Lactobacillus crispatus as the etiological agent in cytolytic vaginosis

Introduction: Lactobacillus spp. dominate the vaginal niche but can also be involved in other vaginal dysbiosis, such as cytolytic vaginosis (CV), which remains poorly studied. It is characterized by a cryptic symptomatology, that often confounds the clinic. Goals: The aim of this work was to search for the etiological agent of CV, by studying the vaginal microbiome and metabolomics of women afflicted with this disease and compare it with women with other clinical diagnostic. Methods: Twenty-one vaginal washes have been collected from women attending a gynaecology consultation of a private clinic. The samples were categorized according with clinical diagnosis at the time of sampling (CV, 11; vulvovaginal candidosis, 8; Healthy, 2). The distribution of bacterial species, and their prevalence was assessed by next-generation sequencing of the 16S V4 region. In addition, total lactate D-lactic acid and L-lactic acid was quantified in all washes by a commercial kit, as well as lactate dehydrogenase (LDH) activity. Results: L. crispatus was dominant (>70%) in all CV samples. Lactate was increased in CV in comparison with other cases. The presence of D-lactic acid isomer was associated with presence of L. crispatus. LDH activity was increased in vaginal washes that tested positive for the presence of L. crispatus, however no direct association was found with CV cases. Discussion/Conclusions: The microbiome of women afflicted with CV was dominated in all cases by L. crispatus, contrarily with the results obtained for women diagnosed with other clinical symptomatology. In addition, the finding that an increase in D-lactic acid is associated with CV patients can be related to the role of L. crispatus in CV. The determination of LDH activity did not correlate exclusively with CV cases. On the other hand, D-lactic acid and total lactate quantification could be used as a valuable biomarker to diagnose this cryptic vaginal infection.info:eu-repo/semantics/publishedVersio

Covering Arrays for Equivalence Classes of Words

Covering arrays for words of length $t$ over a $d$ letter alphabet are $k \times n$ arrays with entries from the alphabet so that for each choice of $t$ columns, each of the $d^t$ $t$-letter words appears at least once among the rows of the selected columns. We study two schemes in which all words are not considered to be different. In the first case words are equivalent if they induce the same partition of a $t$ element set. In the second case, words of the same weight are equivalent. In both cases we produce logarithmic upper bounds on the minimum size $k=k(n)$ of a covering array. Definitive results for $t=2,3,4$, as well as general results, are provided.Comment: 17 page

The Better than Dead Method: Feasibility and Interpretation of a Valuation Study

Background Traditionally, the valuation of health states worse than being dead suffers from two problems: [1] the use of different elicitation methods for positive and negative values, necessitating arbitrary transformations to map negative to positive values; and [2] the inability to quantify that values are time dependent. The Better than Dead (BTD) method is a health-state valuation method where states with a certain duration are compared with being dead. It has the potential to overcome these problems. Objectives To test the feasibility of the BTD method to estimate values for the EQ-5D system. Methods A representative sample of 291 Dutch respondents (aged 18-45 years) was recruited. In a web-based questionnaire, preferences were elicited for a selection of 50 different health states with six durations between 1 and 40 years. Random-effects models were used to estimate the effects of socio-demographic and experimental variables, and to estimate values for the EQ-5D. Test-retest reliability was assessed in 41 respondents. Results Important determinants for BTD were a religious life stance [odds ratio 4.09 (2.00-8.36)] and the educational level. The fastest respondents more often preferred health-state scenarios to being dead and had lower test-retest reliability (0.45 versus 0.77 and 0.84 for fast, medium and slow response times, respectively). The results showed a small number of so-called maximal endurable time states. Conclusion Valuating health states using the BTD method is feasible and reliable. Further research should explore how the experimental setting modifies how values depend on time

Candidiasis, Bacterial Vaginosis, Trichomoniasis and Other Vaginal Conditions Affecting the Vulva

info:eu-repo/semantics/publishedVersio

A review of RCTs in four medical journals to assess the use of imputation to overcome missing data in quality of life outcomes

Background: Randomised controlled trials (RCTs) are perceived as the gold-standard method for evaluating healthcare interventions, and increasingly include quality of life (QoL) measures. The observed results are susceptible to bias if a substantial proportion of outcome data are missing. The review aimed to determine whether imputation was used to deal with missing QoL outcomes. Methods: A random selection of 285 RCTs published during 2005/6 in the British Medical Journal, Lancet, New England Journal of Medicine and Journal of American Medical Association were identified. Results: QoL outcomes were reported in 61 (21%) trials. Six (10%) reported having no missing data, 20 (33%) reported ≤ 10% missing, eleven (18%) 11%–20% missing, and eleven (18%) reported >20% missing. Missingness was unclear in 13 (21%). Missing data were imputed in 19 (31%) of the 61 trials. Imputation was part of the primary analysis in 13 trials, but a sensitivity analysis in six. Last value carried forward was used in 12 trials and multiple imputation in two. Following imputation, the most common analysis method was analysis of covariance (10 trials). Conclusion: The majority of studies did not impute missing data and carried out a complete-case analysis. For those studies that did impute missing data, researchers tended to prefer simpler methods of imputation, despite more sophisticated methods being available.The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Government Health Directorate. Shona Fielding is also currently funded by the Chief Scientist Office on a Research Training Fellowship (CZF/1/31)

A review of RCTs in four medical journals to assess the use of imputation to overcome missing data in quality of life outcomes

Peer reviewedPublisher PD

Analysis of and workarounds for element reversal for a finite element-based algorithm for warping triangular and tetrahedral meshes

We consider an algorithm called FEMWARP for warping triangular and tetrahedral finite element meshes that computes the warping using the finite element method itself. The algorithm takes as input a two- or three-dimensional domain defined by a boundary mesh (segments in one dimension or triangles in two dimensions) that has a volume mesh (triangles in two dimensions or tetrahedra in three dimensions) in its interior. It also takes as input a prescribed movement of the boundary mesh. It computes as output updated positions of the vertices of the volume mesh. The first step of the algorithm is to determine from the initial mesh a set of local weights for each interior vertex that describes each interior vertex in terms of the positions of its neighbors. These weights are computed using a finite element stiffness matrix. After a boundary transformation is applied, a linear system of equations based upon the weights is solved to determine the final positions of the interior vertices. The FEMWARP algorithm has been considered in the previous literature (e.g., in a 2001 paper by Baker). FEMWARP has been succesful in computing deformed meshes for certain applications. However, sometimes FEMWARP reverses elements; this is our main concern in this paper. We analyze the causes for this undesirable behavior and propose several techniques to make the method more robust against reversals. The most successful of the proposed methods includes combining FEMWARP with an optimization-based untangler.Comment: Revision of earlier version of paper. Submitted for publication in BIT Numerical Mathematics on 27 April 2010. Accepted for publication on 7 September 2010. Published online on 9 October 2010. The final publication is available at http://www.springerlink.co