFI-CD ≤8 (sensitivity 78%, specificity 73%, AUROC 0.75) and FS ≥5 (sensitivity 83%, specificity 94%, AUROC 0.88). On multivariable logistic regression analysis, increasing degree of fibrosis on FS (OR 2.68, P&amp;lt;0.001) and increasing fistula tract extension on VAI (OR 0.09, P&amp;lt;0.001) were independent positive and negative indicators of clinical healing, respectively. Conclusion Radiologic disease activity severity using established scoring indices have equally strong correlations with clinical healing of Crohn’s perianal fistulas. Further studies are needed to explore the predictive utility of individual radiologic parameters.

Contextualizing ijime: The relationship between school bullying, socioeconomic status, and academic achievement with a focus on school position

ABSTRACT This study examined the relationship between school bullying (ijime), socioeconomic status, and academic achievement, considering the context of students within the school. While international research has found a correlation between school bullying, students’ socioeconomic status, and academic achievement, indicating that children with lower socioeconomic status and academic performance are more likely to be bullied, there is a lack of research in Japan. Specifically, studies focusing on the interaction between bullying, socioeconomic status, and academic achievement, as well as the influence of school-level variables, such as students’ socioeconomic and academic composition, are scarce. Therefore, this study used the PISA 2018 data to explore these relationships by analyzing individual scores, school averages, and discrepancies between the two. Multilevel analysis further revealed that students with higher socioeconomic status and academic achievement than their peers within the same school were particularly prone to being bullied. Additionally, the school’s overall average socioeconomic status and academic achievement did not affect individual students’ likelihood of being bullied. These findings underscore the importance of considering the overall socioeconomic status and academic achievement in society and students’ specific context and relative positions within their schools in analyzing factors that contribute to bullying.

Knowledge and Attitudes About Obstructive Sleep Apnea Among Dental Students: A Cross-Sectional Study

Objective: Dental sleep medicine is an increasingly recognized medical specialty, but obstructive sleep apnea (OSA) frequently progresses undetected. Dentists are often the first health-care professionals to assess signs and symptoms of OSA and therefore have a key role in OSA diagnosis. The purpose of the study was to assess the knowledge and attitudes about OSA among dental students. Methods: The OSA knowledge and attitude questionnaire was completed by dental students between April 2023 and June 2023. The questionnaire includes 18 knowledge and 5 attitude items on OSA. Chi-square tests and Student’s t-tests were used to compare the differences between individual items and mean scores of the participants. Differences were considered significant at P &lt; .05. Results: A total of 351 dental students participated in the study. The total knowledge scores of the students were poor with a mean knowledge score for all students of 51% (9.18 ± 2.89). While 67.6% of participants considered OSA to be of clinical importance, only 18.2% were confident in their ability to manage OSA. Conclusion: There are some deficiencies in the OSA education provided to dental students. Additional courses on dental sleep medicine are needed, and relevant updates should be made to the dentistry curriculum. Keywords: Knowledge, attitude, dental education, dental student, obstructive sleep apnea

An innovative tool to assess individual reliability among the military with regard to data security

Relevance. In the current international situation, despite augmenting threats to data security in the Russian Federation, the procedures granting access to classified information to the authorized military have not undergone any significant changes so far. The existing approaches and methods of selecting professionals to be authorized to access national security information (NSI) fail to consider the candidates’ personal profiles.The study objective is to development of a set of methods allowing to assess and predict individual reliability of military professionals dealing with information security.Methods. The Automated System for Psychophysiological Diagnostics of Addictive Behavior was used; it comprises 2 psychological questionnaires and 2 psychophysiological methods to assess individual reliability in 78 military professionals. Psychophysiological assessment is supplemented with stimuli relevant for data security. The examination required 15 to 20 minutes per each subject, including explanations and practice. To ensure that individual reliability assessment was of an expert level and unbiased, the professors and commanders were asked to complete a dedicated questionnaire per each subject. The results were analyzed using Statistica 12.0 software package.Results and analysis. Once the subjects of various individual reliability scores completed all he automated assessments, the obtained database underwent a discriminant analysis. Eventually, a statistically significant model (p &lt; 0.001) was developed per every subject to predict their personal reliability level. The model sensitivity was is 85.7 %, while the specificity was 100 %. The study identified the most significant psychophysiological markers of low reliability risk in students of higher military education institutions of the Ministry of Defense of the Russian Federation.Conclusion. The developed automated system for individual reliability assessment in data security is registered in the Rospatent Computer Software Register under N 2024663045 dated 03.06.2024 as the “Automated System for Individual Reliability Assessment among the Military Having Access to National Security Information”. Unlike other well-known methods to identify the risk of data protection offences, the proposed tool is user-friendly and eliminates such types of bias, as distorted interpretation of results, investigator’s proficiency and experience, or the pursuit of the subject to provide socially favorable replies.

Characterizing Parkinson's Disease-Associated Pain in Native Patients with Malayalam Version of the King's Parkinson's Disease Pain Scale.

Pain is an important non-motor symptom in Parkinson's disease (PD) and is often under-recognized. Pain is also a symptom frequently reported by non-PD elderly subjects. The King's Parkinson's Disease Pain Scale (KPPS) is a valid tool to characterize and quantify pain in PD and has been translated into several languages. We translated KPPS to Malayalam for native patients with PD and examined the pain characteristics in consecutive patients. Correlations with comprehensive disease-specific rating scales, including the Movement Disorder Society-Sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS), were explored. A group of age- and gender-matched subjects without PD were interviewed using KPPS to examine how the pain reported by the non-PD aging population is different from that in PD. In this study, 82% of patients with PD reported at least one type of pain, compared to 31.3% of age- and gender-matched control subjects (P < 0.001). KPPS total scores (18.2 ± 14.0 vs. 1.8 ± 3.2; P < 0.001) and all the individual domain scores were significantly higher in patients. Pain scores correlated with age in control subjects (R = 0.46, P < 0.001), but not in patients; females reported more pain in both groups. Patients' pain scores were higher in the postural instability and gait difficulty subtype and showed significant correlations with MDS-UPDRS and NMSS scores. Pain is a prevalent symptom in PD and differs from the pain reported by a non-PD aging population. The Malayalam version of KPPS is a valid tool to characterize pain in native, Malayalam-speaking patients.

Trends in views of democracy and society and support for political violence in the USA, 2022–2024: findings from a nationally representative survey

BackgroundIn 2022, a nationally representative longitudinal survey in the USA found concerningly high prevalences of support for and personal willingness to engage in political violence, but those prevalences decreased in 2023. This study examines changes in those prevalences from 2023 to 2024, an election year in the USA.MethodsParticipants were members of Ipsos KnowledgePanel. Wave 3 of the survey was conducted May 23-June 14, 2024; invitations to participate were sent to all respondents to prior waves who remained in KnowledgePanel. Outcome measures concern justification for the use of violence to advance any of 17 specified political objectives, personal willingness to engage in political violence at 4 levels of severity and against 9 target populations, and expectation of firearm use in political violence. Outcomes are expressed as weighted proportions. Year-to-year change is based on the means of aggregated individual change scores, which have a potential range from 0 (no change) to ± 2.ResultsThe 2024 completion rates were 88.4% (8896 respondents/10,064 invitees) overall, 91.6% (8185 respondents/8932 invitees) for invitees in 2024 who had responded in 2023, and 62.8% (711 respondents/1132 invitees) for invitees in 2024 who had responded in 2022 but not in 2023. After weighting, 50.9% (95% confidence interval (CI) 49.5%, 52.3%) were female; weighted mean (SD) age was 48.5 (24.9) years. From 2023 to 2024, the prevalence of the view that violence was usually or always justified to advance at least 1 political objective did not change (2024: 26.2%, 95% CI 25.0%, 27.5%; 2023: 25.3%, 95% CI 24.1%, 26.5%). There were no changes from 2023 to 2024 in willingness to damage property, threaten a person, injure a person, or kill a person in an act of political violence, and no changes in expectations of firearm use in situations where respondents considered political violence justifiable. Changes on other measures were infrequent (17 of 58 comparisons in the main analysis) and small where they occurred (with 2 exceptions, change < 0.05).ConclusionsContrary to expectation, support for and willingness to participate in political violence in this cohort showed little to no change from 2023 to 2024, an election year in the USA. These findings can help guide prevention efforts.

Factors influencing breast milk donation to a human milk bank in Iran: implications for policymakers and planners

BackgroundThe World Health Organization (WHO) actively promotes breastfeeding as the optimal source of nourishment for infants and young children. However, not all newborns have access to breast milk, leading to deprivation of its nutritional benefits or incurring financial burdens from alternative feeding options. Establishing Human Milk Banks (HMBs) can help ensure equitable access to donated human milk. However, several factors may hinder breast milk donation. This study aims to identify the factors influencing milk donation to HMBs in Iran.MethodsWe conducted a case-control study involving mothers who had given birth at least one year prior to the study. The study included 51 cases (mothers who donated their milk to HMBs) and 153 controls. Data were collected using a questionnaire designed to gather retrospective information on individual health, social networks, and other relevant factors. Logistic regression analysis was performed to examine the relationships between breast milk donation and these factors. Additionally, qualitative data were collected through face-to-face interviews with HMB senior staff and mothers. Thematic analysis was employed to identify perspectives on factors influencing milk donation.ResultsFamily factors, social influences, individual social welfare scores, and breast milk adequacy were significantly associated with increased milk donation. Among these, family support emerged as one of the strongest predictors of milk donation.ConclusionTo establish HMBs and promote human milk donation, health policymakers and planners should implement strategies that motivate mothers to donate. Evidence-based training and motivational programs for mothers and their families, which address barriers to milk donation, are essential to achieving this goal.