Cervical cancer is caused by the persistent infection of certain types of the Human Papillomavirus (HPV) and is a leading cause of female mortality particularly in low and middle-income countries ...(LMIC). Visual inspection of the cervix with acetic acid (VIA) is a commonly used technique in cervical screening. While this technique is inexpensive, clinical assessment is highly subjective, and relatively poor reproducibility has been reported. A deep learning-based algorithm for automatic visual evaluation (AVE) of aceto-whitened cervical images was shown to be effective in detecting confirmed precancer (i.e. direct precursor to invasive cervical cancer). The images were selected from a large longitudinal study conducted by the National Cancer Institute in the Guanacaste province of Costa Rica. The training of AVE used annotation for cervix boundary, and the data scarcity challenge was dealt with manually optimized data augmentation. In contrast, we present a novel approach for cervical precancer detection using a deep metric learning-based (DML) framework which does not incorporate any effort for cervix boundary marking. The DML is an advanced learning strategy that can deal with data scarcity and bias training due to class imbalance data in a better way. Three different widely-used state-of-the-art DML techniques are evaluated- (a) Contrastive loss minimization, (b) N-pair embedding loss minimization, and, (c) Batch-hard loss minimization. Three popular Deep Convolutional Neural Networks (ResNet-50, MobileNet, NasNet) are configured for training with DML to produce class-separated (i.e. linearly separable) image feature descriptors. Finally, a K-Nearest Neighbor (KNN) classifier is trained with the extracted deep features. Both the feature quality and classification performance are quantitatively evaluated on the same data set as used in AVE. It shows that, unlike AVE, without using any data augmentation, the best model produced from our research improves specificity in disease detection without compromising sensitivity. The present research thus paves the way for new research directions for the related field.
Abstract
Background
The World Health Organization recommends a 1- or 2-dose human papillomavirus (HPV) vaccination schedule for females aged 9 to 20 years. Studies confirming the efficacy of a single ...dose and vaccine modifications are needed, but randomized controlled trials are costly and face logistical and ethical challenges. We propose a resource-efficient single-arm trial design that uses untargeted and unaffected HPV types as controls.
Methods
We estimated HPV vaccine efficacy (VE) from a single arm by comparing 2 ratios: the ratio of the rate of persistent incident infection with vaccine-targeted HPV 16 and 18 (HPV 16/18) and cross-protected types HPV 31, 33, and 45 (HPV 31/33/45) to vaccine-unaffected types HPV 35, 39, 51, 52, 56, 58, 59, and 66 (HPV 35/39/51/52/56/58/59/66) vs the ratio of prevalence of these types at the time of trial enrollment. We compare VE estimates using only data from the bivalent HPV 16/18 vaccine arm of the Costa Rica Vaccine Trial with published VE estimates that used both the vaccine and control arms.
Results
Our single-arm approach among 3727 women yielded VE estimates against persistent HPV 16/18 infections similar to published 2-arm estimates from the trial (according-to-protocol cohort: 91.0% , 95% CI = 82.9% to 95.3% single-arm vs 90.9% , 95% CI = 82.0% to 95.9% 2-arm; intention-to-treat cohort: 41.7%, 95% CI = 32.4% to 49.8% single-arm vs 49.0% , 95% CI = 38.1% to 58.1% 2-arm). VE estimates were also similar in analytic subgroups (number of doses received; baseline HPV serology status).
Conclusions
We demonstrate that a single-arm design yields valid VE estimates with similar precision to a randomized controlled trial. Single-arm studies can reduce the sample size and costs of future HPV vaccine trials while avoiding concerns related to unvaccinated control groups.
Trial registration
ClinicalTrials.gov Identifier: NCT00128661.
Objectives: The principal aim of this study was to identify whether the Newcastle Satisfaction with Nursing Scales (NSNS) could be used on cancer patients.
Methods: This was a descriptive, ...cross-sectional study carried out on cancer patients (n = 298).
Results: We found that a majority of cancer patients were around 50 years old (hospitalized patients HP: 49.5 ± 14.9; chemotherapy outpatients COP: 49.4 ± 12.7), were female (HP: 74%; COP: 63.5%), and had received education at least up to elementary level (HP: 70%; COP: 80%). Breast cancer was the principal type of cancer (>34%) in both groups (HP and COP). The groups were comparable in age, sex distribution, place of origin, educational qualification, and type of cancer. Among HP, the experience and satisfaction scales of the NSNS showed good internal consistency (n = 235, α >0.9, r > 0.7), while among COP, only the satisfaction scale showed good internal consistency (n = 62, α = 1.00). Most patients’ perceptions (level of satisfaction) of hospitalization and chemotherapy services were positive (98% and 97%, respectively).
Conclusion: An NSNS instrument specifically designed for ambulatory care cancer patients is necessary for it to be useful in assessing cancer patients' perception of nursing care. This will help improve the quality of care in Mexico. The presence of cancer by itself could modify the patients’ satisfaction level. Further large-scale studies are required to inves- tigate the patients’ perceptions of nursing care using the NSNS on different cancer patient groups.
Keywords: Spanish satisfaction tool; hospital; patient satisfaction; oncology nursing; health care evaluation mechanisms.
Este trabajo aporta elementos para discutir si la movilidad virtual contribuye a incrementar la diversidad en los estudiantes que participan en movilidad internacional en comparacion con la movilidad ...fisica, o si por el contrario produce una suerte de "efecto Mateo" al ofrecer mas opciones para el mismo segmento privilegiado de estudiantes. Para identificar las diferencias entre quienes hacen movilidad fisica y quienes realizan movilidad virtual se diseno una investigacion exploratoria, de corte cuantitativo y sustentada en el paradigma pragmatico, y se recabaron y analizaron datos de estudiantes de una universidad publica estatal mexicana que participaron en alguno de los dos tipos de movilidad. Los hallazgos indican que los estudiantes que realizaron movilidad virtual comparten caracteristicas demograficas y sociales con quienes realizaron movilidad fisica, pero parecen tener una situacion economica menos favorable, pertenecen en menor medida a la clase alta y han sufrido mayor discriminacion. Aunque nuestros resultados permiten afirmar que la movilidad virtual tiene potencial para incorporar estudiantes con menos ventajas socioeconomicas a la experiencia internacional, tambien contribuyen a desmontar el mito de que la movilidad virtual, por si misma, incrementa la diversidad estudiantil en la movilidad y confirman la necesidad de discutir las estrategias de internacionalizacion a la luz de un marco contextual mas amplio.
Supplementation in malnourished pregnant women should not displace natural healthy foods. Objective: To estimate the differential effects of three nutritional supplements on macro- and micronutrient ...intake of pregnant women beneficiaries of the conditional cash transfer program Prospera (CCT-POP). Methods: Prospective cluster randomized trial. Communities were randomly assigned to receive a fortified beverage (Beverage), micronutrient tablets (Tablets), or micronutrient powder (MNP). Pregnant women (at <25 weeks) were recruited. The food frequency questionnaire was applied at 25 and 37 weeks of pregnancy and at one and three months postpartum (mpp). Differential effects of the three supplements on the median change in nutrient intake from baseline to each follow-up stage were estimated. Results: Median change in protein intake from dietary and supplement sources were significantly lower for MNP and Tablets than for Beverages (baseline to 37 w: −7.80 ± 2.90 and −11.54 ± 3.00, respectively; baseline to 1 mpp: −7.34 ± 2.90 for MNP, p < 0.001). Compared to Beverages, median increases were higher for the MNP for vitamins C (31.2 ± 11.7, p < 0.01), E (1.67 ± 0.81, p < 0.05), and B12 (0.83 ± 0.27, p < 0.01) from baseline to 37 wk; from baseline to 1 mpp, there was a higher median increase in B12 (0.55 ± 0.25, p < 0.05) and folate (63.4 ± 24.3, p < 0.01); and from baseline to 3 mpp, a higher median increase in iron (2.38 ± 1.06, p < 0.05) and folate (94.4 ± 38.1, p < 0.05). Conclusions: Intake of micronutrients was higher for MNP and Tablets, likely due to food displacement among Beverage consumers. Although iron bioavailability and absorption inhibitors were not considered for the present analyses, the distribution of Tablets or MNP had several advantages in this context where micronutrient deficiency remains high among pregnant women, but macronutrient intake is generally adequate or even high.
Pro-inflammatory cytokines are directly implicated in the pathogenesis of Rheumatoid arthritis (RA). Variable clinical response to cytokine targeted therapies as TNFalpha and IL-6, strongly ...highlights the heterogeneity of inflammatory process in RA. Another cytokine, IL-15 has also been related to the inflammatory process in RA. Recently we described for the first time, the presence of its specific receptor, IL-15Ralpha, in synovial fluid (SF). The aim of this work was to compare the expression profile of IL-15Ralpha, its ligand IL-15, TNFalpha and IL-6 and how these cytokines are correlated in SF from RA patients taking as a reference Osteoarthritis (OA), an articular but not autoimmune disease.
Synovial fluids were obtained from the knee joints of 60 patients, 30 with confirmed diagnosis of RA and 30 with OA diagnosis. The levels of TNFalpha, IL-6, IL-15 and IL-15Ralpha were measured by ELISA. A statistical analysis was performed with GraphPad Prism v5.0 using the Mann-Whitney U test and Spearman's rank correlation. A cluster analysis was run in MeV software v4.9.0 and differences across clusters were evaluated by an ANOVA including post-test analysis.
We found higher and significant levels of TNFalpha, IL-6 and IL-15Ralpha but not of IL-15 in RA compared with the OA group. Additionally, a high inter-individual variability in the levels of these 4 cytokines was observed in RA, although we identified 4 patients' subgroups by cluster analysis of cytokines concentration in SF. We also found a positive correlation between IL-15Ralpha-IL-6 and IL-15Ralpha-IL-15, but not for other pairs of cytokines in RA. In addition we found correlation between the value of IL-15Ralpha in SF and disease activity score, DAS28.
In our current work we found a high inter-individual variability in the levels of TNFalpha, IL-6, IL-15 and IL-15Ralpha in SF of RA patients and were identified four principal clusters of cytokines concentration in SF, suggesting the importance of identifying disease subset of patients for personalized treatment. Finally, we found a correlation between IL-15Ralpha-IL-6, IL-15Ralpha-IL-15, but we did not find any correlation between other pairs of studied cytokines in SF.
Background. Detailed descriptions of long-term persistence of human papillomavirus (HPV) in the absence of cervical precancer are lacking. Methods. In a large, population-based natural study ...conducted in Guanacaste, Costa Rica, we studied a subset of 810 initially HPV-positive women with ≥3 years of active follow-up with ≥3 screening visits who had no future evidence of cervical precancer. Cervical specimens were tested for >40 HPV genotypes using a MY09/11 LI-targeted polymerase chain reaction method. Results. Seventy-two prevalently-detected HPV infections (5%) in 58 women (7%) persisted until the end of the follow-up period (median duration of follow-up, 7 years) without evidence of cervical precancer. At enrollment, women with long-term persistence were more likely to have multiple prevalently-detected HPV infections (P<.001 ) than were women who cleared their baseline HPV infections during follow-up. In a logistic regression model, women with long-term persistence were more likely than women who cleared infections to have another newlydetected HPV infection detectable at ≥3 visits (odds ratio, 2.6; 95% confidence interval, 1.2-5.6). Conclusions. Women with long-term persistence of HPV infection appear to be generally more susceptible to other HPV infections, especially longer-lasting infections, than are women who cleared their HPV infections.
Patients with juvenile chronic inflammatory systemic diseases (jCID) are vulnerable to many circumstances when transitioning to adult-centered healthcare; this increases the burden of disease and ...worsen their quality of life.
MEDLINE, Embase, Web of Science and Scopus were searched from inception to March 16
, 2021. We included observational, randomized controlled trials and quasi-experimental studies that evaluated a transitional care program for adolescents and young adults with jCIDs. We extracted information regarding health-related quality of life, disease activity, drop-out rates, clinical attendance rates, hospital admission rates, disease-related knowledge, surgeries performed, drug toxicity and satisfaction rates.
Fifteen studies met our inclusion criteria. The implementation of transition programs showed a reduction on hospital admission rates for those with transition program (OR 0.28; 95% CI 0.13 to 0.61; I 2 = 0%; p = 0.97), rates of surgeries performed (OR 0.26; 95% CI 0.12 to 0.59; I 2 = 0%; p = 0.50) and drop-out rates from the adult clinic (OR 0.23; 95% CI 0.12 to 0.46; I 2 = 0%; p = 0.88). No differences were found in other outcomes.
The available body of evidence supports the implementation of transition programs as it could be a determining factor to prevent hospital admission rates, surgeries needed and adult clinic attendance rates.
Several serological assays have been developed to detect antibodies elicited against infections with oncogenic human papillomavirus (HPV) type 16. The association between antibody levels measured by ...various assays and subsequent HPV infection risk may differ. We compared HPV16-specific antibody levels previously measured by a virus-like particle (VLP)-based direct enzyme-linked immunoassay (ELISA) with levels measured by additional assays and evaluated the protection against HPV16 infection conferred at different levels of the assays.
Replicate enrollment serum aliquots from 388 unvaccinated women in the control arm of the Costa Rica HPV vaccine trial were measured for HPV16 seropositivity using three serological assays: a VLP-based direct ELISA; a VLP-based competitive Luminex immunoassay (cLIA); and a secreted alkaline phosphatase protein neutralization assay (SEAP-NA). We assessed the association of assay seropositivity and risk of subsequent HPV16 infection over four years of follow-up by calculating sampling-adjusted odds ratios (OR) and HPV16 seropositivity based on standard cutoff from the cLIA was significantly associated with protection from subsequent HPV16 infection (OR = 0.48, CI = 0.27-0.86, compared with seronegatives). Compared with seronegatives, the highest seropositive tertile antibody levels from the direct ELISA (OR = 0.53, CI = 0.28-0.90) as well as the SEAP-NA (OR = 0.20, CI = 0.06, 0.64) were also significantly associated with protection from HPV16 infection.
Enrollment HPV16 seropositivity by any of the three serological assays evaluated was associated with protection from subsequent infection, although cutoffs for immune protection were different. We defined the assays and seropositivity levels after natural infection that better measure and translate to protective immunity.
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