Faculty Bibliography

BACKGROUND:The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. METHODS:Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. FINDINGS/RESULTS:We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. INTERPRETATION/CONCLUSIONS:A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. FUNDING/BACKGROUND:Gates Foundation, Queensland Health, and University of Queensland.

We present the findings from the genome sequencing project of a plant growth-promoting rhizobacterium Pseudomonas inefficax MG-2, sourced from rhizospheric soil. The genome spans 5,736,804 base pairs with an average GC content of 62.9%. An incomplete plasmid with a length of 16,324 base pairs and a GC content of 52.6% was also identified.

BACKGROUND/UNASSIGNED:Patients with pulmonary hypertension (PH) have previously experienced worse waitlist outcomes than peers with other diagnoses. In 2021, the Lung Allocation Score (LAS) was revised to improve the prediction of expected survival. The Composite Allocation Score (CAS) was subsequently implemented in 2023. The effects of these changes on waitlist outcomes for patients with PH are not known. METHODS/UNASSIGNED:A retrospective analysis of the United Network for Organ Sharing database was performed in 3 eras: LAS Era 1 (November 24, 2017-September 30, 2021), LAS Era 2 (October 1, 2021-March 8, 2023), and CAS Era (March 9, 2023-June 27, 2024). Unadjusted and adjusted competing risks regression analyzed waitlist outcomes within each era comparing diagnosis groups, and for PH patients across eras. RESULTS/UNASSIGNED:Adjusted waitlist mortality for PH patients was worse relative to chronic obstructive pulmonary disease (COPD) and cystic fibrosis in LAS Era 1, not significantly different from other groups in LAS Era 2, and worse relative to COPD and interstitial lung disease in the CAS Era. Waitlist mortality for PH patients was unchanged between the LAS Eras and the CAS Era. Transplantation rate for PH patients was improved in the CAS Era compared to LAS Era 2, when measures of right heart dysfunction were removed from the LAS calculations, but not compared to LAS Era 1. CONCLUSION/UNASSIGNED:In the CAS Era, PH patients continue to experience increased waitlist mortality relative to non-PH diagnoses. Waitlist mortality for PH patients has not improved in the CAS Era compared to the LAS Eras.

BACKGROUND:Assessing dental caries, sealants, and fluorosis is essential for public health surveillance, providing critical data to evaluate national prevention programs. Standard methods performed by dental professionals are often limited by affordability, accessibility, and scalability for both population-level and individualized assessments. Mobile health (mHealth) approaches to concurrently detect caries, sealants, and fluorosis have remained largely unexplored, especially at the population level. OBJECTIVE:This study leverages mHealth technologies that integrate computer vision using machine learning and deep learning with images captured by smartphone cameras and low-cost intraoral cameras. The primary objective is to develop and validate models for detecting caries lesions, identifying sealants, and quantifying fluorosis severity from standardized dental images, using standardized visual clinical examinations as the reference standard. METHODS:The proposed study population will include approximately 1000 adolescents in Colorado, United States, living in communities with naturally elevated fluoride levels in the public water system. Participants will undergo standardized clinical dental examinations and imaging using intraoral cameras and smartphones. Supervised learning models will incorporate reference chart-based color correction, radiomic spatial and textural features, and neural network classifiers. The reference standard will be standardized visual clinical examinations performed by trained and calibrated dental professionals. Two models will be developed and evaluated: one to detect caries lesions and sealants and another to assess fluorosis severity. Model performance will be evaluated against clinical assessments by dental professionals using stratified cross-validation and multiclass performance metrics while minimizing bias and accounting for confounders common to human examiners. RESULTS:A standardized dental examination, an intraoral imaging protocol, and a smartphone imaging protocol are used to assess all 8 permanent molars for caries and sealants, as well as the 6 upper anterior teeth for fluorosis severity. Pilot studies were conducted to test study logistics and calibrate 3 examiners in person, supplemented by debriefings, mobile app training, and a web-based calibration module. The study was funded in September 2022 with supplemental funding awarded in June 2024. The study launched in May 2024, and as of January 2026, data have been collected from approximately 300 participants. CONCLUSIONS:The integration of computer vision and mobile device imaging will enable affordable, scalable, population-level assessments for detecting caries and sealants and quantifying fluorosis severity among adolescents. mHealth technologies have been increasingly incorporated into dentistry for both clinical decision support and at-home use. This protocol will further help establish a structured methodological framework for acquiring, processing, and analyzing mobile imaging data for dental health surveillance and epidemiological studies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)/UNASSIGNED:DERR1-10.2196/91239.

There is growing interest in the impact of internal body states on the brain and behavior. The detrimental effects of chronic lung inflammation on mental health are well recognized; however, underlying mechanisms are not known. Here, using a murine model of allergic asthma we report compromised fear extinction in mice with severe but not mild airway inflammation (AI); an effect abolished by anti-interleukin-17 A (IL-17 A) antibodies. Investigation of innate immune cells, microglia as-well-as transcriptomic signatures in the subfornical organ (SFO), a brain interoceptive node lacking a traditional blood-brain-barrier, revealed significant alterations in severe AI mice. IL-17 Receptor A (IL-17RA) was expressed in SFO microglia and upregulated in severe AI mice. Notably, ablation of microglial IL-17RA improved fear extinction in severe AI mice. Furthermore, we identified direct SFO projections to the infralimbic (IL) cortex, a key area regulating extinction. Importantly, chemogenetic inhibition of the SFO-IL circuit led to improved fear extinction in severe AI mice. Collectively, we report a unique body-to-brain interoceptive mechanism engaging the SFO microglia and an SFO-to-IL circuit, through which airway inflammatory mediators compromise fear extinction. Beyond asthma, our findings are relevant to other pulmonary pathologies (e.g. bacterial pneumonia, ARDS, COVID-19) highlighting a risk for cortical dysfunction and fear pathologies such as PTSD.

OBJECTIVE:Oral frailty, the age-related decline in oral and pharyngeal function, is associated with physical frailty, sarcopenia, and cognitive decline. The Oral Frailty Index-8 (OFI-8) is a patient-reported outcome measure developed in Japan to assess oral frailty risk. This study aimed to culturally and linguistically adapt the OFI-8 for English-speaking older adults in the United States. STUDY DESIGN/METHODS:Cross-cultural and cross-linguistic adaptation of the OFI-8 by an expert committee, followed by administration of the adapted OFI-8 and structured cognitive interviews with 22 English-speaking adults aged 65 years and older. SETTING/METHODS:Outpatient tertiary academic voice and swallowing center in New York City. METHODS:Following the Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines, the OFI-8 underwent forward translation, back translation, expert committee review, and reconciliation. Cognitive interviews were then conducted with 22 participants aged 65 years and older. A think-aloud and verbal-probing approach was used to evaluate comprehension, clarity, and cultural appropriateness. Interviews were transcribed and analyzed using thematic analysis. RESULTS:Several cultural adaptations were made, including replacing Japanese food examples with US-familiar foods of similar texture. Three questionnaire items and the instructions were refined following participant feedback to improve syntactic flow, clarity, and understanding. The final US-English version maintained conceptual equivalence of the original OFI-8 while adapting language and examples for US cultural relevance. CONCLUSION/CONCLUSIONS:A culturally adapted US-English version of the OFI-8 was developed through structured translation, expert review, and cognitive interviews. Further validation studies are necessary to establish its clinimetric properties and support clinical application for early detection of oral frailty in US older adults.

AIM/OBJECTIVE:Periapical mucositis (PAM) is defined as inflammation of the periapical tissues and localized oedema of the maxillary sinus mucosa, typically resulting from periradicular disease. Radiographically on cone-beam computed tomography (CBCT), PAM presents as mucosal thickening or a dome-shaped soft tissue expansion along the floor of the maxillary sinus, adjacent to the affected root apex. Although several studies have evaluated PAM, their findings vary considerably. This study aims (1) to evaluate the prevalence of PAM in maxillary posterior teeth amongst patients at NYU College of Dentistry, Department of Endodontics, and (2) to identify predisposing factors associated with PAM. METHODOLOGY/METHODS:CBCT evaluation and chart review were conducted at NYU College of Dentistry from 2016 to 2021. A total of 586 scans were screened, and 335 scans were included. The presence of PAM, periapical osteoperiostitis, maxillary sinus floor bony erosion, age, sex, pulpal and periapical diagnosis, size of the lesion, the vertical and horizontal distance between the sinus floor and roots, number of roots with apical lesions, type of tooth and iatrogenic errors during treatment were recorded. Chi-square, Fisher's exact tests and logistic regression were used to analyse the data. RESULTS:Of the 335 scans included, 13 presented with mucositis without periradicular disease and were excluded from the analysis. A total of 322 scans were analysed. The prevalence of PAM was 55.5%. The presence of maxillary sinus floor bone erosion was associated with 7.56 times higher odds of PAM than those without sinus floor erosion (p < 0.001). Each incremental increase in CBCTPAI was associated with a 1.43-fold increase in the odds of PAM occurrence (p = 0.004). CONCLUSION/CONCLUSIONS:PAM was present in over half of patients presenting with apical periodontitis affecting the posterior maxillary dentition. Maxillary sinus bony floor erosion and periapical lesion size were predisposing factors to PAM development.

Cavernous sinus thrombosis (CST) is a rare but severe condition that often arises as a complication of head and facial infections. Sinusitis, particularly involving the sphenoid or ethmoid sinuses, is a common precursor. A five-year-old boy presented to the pediatric intensive care unit with fever, ear pain, and eyelid swelling. Magnetic resonance imaging revealed rare bilateral CST with significant intracranial arterial narrowing. Cultures from the ear grew Fusobacterium necrophorum. Subsequent dental examination identified multiple untreated carious lesions, pulpal necrosis, and abscesses. Comprehensive dental rehabilitation, including extractions, pulpotomies, and stainless-steel crowns, was performed under general anesthesia in conjunction with otolaryngologic management. Following treatment, the CST resolved. This case illustrates a potential pathophysiological cascade where untreated dental caries contributed to sinusitis and otomastoiditis, ultimately leading to CST. The absence of valves in the facial and dural venous systems facilitates retrograde spread of infection, underscoring the importance of oral health in preventing severe systemic complications. While a direct microbial link was not confirmed, we postulate that the infection correlated with poor dentition, leading to sinusitis and subsequent CST. Bilateral CST is an uncommon but life-threatening condition that may originate from odontogenic sources. Prompt multidisciplinary evaluation, including dental assessment, is critical in achieving favorable outcomes in pediatric patients.

This study analyzed the association between self-perceived bullying and self-reported toothache among Brazilian students and evaluated the moderating role of school-based health actions, including participation in the School Health Program, oral health promotion, and bullying prevention. A cross-sectional study was conducted using data from the 2019 National School-based Health Survey, including 53,711 students aged 13-17 years. The outcome was self-reported toothache and the main exposure was self-perceived bullying. Moderating variables included school participation in the School Health Program, oral health promotion actions, and bullying prevention actions. Poisson regression models with robust variance were fitted, with standard errors adjusted for clustering by school. Overall, 23.6% of students reported toothache and 13.7% reported bullying. Moderation analyses showed no evidence that school health actions influenced the association between bullying and toothache. For bullying once or ≥2 times, prevalence ratios were: School Health Program participation (PR_once = 0.92, 95%CI 0.77-1.09; PR_ ≥ 2 = 1.07, 95%CI 0.81-1.41), bullying prevention (PR_once = 0.98, 95%CI 0.76-1.25; PR_ ≥ 2 = 0.82, 95%CI 0.72-1.09), and oral health promotion (PR_once = 1.13, 95%CI 0.96-1.33; PR_ ≥ 2 = 1.19, 95%CI 0.94-1.52). These findings indicate that school-based health actions alone may be insufficient to mitigate the impact of bullying on adolescents' oral health.