Introduction: The Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and Endoscopic Mayo Score (EMS) are used as standardized tools to report endoscopic disease activity in ulcerative colitis (UC). The performance of both scores and how they compare as predictors of prognosis has not been completely determined. The purpose of this study was to compare the prognostic capability of UCEIS against the EMS in patients with active UC to determine which scoring system is more accurate in predicting disease outcomes in UC. Methods: This was a retrospective cohort study including UC patients that underwent a baseline colonoscopy/sigmoidoscopy. UCEIS, EMS and partial Mayo score were recorded before and after therapy (in our institution, all scores are collected prospectively at the time the patient undergoes a colonoscopy/sigmoidoscopy). Phenotype and therapy started for UC, laboratory chemistries, C-reactive protein (CRP) and stool calprotectin were also collected. Primary outcomes consisted of non-response to therapy after six months, defined as a need for colectomy, switching therapy, or starting steroids. Secondary outcomes such as emergency department (ED) visits and hospital admissions were also investigated. Endoscopic remission was defined as EMS of 0/UCEIS≤1. Clinical remission was defined as a partial Mayo score < 2. Results: 105 patients met inclusion criteria. 52 (49.5%) were female and the mean age was 46 years (SD=16.6). 36 patients had left-sided colitis, 10 patients had proctitis, and 59 patients had pan-colitis. 17 patients were starting new therapy. At six months, 30 patients required steroids for flares. Both UCEIS and EMS predicted response to therapy well. For steroid-free remission at 6 months, AUC for UCEIS was 0.79 (p-value <.0001) and AUC = 0.77 (p-value <.0001) for EMS. Within the UCEIS sub-scores, the AUC was 0.76 (p-value <0.001) for vascular pattern, 0.67 for bleeding (p-value =0.004) and 0.74 for erosions/ulcers (p-value <0.001). Conversely, UCEIS and EMS poorly predicted ED visits or admissions. ROC curves for 6 months showed UCEIS scoring had an AUC = 0.57 for UCEIS (p-value =0.42) and 0.57 for EMS (p-value =0.25). Conclusion: Our study suggests that the UCEIS and EMS are equivalent when used as prognostic predictive factors in UC patients. However, when comparing scores and their role in clinical practice, we need to consider other potential variables such as inter and intra-observer variability.602_A Figure 1. Baseline characteristics of the study population602_B Figure 2. Performance of endoscopic and clinical scores predicting steroid free remissions within 6 months of baseline colonoscopy602_C Figure 3. 6 month outcomes

Reliable, clinically useful, and globally applicable diagnostic classification of mental disorders is an essential foundation for global mental health. The World Health Organization (WHO) is nearing completion of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11). The present study assessed inter-diagnostician reliability of mental disorders accounting for the greatest proportion of global disease burden and the highest levels of service utilization - schizophrenia and other primary psychotic disorders, mood disorders, anxiety and fear-related disorders, and disorders specifically associated with stress - among adult patients presenting for treatment at 28 participating centers in 13 countries. A concurrent joint-rater design was used, focusing specifically on whether two clinicians, relying on the same clinical information, agreed on the diagnosis when separately applying the ICD-11 diagnostic guidelines. A total of 1,806 patients were assessed by 339 clinicians in the local language. Intraclass kappa coefficients for diagnoses weighted by site and study prevalence ranged from 0.45 (dysthymic disorder) to 0.88 (social anxiety disorder) and would be considered moderate to almost perfect for all diagnoses. Overall, the reliability of the ICD-11 diagnostic guidelines was superior to that previously reported for equivalent ICD-10 guidelines. These data provide support for the suitability of the ICD-11 diagnostic guidelines for implementation at a global level. The findings will inform further revision of the ICD-11 diagnostic guidelines prior to their publication and the development of programs to support professional training and implementation of the ICD-11 by WHO member states.

The pattern of increased risk of white matter microstructure alterations, smaller grey matter volumes, reduced cortical surface area and decreased gyrification, suggests abnormal neurodevelopment in perinatally infected younger adolescents.

Maternal PTSD may be associated with impaired infant neurodevelopment. Further work in low- and middle-income populations may improve early childhood development in this context. (PsycINFO Database Record

Trichotillomania (hair-pulling disorder) is characterized by the repetitive pulling out of one's own hair, and is classified as an Obsessive-Compulsive Related Disorder. Abnormalities of the ventral and dorsal striatum have been implicated in disease models of trichotillomania, based on translational research, but direct evidence is lacking. The aim of this study was to elucidate subcortical morphometric abnormalities, including localized curvature changes, in trichotillomania. De-identified MRI scans were pooled by contacting authors of previous peer-reviewed studies that examined brain structure in adult patients with trichotillomania, following an extensive literature search. Group differences on subcortical volumes of interest were explored (t-tests) and localized differences in subcortical structure morphology were quantified using permutation testing. The pooled sample comprised N=68 individuals with trichotillomania and N=41 healthy controls. Groups were well-matched in terms of age, gender, and educational levels. Significant volumetric reductions were found in trichotillomania patients versus controls in right amygdala and left putamen. Localized shape deformities were found in bilateral nucleus accumbens, bilateral amygdala, right caudate and right putamen. Structural abnormalities of subcortical regions involved in affect regulation, inhibitory control, and habit generation, play a key role in the pathophysiology of trichotillomania. Trichotillomania may constitute a useful model through which to better understand other compulsive symptoms. These findings may account for why certain medications appear effective for trichotillomania, namely those modulating subcortical dopamine and glutamatergic function. Future work should study the state versus trait nature of these changes, and the impact of treatment.

Crohn’s disease (CD) and ulcerative colitis (UC) often require life-long treatment (Tx). In Germany, approved biologic Tx includes vedolizumab (VDZ), a monoclonal anti-integrin antibody, and anti-TNFα; however, real-world comparative drug costs are poorly understood. A chart review study conducted June 2016 in Germany (15 sites), included UC and CD patients (patients) who were biologic naïve (bio-naïve) or received one prior anti-TNFα and initiated VDZ or anti-TNFα (infliximab-originator [IFX-O] or biosimilar [IFX-B], adalimumab [ADA] or golimumab [GOL, UC only]) from 15 July 2014 to 20 October 2015. Pt clinical characteristics and Tx patterns (schedule and dose strength or frequency modifications) were collected. Drug costs at 14 weeks, 6 and 12 months, and per year (yr) during maintenance (Tx post-week 14) were calculated using Lauer-Taxe list prices for patients on continuous Tx; a Student’s t-test assessed significance. Analyses include 140 UC (80 VDZ and 60 anti-TNFα [27 IFX-O, 6 IFX-B, 12 ADA, 15 GOL]) and 179 CD (72 VDZ and 107 anti-TNFα [46 IFX-O, 19 IFX-B, 42 ADA]) patients. Median years since diagnosis in UC VDZ and anti-TNFα patients was 6.6 and 4.4 years, 30% and 68% were bio-naïve, 76% and 65% used corticosteroids in the prior 2 years, median Tx duration was 16 and 14 months, and 33% and 23% had ≥1 dose escalation, respectively. Median years since diagnosis in CD VDZ and anti-TNFα patients was 8.5 and 5.3 years, 15% and 61% were bio-naïve, 60% and 64% used corticosteroids in the prior 2 years, median Tx duration was 15 and 15 months, and 24% and 31% had ≥1 dose escalation, respectively. Mean VDZ vs. anti-TNFα costs were lower in UC at 14 weeks (€8807 vs. €9663, p < 0.01), 6 months (€11879 vs. €14111, p < 0.01) and 12 months (€20430 vs. €23025, p = 0.02) and similar per yr in maintenance (€13017 vs. €15605, p = 0.10). In CD, costs were similar at 14 weeks (€9095 vs. €8835, p = 0.42), 6 months (€12278 vs. €12421, p = 0.75), 12 months (€20005 vs. €21394, p = 0.13) and per year in maintenance (€12515 vs. €13944, p = 0.09). VDZ mean maintenance costs per year were similar or lower vs. each anti-TNFα in UC (€13017 vs. IFX-O: €16315 [p = 0.07]; IFX-B: €26463 [p < 0.01]; ADA: €14041 [p = 0.52]; GOL: €11901 [p = 0.41]) and CD (€12515 vs. IFX-O: €14688 [p = 0.02]; IFX-B: €12088 [p = 0.75]; ADA: €13980 [p = 0.15]). VDZ mean maintenance costs per yr tended to be lower vs anti-TNFα in bio-naïve (UC: €14700 vs. €16261, p = 0.64; CD: €12628 vs. €13803, p = 0.54) and one prior anti-TNFα groups (UC: €12318 vs. €14185, p = 0.14; CD: €12495 vs. €14194, p = 0.11). Real-world biologic drug costs for UC and CD vary greatly in Germany. VDZ is associated with significantly lower costs in UC and numerically lower costs in CD vs. anti-TNFα over 1 year.

Abstract A decision support system (DSS) is developed to optimise the performance of different operations of small water treatment systems to improve day‐to‐day decisions. The support system includes a data management system, knowledge‐based system, performance assessment of different unit processes, fault tree analyses, preventive and corrective actions and event tree analysis (ETA). Performance assessment identifies the critical events (failures) and fault tree analysis identifies the interrelationships between the critical events and the root causes. Fault trees are developed based on the information obtained from events of waterborne outbreaks, responses to questionnaires by the participating smaller utilities, state‐of‐the‐art literature review and personal communication with the operators. ETA is used to identify the potential health outcomes which are further integrated with the quantitative microbial risk assessment. The developed DSS is advanced to an automated user friendly program that can be used by treatment plant operators to assess system performance.

Rodent research delineates how the basolateral amygdala (BLA) and central amygdala (CeA) control defensive behaviors, but translation of these findings to humans is needed. Here, we compare humans with natural-selective bilateral BLA lesions to rats with a chemogenetically silenced BLA. We find, across species, an essential role for the BLA in the selection of active escape over passive freezing during exposure to imminent yet escapable threat (T_imm). In response to T_imm, BLA-damaged humans showed increased startle potentiation and BLA-silenced rats demonstrated increased startle potentiation, freezing, and reduced escape behavior as compared to controls. Neuroimaging in humans suggested that the BLA reduces passive defensive responses by inhibiting the brainstem via the CeA. Indeed, T_imm conditioning potentiated BLA projections onto an inhibitory CeA pathway, and pharmacological activation of this pathway rescued deficient T_imm responses in BLA-silenced rats. Our data reveal how the BLA, via the CeA, adaptively regulates escape behavior from imminent threat and that this mechanism is evolutionary conserved across rodents and humans.

Hoarding disorder is characterized by an obsessive need to acquire, collect, or keep possessions and difficulty in organizing and discarding, resulting in accumulation of clutter, which elicits great concern from family and friends. Functioning is usually impaired in a variety of domains. Obsessive-compulsive disorder is the disorder most closely associated with hoarding. Overvalued ideation regarding the value or usefulness of possessions may make it impossible for individuals to discard items. This review contains 1 table, and 22 references. Key words: clutter, diagnostic and statistical manual, etiology, hoarding, obsessive-compulsive and related disorder

Large-scale collaborative analysis of brain imaging data, in psychiatry and neurology, offers a new source of statistical power to discover features that boost accuracy in disease classification, differential diagnosis, and outcome prediction. However, due to data privacy regulations or limited accessibility to large datasets across the world, it is challenging to efficiently integrate distributed information. Here we propose a novel classification framework through multi-site weighted LASSO: each site performs an iterative weighted LASSO for feature selection separately. Within each iteration, the classification result and the selected features are collected to update the weighting parameters for each feature. This new weight is used to guide the LASSO process at the next iteration. Only the features that help to improve the classification accuracy are preserved. In tests on data from five sites (299 patients with major depressive disorder (MDD) and 258 normal controls), our method boosted classification accuracy for MDD by 4.9% on average. This result shows the potential of the proposed new strategy as an effective and practical collaborative platform for machine learning on large scale distributed imaging and biobank data.