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Accuracy of triage strategies for human papillomavirus DNA-positive women in low-resource settings:A cross-sectional study in China

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Chinese Journal of Cancer Research 2017年第6期29卷 496-509页

作者： Margaret Wang Shangying Hu Shuang Zha o Wenhua Zhang Qinjing Pan Xun Zhang FengChen Jinxiu Han Junfei Ma Jennifer S.Smith Youlin Qiao Caihong Zhou Fanghui Zhao Department of Cancer Epidemiology National Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Pritzker School of Medicine University of ChicagoChicagoIL 60637-5415USA ujmt fogarty consortium NIH Fogarty International CenterBethesdaMD 20892-2220USA Department of Gynecological Oncology National Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Cytology National Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Pathology National Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Wuxiang Maternal and Child Health Care and Family Planning Service Center Changzhi 046300China Xiangyuan Maternal and Child Health Care and Family Planning Service Center Changzhi 046200China Department of Epidemiology University of North CarolinaChapel HillNC 27599-7435USA Department of Education National Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

Objective： CareHPV is a human papillomavirus （HPV） DNA test for low-resource settings （LRS）. This study assesses optimum triage strategies for careHPV-positive women in LRS. Methods： A total of 2,530 Chinese women were concurrently screened for cervical cancer with visual inspection with acetic acid （VIA）, liquid-based cytology and HPV testing by physician- and self-collected careHPV, and physician-collected Hybrid Capture 2 （HC2）. Screen-positive women were referred to colposcopy with biopsy and endocervical curettage as necessary. HPV-positivity was defined as _〉1.0 relative light units/cutoff （RLU/CO） for both careHPV and HC2. Primary physician-HC2, physician-careHPV and self-careHPV and in sequential screening with cytology, VIA, or increased HPV test-positivity performance, stratified by age, were assessed for cervical intraepithelial neoplasia （CIN） grade 2/3 or worse （CIN2/3＋） detection. Results： The sensitivities and specificities of primary HPV testing for CIN2＋ were： 83.8%, 88.1% for physician- careHPV; 72. 1%, 88.2% for self-careHPV; and 97.1%, 86.0% for HC2. Physician-careHPV test-positive women with VIA triage had a sensitivity of 30.9% for CIN2＋ versus 80.9% with cytology triage. Self-careHPV test- positive women with VIA triage was 26.5% versus 66.2 % with cytology triage. The sensitivity of HC2 test-positive women with VIA triage was 38.2 % versus 92.6% with cytology triage. The sensitivity of physician-careHPV testing for CIN2＋ decreased from 83.8% at _〉1.0 RLU/CO to 72.1% at _〉10.00 RLU/CO, while the sensitivity of self- careHPV testing decreased from 72.1% at _〉1.0 RLU/CO to 32.4% at _〉10.00 RLU/CO; similar trends were seen with age-stratification. Conclusions： VIA and cytology triage improved specificity for CIN2/3 than no triage. Sensitivity with VIA triage was unsuitable for a mass-screening program. VIA provider training might improve this strategy. Cytology triage could be feasible where a high-quality cytology program exists. Triage of HPV t

关键词： Cervical cancer human papillomavirus careHPV testing screening triage

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Cardiac Radiosurgery for the Treatment of Atrial Fibrillation

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World Journal of Cardiovascular Diseases 2016年第5期6卷 143-155页

作者： Nikhilesh Bhatt Thomas fogarty Patrick Maguire fogarty Institute for Innovation Mountain View CA USA

An estimated 4 million Americans currently have atrial fibrillation (AF), the most common form of cardiac arrhythmia. The annual growth rate of AF is approximately 9.2% and advanced statistical analyses project that the prevalence of AF will be 12.1 million in the United States by 2030. The current therapeutic options to treat AF put certain patient groups at a high risk for a serious bleeding event, stroke or thromboembolism, myocardial infarction, and death. The most effective treatment for AF—catheter ablation—has been widely reported to require repeat operations and only leaves 59.4% of patients AF-free after five years. A majority of the reported complications and increased risks for catheter ablation occur because the procedure is invasive. Thus, there is a need for a novel, non-invasive therapeutic option to treat AF that can potentially expand the treatable patient population, increase patient safety, and improve clinical outcomes. CyberHeart Inc. has been exploring the efficacy and potential of cardiac radiosurgery as an option to treat heart conditions such as AF. With its proprietary CardioPlanTM software, the CyberHeart System utilizes the Cyberknife stereotactic radiosurgery platform to non-invasively ablate the heart. Early studies have displayed that the CyberHeart System is highly accurate at delivering radiation to cardiac targets and effective at minimizing radiation exposure to healthy tissue that is in close proximity to the targeted anatomic region. The focus of this review is to present the current standard of treatment for AF, identify the specific patient population that is at a high risk for the current treatment modalities, and address the potential for the CyberHeart Stereotactic Radiosurgery System to noninvasively ablate cardiac tissue and return sinus rhythm to patients with AF.

关键词： CyberHeart Cardiac Radiosurgery Atrial Fibrillation Non-Invasive Radiotherapy

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Is it growing exponentially fast? -Impact of assuming exponential growth for characterizing and forecasting epidemics with initial near-exponential growth dynamics

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Infectious Disease Modelling 2016年第1期1卷 71-78页

作者： Gerardo Chowell Cecile Viboud School of Public Health Georgia State UniversityAtlantaGAUSA Division of International Epidemiology and Population Studies Fogarty International CenterNational Institutes of HealthBethesdaMDUSA

The increasing use of mathematical models for epidemic forecasting has highlighted the importance of designing models that capture the baseline transmission characteristics in order to generate reliable epidemic *** models for epidemic forecasting could be achieved by identifying signature features of epidemic growth,which could inform the design of models of disease spread and reveal important characteristics of the transmission *** particular,it is often taken for granted that the early growth phase of different growth processes in nature follow early exponential growth *** the context of infectious disease spread,this assumption is often convenient to describe a transmission process with mass action kinetics using differential equations and generate analytic expressions and estimates of the reproduction *** this article,we carry out a simulation study to illustrate the impact of incorrectly assuming an exponential-growth model to characterize the early phase(e.g.,3e5 disease generation intervals)of an infectious disease outbreak that follows near-exponential growth ***,we assess the impact on:1)goodness of fit,2)bias on the growth parameter,and 3)the impact on short-term epidemic *** findings indicate that devising transmission models and statistical approaches that more flexibly capture the profile of epidemic growth could lead to enhanced model fit,improved estimates of key transmission parameters,and more realistic epidemic forecasts.

关键词： dynamics. process. exponential

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Fitting dynamic models to epidemic outbreaks with quantified uncertainty:A primer for parameter uncertainty,identifiability,and forecasts

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Infectious Disease Modelling 2017年第3期2卷 379-398页

作者： Gerardo Chowell Division of Epidemiology&Biostatistics School of Public HealthGeorgia State UniversityAtlantaGAUSA Division of International Epidemiology and Population Studies Fogarty International CenterNational Institutes of HealthBethesdaMDUSA

Mathematical models provide a quantitative framework with which scientists can assess hypotheses on the potential underlying mechanisms that explain patterns in observed data at different spatial and temporal scales,generate estimates of key kinetic parameters,assess the impact of interventions,optimize the impact of control strategies,and generate *** review and illustrate a simple data assimilation framework for calibrating mathematical models based on ordinary differential equation models using time series data describing the temporal progression of case counts relating,for instance,to population growth or infectious disease transmission *** contrast to Bayesian estimation approaches that always raise the question of how to set priors for the parameters,this frequentist approach relies on modeling the error structure in the *** discuss issues related to parameter identifiability,uncertainty quantification and propagation as well as model performance and forecasts along examples based on phenomenological and mechanistic models parameterized using simulated and real datasets.

关键词： Parameter estimation Uncertainty quantification Bootstrap Parameter identifiability Model performance Forecasts Uncertainty propagation

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Spatial distribution of people diagnosed with tuberculosis through routine and active case finding:a community-based study in Kampala,Uganda

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Infectious Diseases of Poverty 2020年第3期9卷 142-143页

作者： Katherine O.Robsky Peter J.Kitonsa James Mukiibi Olga Nakasolya David Isooba Annet Nalutaaya Phillip P.Salvatore Emily A.Kendall Achilles Katamba David Dowdy Department of Epidemiology Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA Uganda Tuberculosis Implementation Research consortium Makerere UniversityKampalaUganda

Background:Routine tuberculosis(TB)notifications are geographically heterogeneous,but their utility in predicting the location of undiagnosed TB cases is *** aimed to identify small-scale geographic areas with high TB notification rates based on routinely collected data and to evaluate whether these areas have a correspondingly high rate of undiagnosed prevalent ***:We used routinely collected data to identify geographic areas with high TB notification rates and evaluated the extent to which these areas correlated with the location of undiagnosed cases during a subsequent community-wide active case finding intervention in Kampala,*** first enrolled all adults who lived within 35 contiguous zones and were diagnosed through routine care at four local TB Diagnosis and Treatment *** calculated average monthly TB notification rates in each zone and defined geographic areas of“high risk”as zones that constituted the 20%of the population with highest notification *** compared the observed proportion of TB notifications among residents of these high-risk zones to the expected proportion,using simulated estimates based on population size and random variation *** then evaluated the extent to which these high-risk zones identified areas with high burdens of undiagnosed TB during a subsequent community-based active case finding campaign using a chi-square ***:We enrolled 45 adults diagnosed with TB through routine practices and who lived within the study area(estimated population of 49527).Eighteen zones reported no TB cases in the 9-month period;among the remaining zones,monthly TB notification rates ranged from 3.9 to 39.4 per 100000 *** five zones with the highest notification rates constituted 62%(95%CI:47–75%)of TB cases and 22%of the population–significantly higher than would be expected if population size and random chance were the only determinants of zone-to-zone variation(48%,95%simulation interval:40–59%).These f

关键词： Tuberculosis Epidemiology Health system Geographic information systems

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A primer on stable parameter estimation and forecasting in epidemiology by a problem-oriented regularized least squares algorithm

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Infectious Disease Modelling 2017年第2期2卷 268-275页

作者： Alexandra Smirnova Gerardo Chowell Department of Mathematics and Statistics Georgia State UniversityAtlantaUSA School of Public Health Georgia State UniversityAtlantaUSA Division of International Epidemiology and Population Studies Fogarty International CenterNational Institutes of HealthBethesdaMDUSA

Public health officials are increasingly recognizing the need to develop disease-forecasting systems to respond to epidemic and pandemic *** instance,simple epidemic models relying on a small number of parameters can play an important role in characterizing epidemic growth and generating short-term epidemic *** the absence of reliable information about transmission mechanisms of emerging infectious diseases,phenomenological models are useful to characterize epidemic growth patterns without the need to explicitly model transmission mechanisms and the natural history of the *** this article,our goal is to discuss and illustrate the role of regularization methods for estimating parameters and generating disease forecasts using the generalized Richards model in the context of the 2014e15 Ebola epidemic in West Africa.

关键词： Generalized Richards model Parameter estimation Regularization methods Epidemic forecasting Ebola

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A Retrospective Modeling Study of the Targeted Non-Pharmaceutical Interventions During the Xinfadi Outbreak in the Early Stage of the COVID-19 Pandemic — Beijing, China, 2020

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China CDC weekly 2023年第5期5卷 108-112,I0007-I0011页

作者： Yan Wang Kaiyuan Sun Yang Pan Lan Yi Da Huo Yanpeng Wu Shuaibing Dong Jinxin Guo Xiangfeng Dou Wei Wang Shuangsheng Wu Xufang Bai Hongjie Yu Quanyi Wang School of Public Health Fudan UniversityKey Laboratory of Public Health SafetyMinistry of EducationShanghai MunicipalityChina Division of International Epidemiology and Population Studies Fogarty International CenterNational Institutes of HealthBethesdaMDUSA Beijing Center for Disease Prevention and Control Beijing MunicipalityChina Shanghai Institute of Infectious Disease and Biosecurity Fudan UniversityShanghai MunicipalityChina

Summary What is already known about this topic?China has repeatedly contained multiple severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)outbreaks through a comprehensive set of targeted nonpharmaceutical int... 详细信息

关键词： acute respiratory assessed

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Exploring nationally and regionally defined models for large area population mapping

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International Journal of Digital Earth 2015年第12期8卷 989-1006页

作者： A.E.Gaughan F.R.Stevens C.Linard N.N.Patel A.J.Tatem Department of Geography and Geosciences University of LouisvilleLouisvilleKYUSA Biological Control and Spatial Ecology UniversitéLibre de BruxellesBrusselsBelgium Department of Geography and Geoinformation Science George Mason UniversityFairfaxVAUSA Department of Geography and Environment University of SouthamptonSouthamptonUK fogarty International Center National Institutes of HealthBethesdaMDUSA Flowminder Foundation StockholmSweden

Interactions between humans,diseases,and the environment take place across a range of temporal and spatial scales,making accurate,contemporary data on human population distributions critical for a variety of *** for disaggregating census data to finer-scale,gridded population density estimates continue to be refined as computational power increases and more detailed census,input,and validation datasets become ***,the availability of spatially detailed census data still varies widely by *** this study,we develop quantitative guidelines for choosing regionally-parameterized census count disaggregation models over country-specific *** examine underlying methodological considerations for improving gridded population datasets for countries with coarser scale census data by investigating regional versus country-specific models used to estimate density surfaces for redistributing census *** is given to the spatial resolution of input census data using examples from East Africa and Southeast *** suggest that for many countries more accurate population maps can be produced by using regionally-parameterized models where more spatially refined data exists than that which is available for the focal *** study highlights the advancement of statistical toolsets and considerations for underlying data used in generating widely used gridded population data.

关键词： human population modeling random forest regression dasymetric mapping gridded population datasets

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The risk of mpox importation and subsequent outbreak potential in Chinese mainland: a retrospective statistical modelling study

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Infectious Diseases of Poverty 2024年第1期13卷 63-73页

作者： Xiaowei Deng Yuyang Tian Junyi Zoul Juan Yang Kaiyuan Sun Hongjie Yu School of Public Health Key Laboratory of Public Health SafetyMinistry of EducationFudan UniversityShanghai 200032China Division of International Epidemiology and Population Studies Fogarty International CenterNational Institutes of HealthBethesdaMDUSA

Background The 2022-2023 mpox(monkeypox)outbreak has spread rapidly across multiple countries in the non-endemic region,mainly among men who have sex with men(MSM).In this study,we aimed to evaluate mpox's importation risk,border screening effectiveness and the risk of local outbreak in Chinese *** We estimated the risk of mpox importation in Chinese mainland from April 14 to September 11,2022 using the number of reported mpox cases during this multi-country outbreak from *** and the international air-travel data from Official Aviation *** constructed a probabilistic model to simulate the effectiveness of a border screening scenario during the mpox outbreak and a hypothetical scenario with less stringent quarantine *** we further evaluated the mpox outbreak potential given that undetected mpox infections were introduced into men who have sex with men,considering different transmissibility,population immunity and population *** We found that the reduced international air-travel volume and stringent border entry policy decreased about 94% and 69% mpox importations *** the quarantine policy,15-19% of imported infections would remain *** a case of mpox is introduced into active MSM population with almost no population immunity,the risk of triggering local transmission is estimated at 42%,and would rise to>95% with over six *** Our study demonstrates that the reduced international air-travel volume and stringent border entry policy during the COvID-19 pandemic reduced mpox importations ***,the risk could be sub-stantially higher with the recovery of air-travel volume to pre-pandemic *** could emerge as a public health threat for Chinese mainland given its large MSM community.

关键词： Mpox(Monkeypox) Importation risk International air travel Statistical modelling Men who have sex with men

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Systematic comparison of epidemic growth patterns using two different estimation approaches

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Infectious Disease Modelling 2021年第1期6卷 5-14页

作者： Yiseul Lee Kimberlyn Roosa Gerardo Chowell Department of Population Health Sciences School of Public HealthGeorgia State UniversityAtlantaGA30303USA Division of International Epidemiology and Population Studies Fogarty International CenterNational Institute of HealthBethesdaMD20892USA UT One Health Initiative University of TennesseeKnoxvilleTN37996USA

Background:Different estimation approaches are frequently used to calibrate mathematical models to epidemiological data,particularly for analyzing infectious disease ***,we use two common methods to estimate parameters that characterize growth patterns using the generalized growth model(GGM)calibrated to real outbreak *** and methods:Data from 31 outbreaks are used to fit the GGM to the ascending phase of each outbreak and estimate the parameters using both least squares(LSQ)and maximum likelihood estimation(MLE)*** utilize parametric bootstrapping to construct confidence intervals for parameter *** compare the results including RMSE,Anscombe residual,and 95%prediction interval *** also evaluate the correlation between the estimates from both ***:Comparing LSQ and MLE estimates,most outbreaks have similar parameter estimates,RMSE,Anscombe,and 95%prediction interval *** estimates do not differ across methods when the model yields a good fit to the early growth ***,for two outbreaks,there are systematic deviations in model fit to the data that explain differences in parameter estimates(e.g.,residuals represent random error rather than systematic deviation).Conclusion:Our findings indicate that utilizing LSQ and MLE methods produce similar results in the context of characterizing epidemic growth patterns with the GGM,provided that the model yields a good fit to the data.

关键词： Parameter estimation Generalized growth model Least squares estimation Maximum likelihood estimation Epidemiological models

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